On the hunt with Yorkshire’s virus-detectives

By Simon Akam

On a Friday afternoon in mid-September Mark Hutchinson and Claire Brady knocked on the door of a house in a village in Yorkshire, in the north of England. Beyond a dry-stone wall, fields of sheep rolled away. Nearby lay a small cricket ground.

Hutchinson and Brady are contact-tracers who had joined a local team hastily established a few weeks earlier to track covid-19 cases in the area. Neither of them has any medical qualifications. Hutchinson is semi-retired after 37 years in the civil service. Brady had previously worked on road-safety programmes for Calderdale council, the body that administers the local area.

That afternoon they wanted to speak to a woman the national test-and-trace service had been unable to reach by phone after she tested positive for covid-19. But they were late to the party. “It’s ten days since she had a test,” Brady said. “Unless she’s got a temperature, she’ll be due to stop isolating.”

A dog barked frantically as the woman, who looked to be in her late 30s and had a tattoo on her foot, opened the door. Hutchinson introduced himself. She responded cheerfully, though I could hear a testiness lurking within her voice.

“I tried to ring you back earlier,” she said.

The woman had found out about her positive result after a routine test at the care home where she worked.

“So how are you feeling, first of all?” Hutchinson asked.

“Fine. I’ve had no symptoms.” She seemed eager to move the conversation along.

Hutchinson asked for the names and phone numbers of the rest of the household. The woman’s partner joined them at the door. He had seen his sister recently and the contact-tracer tried to work out whether there had been sufficient social distancing during the encounter. The couple, it appeared to me, were being asked to parse time and distance with a precision beyond the powers of ordinary recollection.

They had gone to a pub in Hebden Bridge, a neighbouring town, but insisted that they had been barricaded from other customers by plastic screens. The contact-tracers wrote down the pub’s name. The woman had also gone to Morrisons supermarket.

Hutchinson was a patient interrogator but the atmosphere grew more strained as conversation turned to the woman’s workplace. Had the woman come into contact with anyone at the care home? Hutchinson chuckled as he asked. “I know it’s an obvious question,” he said. “But we have to [ask].”

The woman seemed to find this line of questioning absurd, given that her job involved looking after other people. Despite her frustration, she continued to co-operate. It helped that everyone was rooted in the same community – this wasn’t an inquisition from a disembodied voice in a call centre.

“It’s ten days since she had a test. Unless she’s got a temperature, she’ll be due to stop isolating”

The rules governing when different members of an infected household can safely rejoin the outside world are confusing – even for contact-tracers. Hutchinson and Brady disagreed over whether the woman would have to extend her quarantine if her partner subsequently tested positive. Hutchinson insisted she would, following his “own natural logic”, but Brady believed “she could go out, because she’s had it.” They settled on the second interpretation.

Everyone was trying to act responsibly. But the rules are labyrinthine and occasionally contradictory, and the informality of doorstep chat can lead to crossed wires. I wasn’t certain whether each participant was clear about what they needed to do.

“I think that’s everything,” Brady said brightly as they left.

“Thank you for giving us the time,” Hutchinson added.

Since the coronavirus pandemic began, governments around the world have repeatedly asserted that the only way to resume normal life before the arrival of a vaccine is to track down and isolate those infected with covid-19. Britain’s national test-and-trace system has faced repeated criticism since it was established in May. The government insisted on building its own smartphone app to alert people exposed to infected individuals, even though most countries adopted one developed by Apple and Google. After the bespoke app faced problems, the government fell back on the tech firms’ one, but the launch was delayed until late September. Even then, the app contained bugs that issued false alerts to users.

Thousands of contact-tracers recruited by private-sector contractors spent the summer with few cases to pursue. Some 6,000 were laid off in August, just before the number of infections began to increase again. The test-and-trace team needs to get in touch with 80% of the contacts of positive cases in order to be effective, according to SAGE, the acronym for the British government’s scientific advisory group for emergencies. Week in, week out, that target has been missed – generally no more than 65% of contacts are reached (the most recent figure was 59%). An assessment by SAGE published in October said that the system was having only “a marginal impact on transmission” and that, unless it keeps up with the pandemic, “the impact of Test, Trace and Isolate will further decline in the future”.

A number of countries in east Asia have established effective tracing operations, albeit with scant regard for digital privacy (the Chinese, in particular, are used to intrusive surveillance). But it’s hard to take short cuts. These countries already had systems in place from previous outbreaks of respiratory diseases. A test-and-trace system is “not something you can just develop overnight”, says Carl Heneghan, a professor of medicine at Oxford University.

