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Fast intervention tightens circle around Covid cases

Johnny Bugeja

The Contact Tracing Bureau’s rapid response in detecting and isolating positive cases and their contacts has seen the number of people identified as a close contact limited to just seven per positive case on average.

Behind the scenes, this fast-paced method is the front line to Gibraltar’s Covid-19 response, relentlessly hunting down the virus as it spreads through the community.

Every day for 12 hours, the contact tracing team work to unpick the web of cases and reduce the number of potential contacts by isolating people before symptoms occur.

And despite the rising number of cases, the strategy is working. Data shows that 53% of recent cases had been identified by contact tracers.

But the team needs the public to adhere to public health advice in order to effectively continue this vital work.

Dr Natalie Wright, Public Health Consultant and Clinical Lead for the Contact Tracing Bureau, urged people to call 111 as soon symptoms occur, stressing that the sooner the better.

She explained leaving a sniffle or slight cough to run its course for a few days before contacting the Gibraltar Health Authority can result in more people having to isolate, or at worst, more spread.

Contact tracing is only effective if the person has been isolating for the entire time they were infectious, which is typically up to 48 hours before symptoms start, Dr Wright said.

A person who delays calling 111 for two days after symptoms develop could be spreading the virus for four days, significantly increasing the number of potential contacts Dr Wright and her team may have to isolate.

“We are getting more cases and clearly there is more transmission, we are isolating one person who is positive and then a close contact is testing positive the next day,” Dr Wright said.

“In that sense we are a little bit behind.”

She added: “We are seeing that more often now and that is worrying from our perspective. Even though we identified the person, it was a little bit late.”

“I really can’t emphasise how much time and speed are critical to contact tracing.”

Dr Wright explained that typically a person who was “sporadically” infected with Covid-19 may have around 18 to 20 close contacts.

By identifying these close contacts, the team can break the chain of Covid-19 and stop some of the spread.

If a close contact becomes unwell and has been isolating they will have very few or even zero contacts – ending the passage of Covid-19 in that web.

Through this method, the contact tracing team has been able to reduce the number of close contacts to seven on average for every positive case.

She added despite contact tracing, sporadic infections still occur due to transient visitors from across the frontier and by air.

To catch these cases quickly and efficiently, contact tracers need the public to “do their bit” and immediately make themselves known to 111 if even the slightest symptoms occur.

“In a lot of instances people are delaying or thinking that if they keep quiet they’ll get better and not necessarily coming forward,” Dr Wright said.

“Not all the time, but sometimes. That is really important from our perspective of contact tracing. As soon as people have symptoms they need to come forward and let us know.”

This was echoed by the Director for Public Health, Dr Sohail Bhatti, who told the Chronicle this is one of the biggest challenges facing public health at the moment.

“One of the biggest challenges we face at the moment is people who are symptomatic are not dialling 111,” Dr Bhatti said.

“People are saying ‘it is alright, it’s my allergies’. Actually, in this time, in this pandemic, it’s not ‘just an allergy’ unless proven not to be Covid. We are finding an awful lot of people who have got symptoms are in denial.”

Dr Wright said although there have been issues with people breaking their self-isolation this is a minority and “on the whole people are very cooperative.”

Identifying close contacts can also be a complex task for tracers, who sometimes will have to jigsaw information to understand the level of contact between people.

Not very case is straightforward and mask wearing, location, length of time and even how infectious the person is all come into play when weighing up whether to isolate a contact.

Dr Wright explained the test result will let tracers know how infectious a person is and this will impact their decisions to isolation.

Whether the person was symptomatic when in contact with another is also weighed up.

Another issue for is persons they may forget or be unsure of the level of contact with others, particularly when divulging so much information after receiving the stressful news that they are positive for Covid-19.

In these scenarios they will ring the close contact to further understand the situation.

After listening to both sides and putting the pieces together the tracing team will make a decision.

The recent rise in cases has meant this can be an arduous process for the tracers.

“They may have different stories, so it’s our job to unpick it and use our interview skills,” Dr Wright said.

“It’s a risk assessment and no two are exactly the time.”

DECLARING INFORMATION IS VITAL

When a person tests positive for Covid-19, contact tracing will ask for a detailed list of whereabouts and close contacts.

To make their job easier the team require people to be truthful of all their whereabouts, but there have been instances where did has not been the case.

“One of the key issues is a lack of willingness to come forward with the information,” Dr Wright said.

“People are nervous that they may get themselves or others into trouble if they disclose people they have come into contact with. They understand that we are going to be potentially following these people up and asking them to isolate.”

“So that has been a significant issue.”

She added: “We would really really urge people that it is so important to be honest, particularly with the number of cases coming up.”

But Dr Wright underscored that the majority of people contacted are eager to help and disclose their information.

Dr Bhatti described how a minority of people are tending to withhold information in order not to inconvenience others.

“I have seen with my own eyes people who are very gregarious, very friendly, say openly ‘I’ve only met three people’,” Dr Bhatti said.

He added: “The efficacy of contact tracing declines the more untruthful people are.”

Dr Bhatti described how a few cases of people telling untruths to contact tracers have had to be dealt with by the Royal Gibraltar Police.

An RGP spokesman told the Chronicle in these instances the person has been talked to by an officer about the severity of the issue, but no action has been taken in any of these instances.

The spokesman added there have been cases where people have not isolated after having a Covid-19 test, which has been found out when contact tracers call their residence consistently with no response.

In these instances, officers have been deployed to find the person and escort them to their residence to continue their isolation.

Although the inconvenience not to isolate has seen some skirt around the truth, for others they want to go into isolation.

Dr Bhatti said there has also been an issue with employers finding that staff have photocopied someone else’s close contact certificate to get out of work.

“The question I pose back to the public is: I want Covid to be over, you want Covid to be over, we’re all suffering with Covid fatigue, well the virus never rests, it is relentless,” he said.

“It doesn’t take a weekend off, it doesn’t take a holiday: Do you want us to help save your lives and your jobs, or do you just want to have a good time for the next week or so and then we have to have a lockdown?”

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