How many known close contacts of COVID-19 carriers in Victoria and NSW are notified by government tracing teams?
The answer may seem self-evident — all of them — but if the experience of other countries is anything to go by, many close contacts may be falling through the gaps of the tracing system.
In England, a quarter of people referred to National Health Service (NHS) tracers cannot be reached due to a combination of unanswered calls and incorrect contact details. Of referrals who are successfully interviewed, around a third of the close contacts they provide to tracers are also proving impossible to find.
Putting both factors together means tracing teams in England are currently reaching only around half of the close contacts of known coronavirus carriers. Half.
Worryingly, the US makes England’s numbers look good. In New York, as few as 35% of people referred to tracing teams have been willing or able to provide a list of close contacts. Some areas of New York have even resorted to issuing subpoenas to force suspected coronavirus spreaders to cooperate. No wonder White House health adviser Dr Anthony Fauci has admitted US contact tracing is “not going well”.
So is the contact tracing hit-rate any better in Victoria and NSW? It seems an important thing to know — but we don’t.
Australia’s lack of data
Unlike their counterparts in England and the US, neither the Victorian Department of Health and Human Services nor the NSW Ministry of Health publishes performance data about their contact tracing efforts. Both have refused to provide figures to Crikey.
According to Professor Catherine Bennett, chair in epidemiology at Deakin University, Australia’s contact tracing performance is likely to be a lot better than in England and the US. But, she says, “a relatively small percentage” of contacts may still be unreachable.
“We have been nowhere near as overwhelmed by case numbers as the UK, so I think that alone means we have probably had more capacity to be more persistent in our detective work following up cases and contacts,” Bennett tells Crikey.
The maths suggests a small percentage of missed contacts is still a problem. Even if just 3% of close contacts prove to be unreachable — a mere 10th of the contact failure rates in England — that still equates to hundreds of close contacts in Victoria and NSW never being informed of their status. A 10% contact failure rate would put the number of missed close contacts into the thousands.
(Bennett also points out that less than 1% of tests are positive, including close contacts, so missing a few hundred might only mean a couple of them actually have the disease.)
We can only hope Australia is performing better than England and the US, but without seeing official figures it is impossible to know.
Why is contact tracing so tricky?
Bennett says outright non-compliance with contact tracers is rare, but getting useful information from people requires a lot of time and skill.
“I’ve had contact tracing calls with hundreds of people over a variety of [non-COVID] outbreaks, and don’t recall anyone flat-out refusing,” Bennett says. “They always gave a little info at least, but it can take a lot of time to work with them to even get that.”
“The ability of the contact tracers to build rapport, trust and confidence at first contact is really important and why so much effort needs to be put into training — even in this current crisis.”
Perhaps the biggest obstacle for tracers is getting people to answer their phones in an era when few people are willing to field calls from unknown numbers.
In the US state of Massachusetts, health officials have responded to low response rates by launching an initiative called “Just answer the call”. Instead of an anonymous number on the screen, their contact tracers are also now identified with a caller ID showing they are part of the “MA COVID Team”.
Similarly, New York City has taken out social media ads saying: “HIT ACCEPT. NYC IS CALLING!”.
Victorian Premier Daniel Andrews has conceded “there will always be instances where despite multiple phone calls you can’t actually connect with the person, despite every best effort”. But, for now, at least, official contact tracing performance figures remain under wraps.
Releasing the data would not immediately solve the difficulties of contact tracing. But it would at least shine a light on the size of the challenge — and perhaps encourage more people to pick up the phone when the tracing team calls.
Yes, I don’t answer unknown numbers, and if the phone flags it as spam, I don’t either. If it’s important people can leave a message, or SMS me.
I have stopped responding to “number withheld” calls as so many are coming from “insurance claim” or “taxation department” scammers, but I might respond to a call showing “Covid tracing” or “health department”; at least until I worked that those calls were also coming from scam operators.
Somebody needs to put their hand up and say I’ll get this fixed. Politicians have people to answer their phones so this is not their problem
A fairly simple fix, if you don’t pass the 100 point test, no free calls. If you have multiple phones, only 1 gets free calls. This is not a problem for business, their calls are to generate a return so it’s a cost benefit analysis. If there’s no benefit don’t make the call, spend the time making money.