In Britain NHS Test and Trace, a government-funded body, adopted a model from the world of customer service: contractors tried to reach infected individuals and their contacts by phone to instruct them to isolate. As this failed, there was a growing call for local public-health teams to take charge. These had expertise in infectious diseases and could visit people in person if necessary. An official with on-the-ground knowledge ought to have an easier time winning trust than an anonymous call-centre operative. “Is local contact-tracing the answer?” asked the British Medical Journal in August.

Germany, which has 375 local-health authorities chasing down cases, appeared to have made a success of this strategy early in the outbreak. But when cases rose in the autumn, Jens Spahn, Germany’s health minister, admitted that the country was also finding it difficult to cut off chains of transmission (Germany entered a one-month “lockdown light” in November). Did local track-and-trace schemes offer a fix? In September I went to Yorkshire to find out.

The borough of Calderdale stretches across the southern Pennines, encompassing Halifax, a once-mighty manufacturing town, Hebden Bridge, a market town, and the farm country around them. In the 19th century Halifax was an industrial centre of global stature, producing household appliances, beer and sweets (Mackintosh’s, a confectionery firm, made Quality Street and Rolos there). It was most famous for its textiles: Dean Clough, once among the largest carpet factories in the world, was half a mile long. The area went into decline from the 1960s as the textile mills closed one by one, though recent regeneration projects include the Piece Hall, a colonnaded structure built as a fabric market in the late 18th century, now lined with shops and bars.

When the virus started to affect British Asians, “who carried on working and keeping us going and feeding and transporting us, then there was stigma and blame”

In the early months of the pandemic there were relatively few cases of covid-19 in Calderdale. Over Easter weekend, at the peak of the first wave, the infection rate in Calderdale placed it in the bottom fifth of all local authorities in England. At that time the coronavirus outbreak was concentrated in London. But after the first lockdown was eased in May cases began rising in areas that had previously been less affected.

From early July to early August, the seven-day count of new cases in Calderdale more than doubled, from 33 infections to 84. By mid-July the infection rate in parts of inner-city Halifax was 400 cases per 100,000 people, compared with a national rate of ten per 100,000. In response, at the end of July, the government put Calderdale and a number of other local authorities in the north of England under special lockdown restrictions. “The spread is largely due to households meeting and not abiding to social distancing,” Matt Hancock, the health secretary, wrote on Twitter when he made the announcement.

The message went out just hours before Eid al-Adha, when families meet up to celebrate one of the holiest festivals in the Muslim calendar. The news provoked fury in Halifax, which has a sizeable community of Pakistani origin.

“I think [ministers] were really worried that Eid would drive an increase in infections, and they wanted to be able to say they’d done something before it,” Deborah Harkins, Calderdale’s director of public health, told me. But the announcement came too late. “If you think about it, you don’t rock up on Christmas morning when you’re visiting.”

By mid-August Calderdale had the fifth-highest infection rate in England and the national contact-tracing system was struggling with its caseload. Three-quarters of infected individuals in the area were being spoken to, but only half of their contacts were reached, well below the threshold necessary to cut the chain of infection.

Calderdale decided to set up its own contact-tracing initiative, as did a number of other councils, most of them in the north of England. Some authorities framed these as replacements for the disintegrating national system. Calderdale said it wanted to complement, not replace, the national infrastructure. “We were always really clear that we wanted to be part of a system as opposed to being the independent kingdom of Calderdale,” said Ben Leaman, Harkins’s deputy.

The Calderdale scheme works by following up with those people NHS Test and Trace, the national scheme, has been unable to reach by phone. Initially the council recruited 12 tracers. Some worked for the council on unrelated projects, others were former civil servants, a few were retired or semi-retired doctors. They were paid £9.81 per hour, though some volunteered their services free.

Contact-tracing is a well-established practice in public health, often used for tuberculosis or sexually transmitted diseases. The work requires tact and sensitivity to persuade people to discuss intimate matters. “If you have a disease like that, someone’s going to ask you who you’ve had sexual intercourse with,” one medic told me. “And they don’t know that those people aren’t going to go, ‘Blimey, really? Have you shagged five people in the last month?’ They’re not going to say that. They’re just going to...write them down completely without judgment.”

