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Homepage / Outside MAN / How perfect storm of patient privacy, long phone calls and recruitment issues is causing our contact tracing system to fail
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Outside MAN

How perfect storm of patient privacy, long phone calls and recruitment issues is causing our contact tracing system to fail

Contact tracing is a mess, and the powers that be have known about it for months.

Individual calls are taking three and four times as long as they should, because the traced are arguing the toss with their HSE trackers.

And it’s all down to patient privacy and GDPR, that unparalleled refuge of the jobsworth and busybody.

The EU’s data protection regulation, coupled with medical confidentiality, prevents the HSE from identifying the person who has developed Covid when they call close contacts.

This leads to those being called demanding to know who ‘Patient X’ may be, and launching into long rationales about why they need to know the name – so they can form their own judgement about how extensive their contact with that person has been.

The callers then reply that they can’t discuss or disclose the name, but would like you to make an appointment with a GP for a test, and did we mention that you should already be self-isolating?

Very few, however, want to immediately shut down their lives on the basis of an anonymous say-so, so the argument – and bargaining – rages over the phone.

It’s resulting in people declining to co-operate with the recommendation, and going about their business as usual – yet the associate is still marked as having been traced, even if zero benefit to that person or the rest of society comes from it.

But it is also massively extending the duration of phone calls, meaning fewer can be fitted into the working day.

With 400 people at work on tracing, and even 1,000 people testing positive on a given day, and these having five close contracts apiece, the numbers come to 5,000 divided by 400, or just over 12 calls to be made daily. Even if it were twice that number, or even four times that number, it should be manageable in an eight-hour day, should it not?
But no. Calls are long, and their argumentative or even intemperate nature may be feeding into people not wanting to work in tracing, with all the compounding problems that creates.

Many OTs (occupational therapists), physios and others drafted in from the general health service at the height of the crisis have been just gagging to get back to their original jobs, and were out the door as soon as non-Covid treatment began to be restored.

Attracting people to a job of non-stop working the phones has always been something of a challenge, and not much of a career, no matter how altruistic individuals may be.

A lot of the above was specified by the Tánaiste in the Dáil a week ago – yet somehow the Taoiseach didn’t absorb it. In any case, nothing was done. Before then there had been individual warnings that the system was breaking down, to similar nil effect.

Leo Varadkar said last Thursday: “We are now trying to contact-trace 1,000 people’s contacts nearly every day.”
It is “really tough” on the people manning the phones, he said. “If we’re going to have a couple of hundred or 1,000 positives a day, and everyone has six or seven contacts, that’s 7,000 people a day we need contact-traced.

“You need an army of people — probably an army bigger than our actual army — to trace that many people every day.” There is a current strength of 10,277 in the combined Defence Forces
.

“When there were issues previously, the former minister brought in the army,” said Labour Party leader Alan Kelly. There was an opportunity to address staffing in the summer but it had apparently been missed, he said. “I think the effectiveness of the tracing system is in serious doubt.”

He added: “The Taoiseach keeps referring to the turnaround time for tracing as being 2.2 days but that is not the case in the community where it takes 4.1 days.”

And so, with accumulating delays and an ever-growing workload, the HSE was forced to throw in the towel last weekend, advising the infected to themselves take on the task of informing others.

Ironically, this might actually be ideal. Instead of a behemoth like the HSE taking on the task of tracing someone’s contacts, that person themselves, if not extraordinarily sick, is undoubtedly best placed to identify and inform his or her associates (and to bypass non-disclosure bureaucracy by ‘fessing up themselves).

Of course it may involve admitting they are sick, which is personal information, but there is surely no shame in ‘admitting’ to being hit by a virus that has demonstrated its capacity to strike anyone in the world.

A belt-and-braces approach, including encouraging the individual to reach out, is surely best. The HSE is not best fit to take on the task alone, not with confidentiality tying one hand behind its back.

As Dr Tony Holohan has commented in a related context: “The Government can’t wash your hands for you.”

And the tracing service could do with coming forward itself and making disclosures. Few know who they are, how they work, or how the underlying metrics may have changed.

TDs are belatedly demanding to know that detail, just as those traced cry out for further information themselves. Greater openness just might be the key to a higher level of public cooperation.

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