Case Study

Contact tracing concerns: School wasn't contacted by HSE until four days after confirmed Covid-19 case

A mother has raised concerns about the policy of schools not taking action until contacted by the HSE.

A MOTHER HAS raised concerns about the contact tracing system after it took four days for the HSE to contact her daughter’s school when she was confirmed to have Covid-19.

In particular, she has highlighted how schools and other organisations are advised not to take action in relation to a confirmed case until they are contacted by the HSE, a policy which is under strain due to pressures on the contact tracing system.

Though no Covid-19 cluster has arisen from this particular case, the mother contacted to raise concerns about the contact tracing system in case similar issues are being experienced elsewhere in the country, and in the hope that this may prevent further delays in contacting schools about confirmed coronavirus cases.

In this case, a school located in the east of the country wasn’t contacted for four days about a positive Covid-19 test. This meant the pupils and teacher weren’t able to take the necessary actions for two week days after the student’s Covid-19 test result came back positive.

In a statement, the HSE said that while it cannot comment on individual cases, it is aware of this case and emphasised that there can be delays to the test and trace system that it is continuously working to improve upon.

There have been numerous concerns raised about the test and trace system’s capacity to deal with the recent influx of cases, and what impact these delays could have on schools and workplaces.

Though media reports and anecdotal evidence indicate that not everyone experiences delays with the contact tracing system, there are inconsistencies with the system and public health doctors have raised concerns about the pressures they are facing.

The timeline

The woman’s daughter was confirmed to have a positive Covid-19 test on a weekday in September. She received a call from a HSE test and trace worker the following day.

During this call, known as ‘Call 1′ in the contact tracing process, the woman was told that more ‘complex contacts’, such as a school or workplace, need to be contacted by more senior contact tracers.

The woman had contacted the school and a local sports organisation to inform them of her daughter’s positive Covid-19 test on the day it was received, but both organisations said that they had been informed that they should only take action when contacted by the HSE.

Three days after the positive test, the woman called the HSE helpline to say that the school had still not been informed. She says she was then advised to get in touch with the principal and to tell them to get in touch directly with the HSE.

The woman did this the next day, and the principal contacted the HSE. Later that day, the woman received a call from a member of the contact tracing team who she says had no record of her daughter’s school’s details.

The mother said: “Individually they are all trying their best. [The contact tracer] was quite surprised that nothing had happened. So obviously there had been a mistake.”

The big concern is that the school’s information wasn’t passed on and they say they are the ones being prioritised. So that’s concerning. 
And the other thing is, while we know there are delays, they are still adamant that organisations are not to do anything at all – and should continue on as normal – until the HSE get in touch.

“There were no positive cases in this situation, but if it was two or three positives on this occasion, it could have been a very, very different situation,” the woman said.

On the same day the principal contacted the HSE, the school was advised to send members of the class home to restrict their movements for a week from that date.

The mother understands that some students from the class weren’t tested until three days after being contacted by contact tracers.

In a statement, the HSE said that it recognises that “there will, unfortunately, be people who are not contact traced as quickly as we would like”.

It said that the European Centre for Disease Control (ECDC) recognises that contact tracing will never be 100%, and the HSE “makes every effort to investigate cases where contact tracing did not happen as quickly as possible” to improve the system.

How contact tracing works

Ireland’s contact tracing service operates from eight contact tracing centres around the country, seven days a week, from 8am to 8pm.

The HSE is currently building standing capacity for 500 contact tracers, and says that recruitment is “well underway”, with 400 interviews conducted.

65 new contact tracers began yesterday; but Taoiseach Micheál Martin has said that he wants this recruitment process fast-tracked.

There are currently around 280 contact tracers in eight contact tracing centres around the country.

The HSE explained the contact tracing process, adding that it can be complex:

  • Once a Covid-19 test is completed by a laboratory, it is uploaded within a few hours onto the Covid Care Tracker system. 
  • Firstly, it involves a phone call to the individual who has tested positive in order to communicate their positive result, this is a ‘Call 1‘.
  • Call 1s usually happen within two hours of a positive result being uploaded. If the result is uploaded at night, then the Call 1 is not made until the following morning.
  • The speed of the Call 1 is also dependent on the number of positive cases reported at the upload. For example, if over 100 positives are reported together then it can take 3-4 hours to complete the Call 1.
  • The length of these phone calls can vary with individuals seeking advice in relation to their individual circumstances and understanding what a positive result means for them.
  • Afterwards, the contact tracers carry out a Call 2, this is the collection of all the close contacts of the person who has tested positive.
  • Call 3 refers to the calls made to each of these close contacts to inform them that they are a close contact and will be referred for testing. “This is an incredibly complex process with the person at the centre,” the HSE said.
  • In addition to the high volume of contact tracing calls being carried out, it is compounded by the number of close contacts is averaging at 5.4 per positive case, pushing out the time that it takes to close out all contact tracing.
  • Incorrect phone numbers being provided and multiple calls being required to get through to people are also adding to Contact Tracing Centre workload and impacting turnaround times.

Dr Marion Dyer, a GP based in Blanchardstown, told RTÉ Drivetime that she is receiving a significant number of calls from close contacts who haven’t heard from contact tracers, who she said are “overwhelmed”.

Dr Dyer, who is also an Assistant Professor at the Department of Public Health at TCD, said they see examples of some patients waiting up to six days for a call.

She said that some people on the HSE helpline have advised close contacts who are “frustrated” to go to their GP for a test, but that this “defeats the system and that drops the person out of the contact tracing system and makes us all more vulnerable to the virus”.

“This shows that our contact tracing centres are not adequately staffed,” she said.

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