I met Harkins at the Princess Street buildings in the centre of Halifax, the council’s central office and home to the public-health department. The scale of this honey-coloured structure – its grandeur would not be out of place in the seat of power in London – is testament to the town’s former glory. These days the interior is decorated with one-way signs and bottles of hand sanitiser.

Only Harkins’s eyes were visible between a mask and a headwrap (she lost her hair during treatment for leukaemia). She was thrown into the deep-end when she began her job in April, but has worked in public health for decades. As a young, broke mother living on a council estate in Sheffield after she finished her degree in the early 1990s, she saw first hand the success of “participatory” models of public health, in which local people have a stake. The centralised and didactic approach taken by the British government to covid made her uncomfortable: “In my experience of doing this for 30 years, people in organisations can’t make the change happen on their own. Communities have got to be empowered.”

Harkins is convinced that the restrictions imposed from London on Calderdale prohibiting household mixing had “no impact whatsoever”. Many people in poorer parts of the borough continued to come into contact with other people throughout lockdown because their jobs could not be done from home. Some also found the restrictions unfair. After lockdown ended, pubs reopened but large families could not mix. Harkins said that many in the Pakistani community thought it unjust that they were driving people going out for a drink in taxis but were forbidden from their own communal activities.

Local contact-tracing and engagement with community members and businesses was more effective than rules imposed from afar, reckons Harkins. She attributes the rapid decline in transmission in Park ward in Halifax over the summer to these kinds of efforts: infections there fell from a peak of 400 per 100,000 in July – then at 40 times the national average – to 78 per 100,000 in late August.

As well as being an effective means of breaking chains of infection, local contact-tracing serves another purpose too: it uncovers hotbeds of disease. Harkins suspended the operations of one taxi firm in Halifax because a member of her team suspected the proprietor was lying when he claimed that the fleet was covid-free – it turned out that a number of the drivers had symptoms and the dispatcher was in hospital on a ventilator. The national scheme wouldn’t have spotted such a cluster: “We would have never known if we hadn’t had those local contact-tracers who understand the borough.”

Ispent an afternoon with Colin Hutchinson, another contact-tracer, who is a retired eye-surgeon (and no relation to Mark Hutchinson). Colin works from his study at the top of a Victorian gritstone house. On the wall is a print of “The Scream” by Edvard Munch. Colin joined a Zoom call in which Jo Ngan, who runs the council’s contact-tracing programme, brought him up to date. That morning 13 cases had come through from the national system (anyone that couldn’t be found within 24 hours was referred to the Calderdale team). The earlier shift had managed to speak to only four of them, and the two Hutchinsons were charged with sweeping up the residue.

As they were talking, one medic from the morning shift reflected on her work. Some individuals she had called “didn’t mind at all” giving out information about their contacts. Others did. “And you can’t bully people,” she said. “If people don’t want to tell you someone’s name then that’s it.” Britons have been drilled for the last 20 years to be careful about personal data. “People are quite reticent, I think, about giving out other people’s details.”

“I think I’d be the same,” Ngan said.

The rules of contact-tracing are simple. A team checks that targets are isolating and connects them, if necessary, to a series of hubs that can help with tasks such as shopping or collecting prescriptions. They find out where individuals have been and whom they’ve seen – and might have infected – and then feed that information back into the national system. If, by mid-afternoon, they haven’t been able to reach people by phone, they go out and bang on doors.

“I’m teaching my ten-year-old algebra and my seven-year-old how to do subtraction. And then I’m telling my five-year-old how to write numbers. It’s absolutely mental”

Colin called the first person on his list, a 19-year-old man. (According to 1843’s agreement with Calderdale council, I was allowed to listen to the tracer’s side of the conversation but not the other. Names of contacts have also been changed.) The call went through to voicemail.

“Hello, this is Colin Hutchinson from Calderdale council. I’d like to speak to David, fairly urgently.” He spoke with the reassuring tones of a recently retired doctor. “I’d be grateful if you could give me a ring back on this number.” Contact-tracers never mention the word “covid” in a voicemail message for reasons of medical privacy – they don’t know who will pick it up.

Next on Colin’s list was a 49-year-old man and his daughter. He managed to get hold of them but information was hard to elicit. The woman, who worked at a hair salon, insisted that she never saw anyone apart from her colleagues without wearing a visor.

“And what about for lunch breaks, tea breaks and things like that?” Hutchinson asked. “I was going to say it’s difficult drinking a cup of tea with a visor on.” (A study in Japan recently found that plastic face-shields are “almost totally ineffective at trapping respiratory aerosols”.)

