Pedestrians wear masks in London. The halting start of the virus-tracking operation cast doubt on whether the country could reopen the economy without fuelling a surge of new infections. Photo / AP
Like a lot of the country's pandemic response, contact tracing has been hampered by inconsistency, with much promised but little delivered.
Prime Minister Boris Johnson of Britain unveiled last month a "world beating" operation to track down people who had been exposed to the coronavirus, giving the country a chance to climb out of lockdown without losing sight of where infections were spreading.
As with much of the government's response to the pandemic, however, the results have fallen short of the promises, jeopardising the reopening of Britain's hobbled economy and risking a second wave of death in one of the countries most debilitated by the virus.
In almost three weeks since the start of the system in England, called NHS Test and Trace, some contact tracers have failed to reach a single person, filling their days instead with internet exercise classes and bookshelf organising.
Some call handlers, scattered in offices and homes far from the people they speak with, have mistakenly tried to send patients in England to testing sites across the sea in Northern Ireland.
And a government minister threatened on a conference call to stop coordinating with local leaders on the virus-tracking system if they spoke publicly about its failings, according to three officials briefed on the call, who spoke on the condition of anonymity for fear of retribution.
Contact tracing was supposed to be the bridge between lockdown and a vaccine, enabling the government to pinpoint clusters of infections as they emerged and to stop infected people from passing on the virus. Without it, a World Health Organization official said recently, England would be remiss in reopening its economy.
But the system, staffed by thousands of poorly trained and low-paid contact tracers, was rushed out of the gate on May 28 before it was ready, according to interviews with more than a dozen contact tracers, public health officials and local government leaders. At the time, the government was making a barrage of announcements while also trying to douse a scandal involving Johnson's most senior aide, who had violated lockdown orders.
The troubled rollout has left public health officials across England trying to battle a virus they still cannot locate. Test results from privately run sites, now numbering in the tens of thousands daily, were not being reported at a local level as recently as last week, leaders in six councils said. Public health officials say they catch wind of outbreaks from the news. And while the virus is cooling off in London, infection rates remain high in other parts of England, notably the northwest.
Other nations in Europe are building their public sectors to support contact-tracing systems that might be needed for years to come. Germany, for instance, has hired contact tracers in 375 public health authorities, with doctors on hand to administer tests.
But in England, where a decade of austerity has starved public health departments of workers who used to regularly track illnesses, Johnson has entrusted the job largely to Serco, an outsourcing giant that was recently obliged to pay the government a hefty fine for fraud on a previous, unrelated contract. The New York Times has learned that the contact-tracing contract, awarded in a secretive procurement process, cost 108 million pounds ($208 million).
Allyson Pollock, a professor of public health at Newcastle University, said, "The government has dismantled, fragmented and eviscerated so much of its health service over the last 20 years that it was much more difficult to get a coordinated system."
"They're basically trying to build a centralised, parallel, privatised system," she added.
As a result, she said, "We've had far more deaths than we should have. And lockdown has had to go on much longer than in other countries because we've let the virus rip for so long."
Asked for comment, a spokesman for the Department of Health and Social Care said that its contact-tracing system was already helping to save lives by curbing the spread of the illness.
"In the first week, tens of thousands of people have engaged with the NHS Test and Trace service," the spokesman said. "We are working to reach more people and making improvements to the service to do that."
Garry Robinson, Serco's customer services director for Britain, said in a statement that the company was "committed to supporting the government's test and trace program" and had successfully mobilised 10,500 contact tracers in four weeks, which he called a "significant achievement."
The first part of contact tracing involves health professionals calling people who test positive for the virus and obtaining a list of their recent contacts. Then, a lower-level tier of workers call those contacts to ask them to isolate themselves.
But in the first week of virus tracking in England, government figures show, thousands of infected patients were overlooked: Callers reached 5,407 people with the virus, while missing another 2,710 positive cases that had been transferred into the system — along with an unspecified number that had not.
At the same time, contact tracers have waited to be assigned cases that never came, a problem that officials have ascribed to low numbers of new cases and infected people submitting their contacts online instead. One employee, who like others spoke on the condition of anonymity for fear of being fired, said that most days he watched three films, one after the next, at a salary of about US$11 ($17) per hour.
