Public perceptions and interactions with UK COVID-19 Test, Trace and Isolate policies, and implications for pandemic infectious disease modelling

Abstract

Background The efforts to contain SARS-CoV-2 and reduce the impact of the COVID-19 pandemic have been supported by Test, Trace and Isolate (TTI) systems in many settings, including the United Kingdom. Mathematical models of transmission and TTI interventions, used to inform design and policy choices, make assumptions about the public’s behaviour in the context of a rapidly unfolding and changeable emergency. This study investigates public perceptions and interactions with UK TTI policy in July 2021, assesses them against how TTI processes are conceptualised and represented in models, and then interprets the findings with modellers who have been contributing evidence to TTI policy. Methods 20 members of the public recruited via social media were interviewed for one hour about their perceptions and interactions with the UK TTI system. Thematic analysis identified key themes, which were then presented back to a workshop of pandemic infectious disease modellers who assessed these findings against assumptions made in TTI intervention modelling. Workshop members co-drafted this report. Results Themes included education about SARS-CoV-2, perceived risks, trust, mental health and practical concerns. Findings covered testing practices, including the uses of and trust in different types of testing, and the challenges of testing and isolating faced by different demographic groups. This information was judged as consequential to the modelling process, from guiding the selection of research questions, influencing choice of model structure, informing parameter ranges and validating or challenging assumptions, to highlighting where model assumptions are reasonable or where their poor reflection of practice might lead to uninformative results. Conclusions We conclude that deeper engagement with members of the public should be integrated at regular stages of public health intervention modelling.

Role of mathematical modelling in future pandemic response policy

“…The structure of the model and its input parameters are continuously refined in light of the latest evidence and understanding about the dynamics of the disease and its spread. Perhaps the biggest threat to the usefulness of the models is when important information or knowledge relating to the dynamics is held by experts who are not connected to the modelling community, including the public 27. The modelling related to care homes during the covid-19 pandemic represents perhaps the most important cautionary tale.…”

“…That said, communication must also involve listening—and different people listen differently and from different perspectives. An analysis of public perceptions of UK Test and Trace and its implications for disease modelling concludes that modellers having better understanding of public perceptions of Test and Trace could have changed the structure and parameter ranges of the models for the better 27. Meanwhile, policy makers might use modelling results to support pre-existing policy goals—a kind of policy based evidence selection rather than true evidence based policy 42.…”

Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review

“…People described various practical challenges to following isolation guidance to the letter,51 including limited access to testing,24 unsafe or unsuitable home environments, managing childcare and caring responsibilities,52 the difficulty of managing multiple positive cases or mixed results within a single household,26 53 and avoiding other household members becoming sick 22 43 51. These challenges were magnified in smaller houses and apartments52 or when households included vulnerable family members 29. Ultimately, it appeared that combinations of these challenges heightened barriers to effective isolation 26…”

“…However, this deference to authority decreased over time,54 and distrust in the government was described as a barrier to self-isolation 24. Disagreement with government measures,17 mistrust regarding the accuracy of the NHS COVID-19 app and proximity alerts,22 52 55 and concern over secure handling of details by NHSTT seemed to be associated with lower adherence to self-isolation guidance 17. A lack of trust in test results undermined engagement with isolation; the negative consequences of isolation (outlined below) were considered an unacceptable burden if the requirement to self-isolate might be ‘unnecessary’ if based on a false-positive result.…”

Public awareness of and opinions on the use of mathematical transmission modelling to inform public health policy in the United Kingdom

“…Much of the research into public opinions throughout the COVID-19 pandemic has related to vaccine hesitancy [7][8][9] or adherence to public health and social measures [10][11][12][13]. Although Marshall et al [14] interviewed members of the public regarding Test, Trace and Isolate policies with a view to improving assumptions underpinning mathematical modelling, respondents were not explicitly asked about their perceptions of modelling.…”