Public Health Experts: COVID Contact Tracing Takes a Community
Contact tracing, along with fast-turnaround testing and, where required, quarantining, are seen as the most effective ways of stopping the spread of the novel coronavirus.
While digital contact tracing via apps and other tools is considered a valuable supplement to fighting the pandemic, experts note it is no replacement for old-fashioned legwork, dedication and commitment to community service.
In short, public health officials emphasize, an effective, community-based contact tracing regime requires a village.
Anand Parekh, chief medical advisor for the Bipartisan Policy Center and a former deputy secretary for health at the U.S. Department of Health and Human Services (HHS), notes that contact tracing schemes in Singapore, South Korea and Taiwan made effective use of digital contact tracing. For example, Singapore deployed a tracing app that created a log of smartphone and Bluetooth signals that could be imported into the app.
But concerns about how private data was handled persist, Parekh acknowledged, and a U.S. contact tracing regime must also address issues like decentralized data storage.
Data gathered by contract tracing are used to alert individuals who may have been infected. A widely used metric for potential infections is contact within six feet without a mask for between 10 and 15 minutes. Contact tracers then notify those who might be infected to determine who they came on contact with. Those persons are then notified and tested.
Even with digital tools, Parekh estimates the U.S. will nevertheless require as many as 300,000 human contact tracers. Germany, which was hit hard by a south-to-north wave of infections near the end of the alpine skiing season in March, deployed about five contact tracers per 20,000 individuals. Germany’s population is about 83 million.
Germany aggressive testing scheme, quick-turnaround for reporting test results and overall effective public health and pandemic planning helped limit COVID-related deaths there to about 7,800 as of May 13, according to the Johns Hopkins Coronavirus Resource Center.
Still, Parekh says, “There is no one-size-fits-all plan” for easing restrictions like social distancing and “respiratory etiquette.”
Other public health officials agree, noting for example that Germany lacks the huge coastal population centers of the U.S., prime sites for the spread of the coronavirus. Particularly hard hit are poor, inner city neighborhoods, notes KJ Seung, an infectious disease specialist and strategy chief for the Massachusetts COVID response.
“Contact tracking is not just an epidemiological exercise, not just a data collection exercise. You have to think about the downstream activities,” says Seung, who also works with the commonwealth’s Partners in Health program to jumpstart its Community Tracing Collaborative.
Massachusetts is perhaps four to six weeks ahead of other states in rolling out a contact tracing plan. Unfortunately, Seung adds, that is not very far down the learning curve when compared to Asian nations and Germany.
Seung called Germany's ability to deliver test results to essential personnel in two hours and to the general population in eight hours “really impressive,” particularly since the turnaround in the U.S. is closer to five days.
The Massachusetts effort focuses on connecting human contact tracers armed with digital tools to local institutions like pubic health departments. Those neighborhood-level agencies are the equivalent of databases of local knowledge, language skills and a key attribute that Seung called “priceless,” namely, name recognition.
Massachusetts has so far enlisted more than 2,000 human contract tracers. “It’s about providing high-quality services,” including finding ways to isolate and quarantine the infected in poor neighborhoods along with food and medicine deliveries for the isolated and referrals and child care for families hit by the coronavirus.
While U.S. testing is slowly ramping, Seung said it remains a “real bottleneck” that will hamper the effectiveness of contact tracing efforts. The cascade of testing, contacting and quarantining “has to happen very rapidly,” he said “Are you testing the right people? When do you get test results back?”
Speed is paramount, and so is follow-up. Public health experts note that contact tracers cannot simply provide a referral and a hotline number. “You need someone to run that gauntlet,” Seung said, following up with public health agencies to get a potentially infected person isolated given how fast COVID-19 spreads.
Ultimately, concludes former HHS official Parekh, contact tracers “are part of team collecting and analyzing data. Reliability and sense of service and dedication” are critical.