Recovery, Renewal, Resilience

Test and trace systems have been implemented worldwide to try to track and contain the transmission of COVID-19. While these efforts have been broadly successful, there are some communities in which the test and trace process is inefficient due to limited uptake[1]. This has been particularly relevant in communities where there are language barriers[2], and in work environments in which sharing colleague’s information may be difficult because a positive result could mean unpaid sick days[3]. Commonly, such occupations include those with a large number of migrant workers, or where workers are employed through agencies and staff members are inconsistent or turnover is high[4]. In these cases alternative mechanisms such as mass swabbing through mobile testing units have been employed to try to boost the number of people tested, including those who may be asymptomatic[5]. Taking swabs can be unpleasant, however, using saliva samples can be less invasive, more reliable than nasal swabs, and can be done more frequently, even once a week which would help mitigate the false negatives swabs can produce[6].

Targeted mass swabbing is currently being undertaken in some countries such as Canada, where there have been outbreaks and deaths of those working in agriculture due to poor living and working conditions5. The vulnerability of these groups to COVID-19 was addressed in The Manchester Briefing 13 where it addressed localised spikes in COVID-19 transmission as a result of poor working conditions in food and garment industries.

Mass swabbing could help to mitigate the lack of reporting to contact tracers, improve the transparency of information within the health system, and improve the efficiency of testing[7]. Efficient mass testing should consider:

• Effectively mapping all existing testing and laboratories capabilities including those in health services, research centres[8], and scientific institutes to reduce the risk of running parallel systems with the private sectors which may encourage competition for supplies and potentially reduce the capacity of existing systems13
• Use existing capacities to help develop important localised approaches to improve the coordination of mass testing through involvement with local authorities and industries13
• Develop partnerships with life science industries to build resources and capacity for mass testing14 that should account for, and complement, existing local capacity
• Be mindful of how targeted mass testing may (further) stigmatise certain communities. Careful consideration should be given to the location of testing centres so not to create an association between a particular community and the virus
• Ensure there is clear and simple dissemination of public information in areas in which mass testing takes place. This should include sensitivity to the local conditions including languages, culture and the level of community (dis)harmony

Increasing effective capacity for mass testing, especially in high risk populations, is central to limiting the spread of COVID-19. Developing an integrated localised system that is capable of regular, repeat testing may not only help stem the spread of the virus, it may also help support other sectors adversely affected by COVID-19. For example, this type of testing may help mitigate the issue of quarantine after travel as the virus can be more closely monitored, even in asymptomatic patients. In addition, particularly vulnerable groups may be protected through close observation, including those who work in jobs where there is a high risk of infection, and those who may feel forced to go to go to work due to financial insecurity.

[1] https://www.theguardian.com/world/2020/aug/04/four-key-failings-of-england-covid-19-test-and-trace-system

[2] https://www.theguardian.com/world/2020/aug/04/four-key-failings-of-england-covid-19-test-and-trace-system

[3] https://www.theglobeandmail.com/canada/article-ontario-pivots-on-testing-strategy-for-migrant-workers-to-contain/

[4] https://www.iheartradio.ca/am800/news/mass-testing-planned-after-24-year-old-migrant-worker-dies-of-covid-19-1.12612356

[5] https://windsor.ctvnews.ca/mass-testing-for-migrant-workers-planned-following-death-of-24-year-old-man-1.4972533?cache

[6] https://www.newscientist.com/article/2246880-city-in-uk-takes-steps-to-test-entire-population-for-coronavirus/

[7] https://www.bma.org.uk/news-and-opinion/a-hidden-threat-test-and-trace-failure-edges-closer

[8]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878121/coronavirus-covid-19-testing-strategy.pdf

To read this case study in its original format, follow the source link below to TMB Issue 20 (p.22-23).

The health impacts of COVID-19 such as organ scarring, and long-term lung problems are gradually coming to light. However, wider implications from lockdown on working socialising and living in small spaces is less understood. Consider the impacts of this and the steps that can be taken to address them:

• Eye strain. Consider the amount of time being spent on online calls e.g. on Zoom or Skype:
  • Where possible replace Zoom with phone calls
  • Make meetings shorter and limit them to 40 minutes
  • Use the 20/20/20 rule. In a 40 minute meeting, take a mid-time break to rest your eyes and look at something 20 feet away for 20 second
• Back pain. Consider impacts of home working environments on back pain such as working from the sofa:
  • Ensure employees have a set-up that's fit for purpose like they do at their office
  • Do not stay seated all day as the spine is out of alignment - set reminders to walk every hour for a few minutes or do simple stretches
• Circulation. Improve awareness of the risk from poor circulation as a result of moving less:
  • Look for signs of varicose veins such as aching legs, swollen ankles, and red or brown stains around the ankles
  • Keep hydrated and mobile to decrease the risk of deep vein thrombosis (DVT), or clotting in the deep veins of the legs
• Maintain contact with your doctor as DVT is associated with underlying health issues that may go undiagnosed

Councils maintain crucial services, have set up community hubs, and established local teams for tracing and tracking. Councils provide food and shelter to people at risk, help local businesses stay afloat and have mobilised volunteers and therefore know their communities in depth which can support trace and track. Councils:

• Are naturally placed to respond quickly to the distinct needs, challenges and infection rates of their own area
• Are equipped with their own teams of public health professionals