Government data collected since mid-June shows that only 11 per cent of people told to self-isolate by Covid-19 contact tracers actually do so for the full 14-day period. Although the Department of Health and Social Care (DHSC) has been aware of the survey data for months, it was only made public in the form of a non-peer-reviewed academic paper published online on September 18.
The study into the tracing system was commissioned by DHSC and the data was then analysed by members of the Sage advisory group. Susan Michie, a member of Sage and a co-author of the study, confirmed that DHSC had access to the data throughout the period the surveys were conducted. She also confirmed that officials had requested that the publication of the data be delayed until August.
The survey, which has been conducted either weekly or fortnightly since February with new questions added as contact tracing went live, found that only 18 per cent of people with symptoms self-isolated. It also found that just 11 per cent of those told to self-isolate by NHS Test and Trace after coming into contact with a confirmed Covid-19 case did so. While the data has not passed peer-review and should be read with caution, the research provides the first snapshot of how many people are following self-isolation guidelines.
The low adherence to self-isolation may go some way towards explaining why the UK is currently experiencing a sharp rise in cases, experts say, despite the work of thousands of contact tracers trying to slow transmission.
In recent weeks, government ministers have repeatedly insisted that NHS Test and Trace has been a success, even though they have had access to data showing that nearly 90 per cent of people did not self-isolate after being told to do so. On June 24, prime minister Boris Johson told parliament that contact tracers had reached “87,000 people who have voluntarily agreed to self-isolate to stop the virus from spreading.” Data from that same week suggests that just 13.6 per cent of people surveyed had self-isolated after being contacted by NHS Test and Trace telling them to not leave their homes under any circumstances.
In their research, the preprint authors explain that those who reported breaking their 14-day self-isolation gave a variety of reasons for doing so. These included caring for a vulnerable person (9.9 per cent), going to work (8.9 per cent) and thinking they had already had coronavirus and were immune (10.4 per cent). A total of 405 people told to self-isolate took part in the study, with roughly 60 responding in each weekly or fortnightly survey.
“Those results are worrying,” says James Rubin, co-author of the preprint and reader in the psychology of emerging health risks at King’s College London. He says the government could be doing more to encourage people to self-isolate when they are told to do so. “People need to understand what’s going on with self-isolation, why are we asking people to self-isolate, why does it help,” he says. He adds that providing more emotional and financial support to those who may find it particularly difficult to self-isolate could go a long way to helping them adhere to the full 14-day period. The good news, he says, is that generally people did have the right intentions, with nearly 70 per cent saying they planned to self-isolate as directed.
Although the data on the non-compliance with the self-isolation rules has been available to officials since mid-June, a new package to support those on low incomes who are asked to self-isolate was only announced by the government last week. It will provide a payment of £500 to such people who have lost income as a result of self-isolating. Fines for those breaching guidelines were also announced, starting at £1,000 but rising to up to £10,000 for repeat offences and “the most egregious breaches”, including those that prevent others from self-isolating.
Rubin and his colleagues provided other periodic assessments of the data, besides the analysis in their preprint, to the DHSC during the summer. Rubin says that he does think these analyses have influenced policy but argues more could be done.
Martin Hibberd, at the London School of Hygiene and Tropical Medicine, agrees. Government policies and messaging around self-isolation have remained largely the same in recent months, he argues. “There hasn’t been much change and I think there should have been,” he says. “The way to save the economy and save the people together, is by making this work.” He questions the effectiveness of fines, for instance, and suggests we need “carrots rather than sticks”.
A DHSC spokesperson says that the data analysed in the Sage study had “informed various policy decisions throughout the pandemic” including the aforementioned fines and the payment of £500 for people on lower incomes who are asked to self-isolate. Both of those policies will be in place from September 28, although the self-isolation payment has already been trialled on a limited basis in northwest England.
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