After the call was finished, Colin told me the woman had claimed to take all her lunch breaks on her own. He was clearly sceptical. “I will make a note of the workplace,” he said. “Just in case it leaks.”

Then David, subject of his first call, called Colin back. Colin asked for the names of the people he lived with.

“We’re trying to piece together how the virus is spreading through, from person to person,” Colin said gently.

Though I couldn’t hear David, it seemed the conversation had grown frosty. “Right,” Hutchinson said. He sounded sceptical.

“What’s his name or her name? Harry? Or Hannah? So, what’s the surname?...Hello there?”

David was gone.

“He was obviously furious,” Colin said. “When I explained what it was about, he started speaking in a rather slurred voice, so I couldn’t hear him. And then when I asked the name he was saying, he hung up.”

“That’s not happened before,” Colin added. “So the question is: do we need to go around and find out where he lives?”

Halifax has played host to successive waves of immigrants since the Industrial Revolution drew labourers to its textile mills. First came the Irish who, by the 1870s, made up one-sixth of the population. Then came Italians, West Indians, Ukrainians and Poles. The migrants who have done most to shape the character of modern Halifax arrived from the 1960s onwards after the vast Mangla Dam displaced hundreds of thousands of people in Pakistan-controlled Kashmir. Many of them emigrated to Britain to work in factories in the Midlands and the north. In Halifax they settled in Park ward in the west of the city, as other immigrants had before them. Today over 60% of the population in this densely built-up area are British-Asians (in most other wards this group makes up less than 5% of residents). Unemployment is high – this is one of the most deprived areas of the country.

The announcement of a lockdown on the eve of Eid provoked understandable uproar in the area. Families who had planned to gather for elaborate meals with relatives were left high and dry. Faisal Shoukat, a councillor for Park ward, posted an outraged video on Facebook. “I’m absolutely appalled and shocked. My phone’s been off the hook,” he said. “The night before Eid you put out an announcement. Would you do that the night before Christmas? No, you wouldn’t.” It was an analogy I heard repeatedly throughout my visit.

Divisions were exacerbated when Craig Whittaker, a Conservative MP whose constituency covers the rural part of Calderdale, was a guest on LBC radio. There were “sections of our community that are just not taking the pandemic seriously,” he said. Asked whether he was referring to the Muslim community, he replied, “Of course”.

“Blimey,” said the presenter. “You could come in for a lot of criticism with this.”

He was right. Marsha de Cordova, shadow equalities secretary, spoke of “disgraceful and overt racism from this Tory MP”. The Muslim Council of Britain condemned the “shameless scapegoating of minorities”.

The interview led to a further breakdown of trust. “That comment that Craig Whittaker made was repeated and repeated and repeated by lots of people who are probably fairly prejudiced anyway,” Jenny Lynn, another councillor, told me. When I arrived in Halifax and was waiting to pick up a rental car, I struck up conversation with a white couple who gestured down the hill towards the tight Victorian terraces of Park ward. Their meaning was clear: be careful, there’s a lot of covid over there. Safoora Masood, in her late 30s, told me she couldn’t avoid hearing the slurs that Muslims were “sticking together” and visiting each other’s houses.

The inner-city wards were indeed disproportionately affected by covid. That was owing to overcrowding and a concentration of multi-generational families – demographic factors that accelerate the spread of the disease. “There’s no evidence whatsoever to say that people in those communities were less likely to adhere to the social distancing,” Harkins told me. On average, those who tested positive in Calderdale in the early days did have more contacts than those in the country at large – but Harkins suggested that was because they were likely to live in large households and have jobs that could not be done from home.

In her previous job in Dudley in the West Midlands, Harkins had watched covid-19 flood the country: “It was doctors, nurses, professionals who had been on skiing holidays in February half-term.” Some of these people were soon feted every Thursday night by applauding citizens on their doorsteps. But, says Harkins, “when the virus moved into people who live in deprived areas, who were largely of Asian ethnicity, who carried on working and keeping us going and feeding us and transporting us, then there was a stigma. And then there was blame.”

Even if the system is theoretically capable of working, contact-tracers face a final problem: compliance

I walked around Park ward with Shebana Sadiq, who works for the council. The sense of mistrust around covid was palpable and people were reluctant to talk. A man named Shak pulled me aside and claimed that the council was using coronavirus as an excuse to gouge money from the government.

“In this area you get a lot of the council taking on stuff like this...They always apply for grants [but] we don’t see anything back on the streets outside. They’re literally making a pay cheque for themselves,” he said.

