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

Abstract

The efforts to contain SARS-CoV-2 and reduce the impact of COVID-19 have been supported by Test, Trace and Isolate (TTI) systems in many settings, including the United Kingdom. The mathematical models underlying policy decisions about TTI make assumptions about behaviour in the context of a rapidly unfolding and changeable emergency. This study investigates the reported behaviours of UK citizens in July 2021, assesses them against how a set of TTI processes are conceptualised and represented in models and then interprets the findings with modellers who have been contributing evidence to TTI policy. We report on 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. The study demonstrates the potential of input from members of the public to benefit the modelling process, from guiding the choice 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. 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

“…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.…”

“…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 Policy makers also do not always engage with or understand the process underlying the modelling results they choose to base policy on.…”

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

“…36 50 On the other hand, uncoordinated and inefficient communication during isolation caused frustration. 25 Logistics of isolation: convenience and practical challenges 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 apartments 52 or when households included vulnerable family members.…”

“…56 Negative publicity may have undermined trust in testing processes and, in turn, willingness to isolate. 52 'Several of those interviewed were concerned about reports of accuracy, concerning the LFDs [lateral flow devices]. There was a particular concern about false-positive tests and its potential to reduce their already fragile workforce in the event that they ended up having to send "non-infectious" employees home to self-isolate because of faulty test results.'…”

Indicators of recent COVID-19 infection status: findings from a large occupational cohort of staff and postgraduate research students from a UK university

“…people who had more severe symptoms will have been more likely to be tested), and that can incorporate bias or lead to a lack of generalisability of results [46]. While this is most relevant for infections in the first wave when testing in the UK was severely limited, accessibility of testing may be limited and likely skewed at times of greatest infection and in places with poorer infrastructure or where there are low levels of trust in the authorities [29]. Also notable is that while antibody testing gives an objective outcome, timing is important, and accuracy may be an issue depending on how it was used; in our study likely leading to an underestimate of cases.…”