SALT LAKE CITY — Public health officials say contact tracing will become increasingly important as routines become more normal and the world reopens in the midst of the novel coronavirus pandemic.
The process will be harder and communities will need to invest in hiring, training and deploying more people to identify those directly exposed to COVID-19, then teach them how to protect others and stop the virus’ spread by going into quarantine. That’s contact tracing in a nutshell.
“It’s critical to have these capacities in place, especially now that we are starting to open up. Without population-level social distancing measures, then we don’t have really another tool to control the threat,” said Dr. Crystal Watson, a senior scholar at Johns Hopkins University’s Center for Health Security and lead author of a report recommending Congress allocate $3.6 billion to contact tracing and related disease-control efforts.
More than 20 states are seeing a rise in cases, The Washington Post reported this week, including Arizona, Texas and Florida. Utah’s cases have increased, too. “We are in the acceleration phase,” Utah state epidemiologist Dr. Angela Dunn recently warned.
“As we restart society, we are going to have more and more risk. The importance of quickly identifying, isolating and alerting people about potential exposures is so vital to the reopening plan,” said Ilene Risk, Epidemiology Bureau manager in the Salt Lake County Health Department.
Contact tracing is what the name suggests: When a COVID-19 test comes back positive, public health staff get a list of people who might have been exposed — those who spent 15 minutes or more within 6 feet of an infected individual going back at least two days before symptom onset. Tracers then ask those contacts to quarantine for 14 days to curtail disease spread.
Close contacts who show symptoms are encouraged to be tested and, if positive, provide a list of their own close contacts, Risk said.
It is a labor-intensive practice that allows public health officials to find the disease early and slow or stop spread, she said.
Great need everywhere
Nationally, contact tracing is gaining momentum, including a push on the Centers for Disease Control and Prevention website to train more people for the job. CDC sees contact tracing as vital so states can ease restrictions. But while it offers guidance on exposure, CDC leaves the design of programs up to states.
In April, the report by Watson and other experts at Johns Hopkins University and the Association of State and Territorial Health Officials said Congress should allocate $3.6 billion to boost contact tracing and COVID-19 surveillance nationwide. That would cover hiring 100,000 new contact tracers.
The New Yorker recently reported that along with a push for better testing, more effective treatment and developing a vaccine, 44 states are planning to hire enough contact tracers to monitor outbreaks themselves.
States like Utah that weren’t so hard-hit by COVID-19 have been able to develop robust contact tracing programs, usually on the county level. States like New York that were overwhelmed with COVID-19 early on have just begun to ramp up efforts, Risk said.
As malls and schools and businesses reopen, people will be in closer contact than they’ve typically been recently. The volume of COVID-19 cases and the number of potential contacts an infected person has are likely to grow. Crowds gather for lots of reasons, the risk of exposure rising on both busy beaches and protest sites. People who choose to be part of a crowd can protect others by quarantining afterward, as if they were exposed to the virus, Watson said.
People who have been exposed to COVID-19 are asked by contact tracers to quarantine for 14 full days because the COVID-19 tests may not be sensitive enough to consistently detect the virus in different parts of the incubation period.
“You may test negative even if you are infected, especially early on in the infection,” she said. Someone with a false negative can go out and infect others.
Making it work
The Salt Lake County Health Department started contact tracing as soon as the virus started circulating in the area, even redeploying workers who had other jobs. When in-person dining wasn’t barred, for instance, restaurant inspectors joined the effort to contain the spread of COVID-19. So did clean air and water experts, among others.
Some people who’ve been temporarily reassigned to contact tracing may need to go back to their regular jobs, Risk said, but the department is likely to seek a balance so it can continue to help trace contacts, too.
Salt Lake County Health is also trying to align contact tracing within its different communities. “Can we hire community health workers who can champion the issue for their community? We are trying to engage the population as much as possible,” so people can find the resources they need in familiar places and get information from those they already trust, Risk said, “instead of in a tent in the middle of a parking lot somewhere else.”
Partners in Health in Massachusetts said an overlooked and underdiscussed issue with contact tracing is making it possible for people to actually quarantine for 14 days. Some don’t have a place to do it, while others may need help to get supplies, like food or medicine. That’s a separate job or an expansion on contact tracing, but one that’s vital.
America has a lot of COVID-19 circulating and it will take a very hard contact tracing push to eliminate the virus here, Watson said. Even so, “it can still make an enormous difference that can save potentially thousands and thousands of lives by doing this and it doesn’t have to be perfect in order to make that difference.”
Man or machine?
Technology may play an expanded role. Several apps are being developed to help with contact tracing, but it’s too soon to say how well they will work. Even effective ones are unlikely to replace human contact tracing, Watson and Risk said. Humans can answer questions and offer advice.
That’s very important, said Watson. “This is a really sensitive time in people’s lives if they are sick or if they’ve been exposed to the virus. You need some human empathy, so having contact tracers who can try to understand people’s situations and provide them both the moral support as well as actual physical support for doing what’s best to reduce the spread makes a difference.”
She said apps that tell someone they’ve come within a certain distance of someone with illness have not been used before. So public health officials and the individuals who might opt to use them are still trying to understand how effective they are and what harms or benefits they might offer.
“We are still trying to get the balance right here with the digital technologies and how it can support public health as well as protect people’s privacy and identity,” said Watson.
In the meantime, If public health calls, pick up the phone.
“Until we have a safe and effective vaccine, I think this is the best tool we have and it can make a real difference,” Watson said.