The only people with a huge problem are criminals and the like using burner phones.
You won’t find out the numbers, because trying to find out what any Australian Government is us to is impossible You could try an FOI request, but by the time you get the Bromides puprting to be the information you have asked for or you just get outright rejection on the spurious grounds of “it was talked bout in cabinet” you will probably be dead. The Austrlian public service has the same articles of faith as the UK system:
– Its more expensive to do things cheaply
– Things must be done in secret. If people don’t know what you are doing then they won’t know what you are doing wrong.
– We must do something, this is something therefore we must do it.
That’s why they hate Julian.
The whole problem with the testing regime is that they don’t test often enough, the turnaround time on the results is too long and the tests cost too much leading to rationing. What is needed immediately is not a vaccine, but a high speed cheap test for covid-19 that can be given to everyone likely to come into contact with ex family people. As an example, before schools went back they tested all of the Victorian Teachers once. What was the point. Everyone had been locked down, the virus had subsided yet they tested all the teachers. Not the students who outnumber the teachers 20 to 1. it was a triumph of a government
Such tests exist, but regulatory authorities are either unaware of them or its all too hard. These test use monoclonal antibodies printed on paper strips. Instead of peeing onto them you spit on them. In large quantities they would cost $1 US or $2 Au. For those who are skeptical about the cost have a look at the Coles website.
https://shop.coles.com.au/a/national/everything/browse/health-beauty/personal-care-hygiene/pregnancy-tests?pageNumber=1&cid=colsup_cpc_Brand%257cColesSupermarkets%257cHealth&Beauty%257cAustralia%257cExact&gclid=Cj0KCQjw3s_4BRDPARIsAJsyoLPSrLPErtvE04KtFcgIGKDsW842E9Z2xp38F6j-hEnmwxen5hjPYIIaAlhvEALw_wcB
You can get a pregnancy test in a pack of three for $17. Now if the government bought tests wholesale as part of public health, there would be no marketing, packaging and retail costs so the $5.60 per test would be at least half that, so the $2 test is quite feasible.
The issue with these rapid test for covid-19 is that they are a little less sensitive than the PCR tests being used at the moment and the FDA hasn’t approved them. But as the researchers point out, you don’t need a clinical grade test to find out if someone who is in the early stages and shedding virus all over the place. A surveillance test will do very nicely.
I have written the following letter to my MP about these tests hoping for some action. As they say hope springs eternal in the human breast.
The letter pretty much explains it all. I haven’t heard back from him yet, here’s hoping.
————————————————————————————————————
Hi Russel
I was listening to the latest This Week in Virology Posdcast No 640 and they had Assistant Professor Dr Michael Mina on talking about using high speed, low cost tests for covid-19. These tests whilst not as sensitive as the current PCR tests being used are nonetheless more than sensitive enough for surveillance monitoring to pick up people with covid-19 before they become symptomatic. These tests use technology, similar to pregnancy tests, and use monoclonal antibodies to detect Sars-Coc2 virus in nasal or pharyngeal swabs or sputum. These tests are simply mono-clonal reagent printed on paper strips and can be produced in large quantities at a cost of $1 US. and produce results at the point of testing in five to ten minutes. These results are immediately able to be interpreted by the tester.
The problem is that the US FDA is requiring any new tests to have a sensitivity of at least 80% of PCR testing.
Dr Mina shows that this level of accuracy is not required for the detection of virus load pre-symptoms because the virus replicates at extremely high rates and produces viral loads way above the minimum sensitivity of these rapid tests.
There is no reason why Australia could not evaluate this mode of testing independent of the FDA and approve it for use as a surveillance test use in Australia. As the current outbreak shows PCR testing is a blunt instrument. People who get covid-19 show no symptoms for the 5 days incubation period but shed 40% of the virus during this time. If these tests were available in quality everyone who was exposed to group situations could be tested daily. This testing would be a game changer.
PCR testing is not suitable for surveillance testing, it is a clinical tool for the treatment of patients who are known to have the disease. Unless testing is carried out at least every second day we will NOT control this pandemic. It may subside for a while but then flare up and become dangerous again.