For months, there was no testing site within walking distance. A mosque hosted a mobile-testing unit over the summer but the Pakistani community, keen to avoid further stigma, pushed for a neutral location for the permanent site. Only in August did a testing centre open at a nearby Asda.

Though the concentration of cases began in the inner-city wards of Park and Warley, nowhere was immune from the disease. Infections rose in rural, Tory-voting areas from September onwards. Yet Whittaker, the local Conservative MP, successfully lobbied for some restrictions to be lifted in his constituency, causing further divisions between town and country (on November 4th Whittaker was one of 39 MPs who voted against the new lockdown).

On the streets of Halifax it was evident that the rules were being stretched. I passed three teenage boys sitting on a bench when they should have been in class.

“We got sent back from school,” one of them said.

“Why?” I asked.

“’Cause…No comment.” He giggled.

I asked another.

“I had a headache, so they sent me back home,” he replied. “I lied to them. I’m not going to go back to school.”

“Nothing wrong with us now,” another chipped in.

They looked smug at having worked out how to game the system.

Safoora Masood, the mother I spoke to, chafed at the constraints, even though coronavirus had struck close to home: in the first wave her brother-in-law, a paramedic, had been admitted to intensive care. But she doesn’t believe that people will comply if they are continually told to isolate: “Even if you get a call. I’m like…I don’t have a fever. I don’t have it, my kids are fine, why should I?”

She is loth for her children to miss more school when they have only just returned, and bristles at the memory of home education: “I’m teaching my ten-year-old algebra, and I’m teaching my seven-year-old how to do subtraction. And then I’m telling my five-year-old how to write numbers. It’s absolutely mental.”

Along with the friction caused by social divisions, contact-tracers also have to contend with bureaucratic obstacles. Public records often don’t match up with the facts on the ground. The Hutchinsons went in search of one woman only to endure a baffling doorstep conversation with a man whom they presumed was her husband. He turned out to be her father-in-law and the woman in question was living with her mother.

The system contained infuriating bugs. NHS Test and Trace is incapable of designating a co-habiting household as a single entity, so when many people live under the same roof, as is common in Park ward, they can get trapped in a kind of perpetual-motion machine. When a person tests positive, her housemates report each other as close contacts, leading to a seemingly never-ending succession of alerts. “They get 30 phone calls,” said Leaman. “And actually, one phone call will probably do the trick.”

Though both systems theoretically use much of the same information, tracers can’t automatically transfer data from the national one to the council’s own and must fill in spreadsheets themselves (the use of ad hoc spreadsheets had led to NHS Test and Trace overlooking nearly 16,000 cases at the end of September).

In practice, the number of cases that the national system filters through to local tracers is unpredictable. On one day during my visit there were 13, on other days just a couple. Some days no cases came through from the national system at all, which seemed improbable given rising infection rates. The time lag between an individual being tested and the case being handed over to local contact-tracers also hamstrung attempts to tamp down the virus. At times this stretched beyond a week, far too long for action to be taken to break the chains of infection.

Airborne respiratory infections that can be transmitted asymptomatically are particularly difficult to contain. Above a certain level of prevalence, the task becomes virtually impossible. Some doctors argue that any such attempts are futile. Druin Burch, a consultant in geriatric medicine at the John Radcliffe Hospital in Oxford, recently summed up the argument against track-and-trace schemes in the Times Literary Supplement: “The current impact of our current track-and-trace policies is dubious. It lies in the realm of politics and psychology, not epidemiology.” Yet even if the system is theoretically capable of working, contact-tracers face one final problem: compliance.

Imet up again with Mark Hutchinson in a suburb of Halifax as he set out with another colleague to track down David, the young man who had hung up on Colin Hutchinson. They approached a pebbledash house and saw a dog peering out of a window. A middle-aged man wearing a grey sweatshirt answered the door.

“How we doing, alright?” He sounded like he’d been expecting them.

“We’re looking for David,” Mark said. “Is he in at the moment?”

“Yeah, he’s at uni. We’re isolating. Do you mind stepping back?” said the man, who was evidently his father, a touch defensively.

“He tested positive last Tuesday. Okay. So he’s had his seven days. He’s got back over to uni, and he’s in Leeds.”

“The rule is actually ten days,” said Mark, “but we’re not here to put any blame.”

The boy’s mother arrived at the door. A younger son in a Liverpool shirt lurked behind her. The mother took over. It was clear, from the detail in which she recounted the trips to get various family members tested, that she took pride in following the rules. But her elder son lay beyond her jurisdiction.

