Surge testing in Bristol and South Gloucestershire

Surge testing started in parts of Bristol and South Gloucestershire in February after 11 cases of the UK variant with E484K mutation were identified as part of routine sampling.

This is part of a series of case-studies published on the 18 March 2021

Key steps 

  • Scale of surge testing meant door-to-door could not be the main approach, but network of collect-and-drop sites was very effective in supporting mobile testing units 
  • Outreach undertaken with an asylum seeker hostel, homeless services and in underrepresented communities, building on existing networks and community groups  
  • Those in receipt of social care or deemed most likely to have problems accessing testing by themselves were contacted directly 

What was done?

Surge testing started in parts of Bristol and South Gloucestershire on Sunday 7 February after 11 cases of the UK variant with E484K mutation were identified as part of routine sampling. It lasted two weeks. 

In total the areas involved covered 24 postcode districts – home to around 150,000 people, in Bristol and South Gloucestershire. The two local authorities worked closely together, supported throughout by Public Health England. 

Over 40,000 tests were carried out in the two-week period. Less than 1 per cent of which was found to be positive for COVID-19. All positive cases from pillar two and asymptomatic surge testing during this period were sent for genomic sequencing.

How was it done?

Bristol Director of Public Health Christina Gray said: “There was very little notice. The announcement came in at about 3pm on the Friday afternoon and by 5pm we were having an emergency meeting and the testing went live on the Sunday morning from the first three Mobile Testing Units.

What surprised us most was the public response. At 9.30pm on Saturday night we posted information about the testing sites and by 9am on Sunday morning there were queues.

“We spent Saturday working to get all processes stood up. We selected postcode areas defined by the first four digits because of the number of cases we had. They were quite spread out and if we had done it just by the first three digits like other areas had, it would have been too wide.”

Within days there were six mobile testing units set up and operated by the Department of Health and Social Care, three in Bristol and three in South Gloucestershire. In the first few days of the programme some of the sites were doing 1,000 tests a day.

By the middle of the week, a network of collect-and-drop facilities were also in action. There were six in Bristol, mostly at libraries, and seven in South Gloucestershire, a mix of libraries and community centres.

Ms Gray said: “They were very popular. We had more tests done via the collect-and-drop route than the mobile testing units. People were able to pick up tests for their neighbours and families. We also wrote to all those who are receiving social care to inform them of this facility. It was really convenient.”

Those who could not access collect-and-drop could arrange to have tests delivered to their home.

Sara Blackmore, Director of Public Health for South Gloucestershire added: “Developing this comprehensive outreach offer alongside the established testing facilities wouldn’t have been possible without the support of our networks of incredible community groups and community health partners.

“We used existing lists to identify people who were more likely to be vulnerable or find it hardest to access a test, and wrote to these people directly, asking if they would like to have one. More than 1,100 tests were delivered directly and then picked up again from people’s homes in this way.”

What was learnt?

Ms Gray said it took an enormous amount of effort from all parts of the council, working closely with PHE and partners, to get the systems up and running so quickly:“We called on mutual aid from a range of partners. Given the size of the area, we knew we could not go door-to-door like other local authorities had, which was why it was so important to get the collect-and-drop and the community outreach right.  
“We used libraries to do collect-and-drop and worked together with the library service to identify the most suitable locations. They had done the work to become Covid-secure for collect-and-drop for books so could easily be repurposed for this. The librarians were just wonderfully responsive and efficient - the libraries were known and trusted locations in our communities.” 
Businesses and schools in the area were encouraged to use the service, but there was also an asylum seeker hostel and services for homeless people in the area that needed a more bespoke approach and staff went out to these locations to explain the importance of the testing.  
Ms Gray said: This specific outreach work was undertaken in partnership with our homeless services, asylum and refugee health services, Public Health England and voluntary sector colleagues.    
“Having the pre-existing relationships is vital. Just introducing a Mobile Testing Unit requires work. You need input from traffic services, you need toilets, you need a suitable location, you need marshals.  
Ms Blackmore said: “Our communications cell was brilliant, working across the three organisations and with the Local Resilience Forum. Communication was key, and our joint communications cell managed traditional media, including local and regional outlets and managed queries from all the major broadcasters, as well as targeted social media.  
“Clear messages were crafted, FAQs produced and websites were updated as the programme evolved. Officers managed multiple direct queries, helping to manage public anxiety. Briefings were arranged for local councillors, MPs and our local engagement board.  
“An intense response like this requires everyone to pull together efficiently and quickly.”  
Both Ms Gray and Ms Blackmore said the exercise proved to be reassuring - the low positivity rate confirmed that there was not a “reservoir” of infection in our communities that was not being spotted or contained.   
However, the delay in receiving the full genomic sequencing back quickly means that the councils have not yet been able to let our residents know the full, final outcome of the exercise.  
“It is important that we keep public confidence. There was such extraordinary support for this exercise, but if it has to be repeated too often and we can’t feed back the results, we may start to lose this,” added Ms Gray.

Contact details

Christina Gray 
Director for Communities and Public Health 
Bristol City Council 

Sara Blackmore 
Director of Public Health 
South Gloucestershire Council