If PCR tests were carried out weekly, a person can pass a PCR test on week one, go to a bar or school or both, become infected pass it on to someone else and then be picked up the following week. That’s if they don’t miss the test and/or ignore symptoms they may have.
The scientists and doctors who run the podcast were blown away by Dr Mina’s findings and were convinced of the benefits in the first five minutes of the talk Dr Mina gave and I was with them. It’s so simple even a humble engineer can get it.
Please listen to the TWIV Podcast No. 640. The relevant part is only 15 or so minutes long.
Such tests could be provided for long-term protection against the spread of this virus. They be used in a wide range of settings including: medical clinics,
– Dental surgery
– Aged care,
– schools police, fire and ambulance settings,
– all work-places with more than a few people
– child care centers
– Parliament.
With clever logistics they may even be useful in the public transport domain.
Please find a rough summary of TWIV 640 with some links below.
I have attached the relevant papers about rapid testing one for a commercially available fast test and one for the mono-clonal antibody test that costs a dollar.
I have also attached an email I sent to the TWIV team to ask if they knew any Australian Virologists who would be interested in the process. The medical fraternity in the US are pulling their hair out because of the incompetence and inaction of the US federal government. I hope we don’t go down that same path.
Best regards
Rob
Your dissing of the Australian Public Service is a bit pointless. The FOI is applied as it is because the pollies don’t want information to go out, the PS doesn’t give a toss and most would be happy to comply to any pointed FOI request, but not the “give me every piece of information on everything at all times” enquiry
“It’s more expensive to do things cheaply”. I don’t know what this is about, although it is generally true in all things in life and more so in the public sector. Why do a crap job when you can do a real one?
You say the test takes too long, but results are back in 24 hours, or at worst 72 during peak testing. My daughter recently got hers back in 20. When they are required to go home after testing anyway, why would you use a test that is less accurate to save one day. The corollary of a less accurate test is people walking around the community with a false sense of security, shedding virus wherever they go. Alternatively a false positive causes quite a degree of anxiety which you would want to follow up with a proper swab test.
And complaining about the expense is just froth and bubble. Use the best test we have available, the swab test, why quibble about saving a few bucks when the difference can bring an economy to its knees.
Sounds like classic corporate thinking, here’s something quicker and cheaper, why aren’t the public servants doing it, this is something and we need to do something, why am I so smart?
Anyone can diss the public service Robert, but your solution has real pitfalls. It was the private sector security firms that mucked up the quarantining, it appears. Guess what, the pollies take the blame for that too. Corporate Australia is all about avoiding accountability, it’s just that they are better at it then the public service.
So easy to make sweeping, glib generalisations, I think I’ll do more of it.
OMG. Thank you for standing up for the public servants.
In my experience, public servants are quality, accountable, trained, expert professionals. Despatched immediately for a breach of privacy (Federally at least), while private and community sectors do not have the same high standards.
Money is tight, no training, reputation matters more than accountability/professionalism.
I hate the constant bagging of public servants. Having been one for thirteen years I have great trust in them. They give good advice, act professionally and know a good deal more about the subject of their relevant departments than any politician, who will often ignore public servant’s advice for short term PR to win the next election.
Obviously, not all public servants are fabulous, but that is the same everywhere.
I just trust the public service as educated and fair and expert.
There used to be accountability – the public service would serve over the years for successive governments providing quality advice and being paid an average and consistent and safe wage.
Somewhere along the way, there was a buffer put in called: consultants. The consultants are paid millions, are not accountable and allow the politicians to appoint people with a political agenda who are not accountable and can be blamed, while doing all the dirty work public servants would never do.
Accountability comes through a constant public service > politicians > parliament.
The input of these private consultants getting millions in tax payer money under the guise of bringing in ‘experts’ is bogus and simply wastes money on allowing politicians to by pass the public service and provides the politician with a partisan person to blame – and who cannot be held to account by the Senate.
We should ditch them… all of them. Go back to open accountable government with politicians using their expert, educated public service.
No reply to my answer to your rather negative response to my original comment. Cat got you tongue?