Local public health officials were asked to make plans by the end of June for possible tailor-made shutdowns around clusters of infections. But they say they still have neither the powers to do that nor the testing data to pinpoint infections.
"We are kind of driving the car while building it," said Dominic Harrison, the director of public health in Blackburn, in northwest England. "There are still enormous problems to be resolved."
The troubled rollout bears the hallmarks of Britain's disastrous efforts to respond to the coronavirus: haphazard data, an emphasis on political theater and a heavy dependence on the private sector. With deaths nearing 50,000, Britain sits alongside the United States and Brazil among the countries suffering the greatest blows from the coronavirus.
After working to trace contacts in the early days of the pandemic, Britain largely scrapped that plan by March 12, with government scientists saying it was no longer practical. Eleven days later, Johnson declared a lockdown.
The government has denied that contact tracing was ever stopped, and said that to claim otherwise would be entirely wrong. However, in internal notes mistakenly forwarded to The New York Times in response to questions about why it initially ended contact tracing in March, government officials wrote: "The answer to this is we basically didn't have the testing capacity."
By April, with the death toll soaring, the government reversed course and promised to reconstitute the system for England.
Other nations within the United Kingdom, including Wales and Scotland, which are in charge of their own contact tracing, appointed public health officials to run their programs.
For England, however, Johnson's government contracted Serco and another company to hire most of its 25,000 contact tracers, despite Serco having recently been fined 19 million pounds over claims involving a separate contract that it had charged the government for monitoring convicts who were dead, jailed or living outside the country.
The government said that Serco was regularly monitored and that no concerns had been raised about the company before it was awarded the test and trace contract.
The government has spent heavily on private companies in its response to the pandemic: Deloitte, an accounting firm, manages testing centers; and Palantir, a data-mining company, has helped organise supplies of protective gear.
But it is trying to do contact tracing on the cheap. While some American states are paying tracers salaries of around US$50,000 ($77,000) a year, many English tracers said in interviews that they were paid 8.72 pounds ($16.85) an hour, barely above the minimum wage, a figure equivalent to less than US$24,000 ($46,000) a year. Some of them were teenagers who had never held jobs before.
After answering online ads for generic customer service jobs, they started work with little or no training. One Serco-employed contact tracer said that at least a third of his 40 or so colleagues in London had not received any online training before starting.
"We weren't talked through how a conversation could go or anything," said a tracer working in Sheffield, England.
Details of the procurement process, shared by a senior civil servant, suggest a possible reason for the low pay and sketchy training: Serco offered to provide the service at an extraordinarily tight profit margin of less than 5 per cent, roughly half the margin of the next cheapest contender.
The contract was awarded without any real competition, the senior civil servant said, speaking on the condition of anonymity to describe a confidential process.
"Serco are pretty much the only people who can stand up a workforce in that time, and love them or hate them, it is about having the numbers," the civil servant said.
The virus-tracking system was supposed to be augmented by a smartphone app that automated some tracing. But the tool, promised initially by mid-May, has been shadowed by fears about technical glitches and data breaches, and the government said it was now trying to introduce the app before winter.
Even some of the more experienced, higher-paid contract tracers who speak to infected people said they were feeling underutilised. Gerry, a former nurse, said she had expected to begin work as a contact tracer in early June. Instead, at 10:30pm on May 27, she received an email telling her the program would begin the next day. The computer system crashed as thousands of contact tracers tried to log on.
More than two weeks later, she still has not spoken to a single contact. Other contact tracers complained on a private Facebook group that they were still waiting for login details two weeks after the start date, according to screenshots from the group.
Some contact tracers also said they were unaware of any translation services, a problem that could keep England from tracking the virus through migrant and ethnic minority communities, which have suffered disproportionately.
"It's a total shambles," said Ben Bradshaw, an opposition Labour lawmaker, who has spoken to government officials about contact tracing.
"Everyone has accepted all the way through this crisis that the countries that have dealt with it best have always had effective track and trace systems in place, and that any country wishing to emerge from lockdown and live with this virus for the foreseeable future will need an effective track and trace system," he said. "Yet, the history of this in Britain is a catalogue of disasters."
Written by: Benjamin Mueller and Jane Bradley
Photographs by: Andrew Testa and Alessandro Grassani
© 2020 THE NEW YORK TIMES
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