Test, Trace, Protect

Test, Trace, Protect was Wales's strategy to reduce the spread of COVID-19, based on the classic public health triad of testing, contact tracing, and support for isolation. It was launched on 13 May 2020, shortly after the first UK lockdown began to ease, and was designed to be a 'test, trace, protect' programme that would allow targeted interventions rather than blanket restrictions.

The programme had three pillars: testing for the virus, tracing of contacts of positive cases, and protecting by providing practical and financial support to those asked to self-isolate. Unlike the centralised approach in England, TTP was delivered through a partnership between the Welsh Government, local health boards, and local authorities, with a network of contact tracing teams based in each region.

Testing was initially conducted through drive-through centres and mobile units, with results typically available within 24 hours. Contact tracing was performed by trained call handlers who reached out to positive cases to identify close contacts, who were then asked to self-isolate for 14 days (later reduced to 10). The programme aimed to contact at least 80% of positive cases within 24 hours and 80% of their contacts within 48 hours.

To support self-isolation, the Welsh Government introduced a £500 payment for those on low incomes who could not work from home, and provided practical help such as food deliveries and medication collection. This 'protect' element was considered crucial to encourage compliance, as evidence showed that financial hardship was a major barrier to isolating.

Studies evaluating TTP found that it contributed to reducing transmission, though its impact was limited by the speed of test results and the proportion of contacts reached. A study published in Public Health in Practice estimated that TTP prevented a significant number of cases during the summer of 2020, but its effectiveness waned during the second wave when case numbers overwhelmed the system.¹

Independent reviews noted that TTP was more locally integrated than England's NHS Test and Trace, and that the support payments improved adherence to isolation. However, challenges included delays in testing, low uptake of the app, and the difficulty of tracing contacts in crowded settings.²

One lesser-known aspect is the use of 'community testing' pilots in areas with high prevalence, which offered rapid lateral flow tests to asymptomatic people. Another is the role of environmental health officers in tracing outbreaks in workplaces and care homes, which went beyond the standard call-centre model.

Wales also developed its own contact tracing app, the 'NHS COVID-19 app' was used across the UK, but Wales was the first to integrate it with the TTP system, allowing users to receive alerts and advice directly from local teams. Additionally, TTP included a 'digital triage' system that used online forms to prioritise calls, and a dedicated team for schools to manage outbreaks among children.

TTP was praised for its collaborative approach, but it also faced criticism. Some argued that the £500 payment was insufficient and that the programme was underfunded relative to the scale of the pandemic. Others pointed to the lack of a clear exit strategy and the difficulty of maintaining public trust as restrictions evolved.²

After the pandemic, the Welsh Government published a review of TTP, which highlighted lessons for future public health emergencies, including the need for robust data systems and flexible workforce capacity. The programme was officially wound down in 2022, but its legacy influenced the design of the UK's response to subsequent outbreaks, such as monkeypox.

Contact tracing

The process of identifying and notifying individuals who have been in close contact with a confirmed case of an infectious disease.

Self-isolation

The act of staying at home and avoiding contact with others to prevent the spread of a contagious illness.

Lateral flow test

A rapid diagnostic test that detects the presence of viral antigens, often used for mass screening.

NHS COVID-19 app

A smartphone app used in the UK for contact tracing and exposure notifications during the pandemic.