I’m 65 years old. And I cannot remember a time when we had your “open accountable government”
Legally, all Australian Governments, federal and state government has no constitutional obligations to the real people they persecute, only “the crown” All of the public service legislation is written on that basis.
I was a public servant myself before I got privatized so I do have quite a bit of experience about the relationship of public servants to politicians. My is a state primary teacher and so I know quite a lot about that as well
There are a lot of good people in the service, but with privatisation huge numbers of the lower grade public servants were dispatched out leaving only a hollow shell within government.
I gave a couple of examples of senior public serevants Ken Henry and Arthur Sidonidis. Ken Henry in particular was a significant player in getting Australia through the GFC with only a few bruises, Sidonidis did a good job as Secretary to the Prime Minister, but my resepect for both of them was significantly diminished particulalry in Henr’s case when he went to work as an executive director at NAB. In his job at Treasury Henry was paid something of the order in todays terms of $900000+ per annum. He worked in the job for 10 years which adds up to millions. Not satisfied with this he turns up at the NAB and behaves egregiously at the Banking Royal Commission.
Leaving aside the fact that he had insider Treasury knowledge when he went to the NAB, and the fact that he would have all of the Treasury phone numbers of all the key people, he could have found a job where he could give back to the community for nothing. I mean how much money does someone like him need?
With his qualification and experience he could have given his time to help not for profit NGO’s not help and defend the bad behavior of one of the banking oligopoly.
Sidinidis is much the same. Now senior public servants are not the only ones up to this. I used to have a great deal of respect for Anna Bligh, she was a very effective Premier. Like the two above she would have been in community terms well paid for this, however what does she do? get’s a job with the Australian Bankers Association. Basically a class traitor.
Sorry, but people have to earn my respect and these people are good examples of why I don’t have resepect for them. They are nothing but greedy elites completely out of touch with the ordinary Australian and they freeze out ordinary people from the political process exactly as this political masters do. This isn’t democracy.
My philosophy is that when good men do nothing, that’s when bad men prosper. The US has had a number of important whilstle-blowers who whilst they weren’t direct public servants, as their roles had been privatised to contractors pretty much exclusively for the Federal Government and who were only cogs in the wheel saw bad things and let the public know about them. Why aren’t there whistle-blowers in Australia. I suppose our governments don’t do anything illegal or immoral, or unethical. Really?
Remember the Victorian Education Ministry’s foray into computers where the contractor they hire and were supposedly manageing. The system collapsed, and the government lost something like $7 million.
“Corruption watchdog finds.
Victoria’s anti-corruption corruption watchdog has found a former Department of Education and Training contractor misused his position when almost $14 million-worth of work was sourced from a company he owned over more than a decade.
“The Independent Broad-based Anti-corruption Commission today released its Operation Betka report [PDF] into the conduct of an unnamed male senior project manager following a three-year investigation.”
So you think this is worth respect?
I have plenty of other examples of why I don’t respect the public service, but I think I’ve provided sufficient evidence for my skepticism of them. Why don’t you take your blinkers off and look at what’s really going on.
On the issue of testing, it wasn’t me that came up with the idea that we needed faster and cheaper tests it was the professors and researchers of virology, epidemiology and public Health who have run a podcast to educate people about viruses and related matters. I explained where I got the information in my comment. Did you bother to listen to it? Here is the link. https://www.microbe.tv/twiv/
Listen to TWIV #640, Mina, #641 Fauci and #642
Lets take each of your points:
Cost: As far as I can find out, there is no data published by the goverments, The current PCR tests cost about $100 per test. This is not inconsistant with the cost of routine lab testing of blood. The tests proposed by Dr Mina cost about $1.
The Victorian Government tested every teacher using this type of test the day before the kids went back to school after the lockdown. There are around 45000 teacher sin the ministry 100 * 45000 = $4.5 million.
They didn’t test the kids. If they had at a student teacher ration of about 20 to 1 that would have cost $90 million.