“So, he’s gone back to university?” asked Mark. “What’s the address of the house?”

“I couldn’t even tell you. We’ve been obviously…” Her tone suggested that she’d done all she could – that young men will be young men.

She offered to phone him but said he rarely answered. There followed a slalom of maternal apologetics.

“We were always really clear that we wanted to be part of a system as opposed to being the independent kingdom of Calderdale”

“There’s five of them that lived there. And there was only one other boy that was living there at that moment. And he’s been tested positive. They were together when they both got it.”

Mark asked for details of the boy’s housemates. The father now intervened.

“They’re not there.”

Everyone looked even more confused.

“They’re staying away,” he added.

“There’s not four people? There’s just two of them?” asked Mark.

“Well, there’s five,” said the mother.

“There’s a girl,” said the father.

“There’s a girl?” The mother seemed surprised.

It was now even more unclear where David was and how many people he had been in contact with. Mark asked David’s mother to tell her son to expect a call from them. Then something seemed to click in her mind.

“He did say he missed a call from Track and Trace when he was here.”

“We have got on record that there was a call but it wasn’t concluded,” said Mark, diplomatically.

“As in you didn’t speak to him or…?”

“All the notes say was that a call began but then the call went dead.”

“Oh,” David’s mother said, stretching out the syllable, a time-honoured expression of parental suspicion.

“Don’t tell him off,” said Mark. “But tell him to look out for the call.”

“I tried to be a bit…polite,” Mark told me as we walked away from the house.

The aim of contact-tracing is to protect society. But on the doorstep, even when confronted with a cheery face, friends and relatives feel the need to cover for each other. The government’s attempts to enforce covid rules with a programme of aggressive fines has made it even harder to strike the right tone. And tracing teams know that, since stigmatisation can lead to a drop in compliance, it’s often better to glide over bad behaviour than to shame it.

In early November I checked in with Leaman, the second-in-command of Calderdale’s covid-response team. “Our infection rate, as with everyone else, has shot through the roof,” he told me. The average number of cases across the entire borough now exceeded the threshold of 400 per 100,000 that had caused such alarm when Park ward breached it in July (though the testing rate had increased, the incidence of infection had risen even faster). In Park ward itself, which the public-health team had earlier pointed to as an example of the efficacy of contact-tracing, the rate had also rebounded dramatically, and now stood at 560 per 100,000. The number of individuals the national test-and-trace team couldn’t find had grown, reaching into the 20s and 30s each day.

Fortunately turnaround times had speeded up, so the Calderdale contact-tracers generally received them within four or five days of the test, though local officials believe that’s still too long. But, since the virus was spreading faster elsewhere in Britain, Calderdale was now only the 34th-most-infected local authority in the country. The hospitals seemed to be coping; they had fewer covid patients than at the peak of the first wave.

“They get 30 phone calls...and actually, one phone call will probably do the trick”

Leaman talked up the effectiveness of Calderdale’s apparatus. They had learned that house visits were more effective than phone calls, which are the only tool available to NHS Test and Trace. “Some people don’t want to engage on the phone, but do engage on the doorstep,” he said. A system had been created for cases to go to an “enforcement team” when there was reason to believe a household wasn’t isolating.

NHS Test and Trace and the local operation were collectively reaching between 90% and 95% of infected people, a significant increase on the 75% figure when the Calderdale team was established. But between them, they were still finding it hard to talk to the contacts of positive covid cases. In the seven days prior to October 28th, they got in touch with only 54% of contacts, which is lower than the national average and well below the 80% threshold for effective curtailment of infection. Harkins has repeatedly asked the national service if her local team could start approaching the contacts of infected individuals directly, rather than just feeding that information back into the national machine. She has not heard back.

The great unknown was compliance and Leaman acknowledged that they were flying blind. “We can’t really measure compliance, unless we follow everyone around all the time,” he said. Anecdotal evidence suggested that people were following advice, he said, but research published by King’s College London in September found that the overwhelming majority of people instructed to self-isolate failed to adhere fully to the law.

Leaman acknowledged that this was his moment. “If you work in public health and you’re not prepared to really get stuck into trying to manage a pandemic, then you’re probably in the wrong profession.” But he sounded tired, too. “It’s obviously a slog,” he said. “I’ve been at this since February.”■

PHOTOGRAPHS: CHRIS DORLEY-BROWN