The Central Contact Tracing Team (CCTT) was established on 12 March 2020 in response to an increasing COVID-19 caseload with a corresponding increase in casual and close contacts. CCTT supplemented the capacity of public health units to contact trace and provide isolation instructions. The team grew from zero to around 100 staff within several days. CCTT staff were initially drawn from skilled public health teams in the NSW Ministry of Health, such as communicable diseases, environmental health, sexual health, population health, and alcohol and other drugs, along with Biostatistics Trainees. Biostatistics Trainees later formed the initial data team who, among other functions, developed key data capture tools for use by tracers.
Over the coming weeks, large intakes of surge staff – sometimes 30-40 at a time – were brought in, including tranches of personnel from the Australian Defence Force, airlines, and other NSW Government agencies. Interview scripting and development of brief, tailored training materials was required as most of these staff had no, or very little, public health experience, creating an urgency to ensure the delivery of consistent information, advice and support to contacts. Team leads and managers learned it was essential to allow staff, with their diverse skills, to freely contribute to problem solving.
The structure and functions of the team developed organically, borne out of necessity and constant problem solving. A fit-for-purpose structure was established, including a series of small teams or ‘pods’ with continuity across shifts and a dedicated team leader for each to provide appropriate oversight, escalation and up-to-date information flows. A leadership team was established to manage day-to-day operations and address novel and complex issues. The need for someone dedicated to, and with requisite skills for, bedding down processes, procedures and policy was recognised and actioned.
Offsite working models were trialed as there was concern about potential COVID-19 exposures in the workplace due to escalating case numbers at this time. The number of working contact tracers from each agency was also increased by utilising staff who resided outside the Sydney region. There was also an urgent need to find appropriate accommodation for hundreds of onsite staff working across multiple shifts. Safe distancing needed to be considered but so did the advantages of co-location for problem solving across teams.
The early technology set-up of CCTT was rudimentary with the small team using mobile phones and IT systems that were stretched to their limits. A move to cloud-based sharing platforms, Microsoft Teams and digital telephone systems rapidly and dramatically improved workflow efficiencies and collaboration. Briefings between CCTT and other Public Health Emergency Operations Centre teams two to three times per day became a key means of information sharing. Use of simple and highly visible techniques, such as prominent whiteboards for quick reference on twice daily updates and electronic screens displaying tracking of call numbers, proved useful to inform and incentivise CCTT staff.
Follow-up of contacts was initially done through the NSW Notifiable Conditions Information Management System (NCIMS) using daily surveys distributed via text message. These surveys collected basic data and enabled individuals in isolation/quarantine to flag health and welfare concerns. As the number of contacts increased, the capacity of NCIMS to continue follow-up was exceeded in late March 2020. A new digital solution (‘Whispir’) for the follow-up of contacts was piloted in May 2020 and embedded into CCTT follow-up processes.
Some early process and technology enhancements included:
Alex Willems1, Julie Letts1, Tove Fitzgerald2, Carolyn Murray2