I find it difficult to understand how you can consider that this is just a case of “froth and bubble”
Turnaround time:
The time period that a person sheds virus is for about three days before they have symptoms and about four to five days after they become symptomatic if they don’t end up in hospital. The virus increases exponentially in the body until the body’s innate immune system starts to work. The tissues in the upper respiratory tract are the first to be infected, but the immune system doesn’t work rapidly in this part of the body because the body considers these organs to be part of the external environment. Thus the peak of the viral load and shedding is reached just before the onset of symptoms. In fact 40% of the viruses shed are thought to occur in pre-symptomatic phase of the disease. Thus testing has a window of about three days to pick up infections. Therefore unless you test people at least every three days or less you won’t pickup many infections before they are passed on to someone else.
My wife was tested ONCE. Three days later she could have picked up the virus from a child and given it to me. She has not been tested a second time. If testing was necessary the first time she started the term back at school why not the second time?
Your question “why quibble about saving a few bucks when the difference can bring an economy to its knees”
This can be simply answered by saying that the current testing regime isn’t working.
Firstly: Infections are going up and no one has any idea of the real number of infected people.
Secondly: It isn’t me saying that the current testing is ineffective, it’s world class experts in the field.
Thirdly: Examine the statistics and trends here and in other countries. Only lock down is really effective, the current testing regime and the associated disease tracking is marginal at best.
Forthly: The principles of data analysis and sampling require that the frequency of measurement be at least twice the maximum frequency of the signal being measures. It’s called nyquists sampling theory and it can easily be proven mathematically. The spike in viral shedding and it’s testing when takes over a large number of people has an effective bandwidth much greater than the rate that the spikes occur. In fact the viral load prior to the peak and before symptoms may be aproximated by a delta function (unit impulse) Such an impulse has an infinite bandwidth which therefore requires an infinite sampling frequency to get 100% detection. Of course this is not possible in the physical world, but the time between tests is driven by the duration of the window for detection.
Bringing up the issue of testing wasn’t motivated by my thinking that the Victorian public service is populated with a bunch of dud’s. If you bother to listen to the TWIV you will find that the new tests are still in the lab because they have to get through the FDA before they can be used. The covid-19 pandemic is a world emergency and we are only at the very beginning. I was trying to help by bringing the thinking of the US experts to the Australian scene. I know that the public servants are working extremely hard to control this pandemic, and that they are stretched very thinly and may not have the time to get up to date with the very latest info.
My disrespect of the public service was not about their competence it’s about their secrecy and the patronizing way they treat the public, as if we are all stupid corporate morons. I also strongly object to well paid and very rich public servants moving to the corporate world when they leave. I don’t apply this objection to the middle ranking and junior public service wage slaves who work for them.
You sideways swipe at me about my corporate thinking on cost was quite objectionable. I think that corporations are amoral, nasty self serving arseholes. Compared to what other say of them that’s a generous tribute. Everywhere you look from public transport to electricity production, privatization has been a disaster. I worked in the power industry for forty two years and saw it as an employee of the State Electricity Commission and then as a wage slave for a US company, then a UK company then a French/UK company then a fully French Company and then a Chinese Jewler. And every time the ownership changed or they had to refinance, the banks made tens of millions of dollars just to talk about it. The same banks like the one that Ken Henry worked for.
Over that period my electricity price has gone from 11.5 cents per kWhr to nearly 40
Neo-liberal economics and the privatizations that were spawned by it have seen the greatest movement of wealth to rich elites since the golden age. And during this time democracy has been eroded away by “Commercial In Confidence” and all of the other instruments that senior public servants and their political masters have at their disposal.
Here’s a little jolt from the Emerald Isle –
https://www.theguardian.com/world/2020/jul/20/cheap-popular-and-it-works-irelands-contact-tracing-app-success
Thanks Indunn, an interesting link. The Irish have taken up this App quickly, it it is vastly different to ours.
Approx 120 IT Practitioners wrote a letter to our political and health leaders recommending a decentralised App, where data is stored on each individuals phone. This is the Irish system, and it removes the risk of privacy breaches in centralised data, which would give the Irish confidence.
Our Govt preferred a centralised data collection system, which increases the risk of breaches, and once downloaded by State Govts / health authorities, removes it from the national security protocols, such as they were on an insecure App.
From there, you need to place trust in institutions downloading and managing the data securely, and that track record is abysmal.