As Delta grows, contact tracing takes center stage COVID

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August 31, 2021 – As the pandemic raged last year, Ilish Pérez, a contact tracer and case investigator for the Los Angeles County Department of Public Health, often contacted more than 100 people a day. She would tell people about their positive COVID test result and tell others that they had been exposed to COVID.

“Our shifts were typically 8 hours long,” says Pérez, an experienced health educator who worked on HIV and other sexually transmitted diseases before being transferred to the COVID-19 effort. But “sometimes we worked overtime. At the end of the day, I was exhausted not only physically, but also mentally. All the emotions you go through on each different call can be quite exhausting. downtime between calls to reset your mind. “

Once vaccines became available and new cases slowed down, his call list grew shorter. Just a few months ago, she sometimes only had 10 contacts a day to reach.

But now, with the Delta variant triggering a dramatic increase in cases, Pérez and other public health officials and nationwide officials involved in contact tracing have prepared.

While contact tracing – the process of identifying people potentially exposed to an infected person and advising them to quarantine and test – has been left out in recent months to pandemic control plans, experts say it’s time to step it up again.

It’s also time, some say, for smarter contact tracing. This means merging it with screening and vaccination efforts.

Public perception of contact tracing may also need to change.

“Contact tracing is more than getting a hold of someone and telling them to quarantine themselves,” says True Beck, COVID-19 response manager for the Los County Department of Public Health. Angeles. Ideally, she says, it starts with a call from a compassionate person who is able to personalize the advice.

“Anyone can google ‘What if I’m positive for COVID,’” says Beck. An effective contact tracer will go way beyond that. For example, she says, “Our contact tracing agents will ask, ‘Do you live in a one-bedroom apartment? They also connect people to services. And now, of course, contact tracers should help people get vaccinated, she says.

Contact follow-up, well done

Many other countries have beaten the United States over infectious disease contact tracing, says KJ Seung, MD, senior health and policy adviser for Partners in Health, a global nonprofit health organization involved in COVID-19 efforts.

This is partly because these countries have more practice, he says, as they frequently track down tuberculosis and Ebola, for example. Even so, the current US contact tracing protocol is outdated, he says.

“It is clear that we are going to have contact follow-up in the future,” he said. “But we have to do it smarter than before,” says Seung, also an assistant professor of global health and social medicine at Harvard Medical School.

One way is to stop “silos” testing, tracing, and vaccination into three separate measures and integrating them instead, like Seung and Natalie Dean, PhD, assistant professor of biostatistics and bioinformatics at Emory University from Atlanta, wrote recently in New statistics.

While the call of a contact tracer covers a lot of ground, like if and when people need to be tested or quarantined, it’s also a perfect opportunity to suggest getting the shot right away, Seung argue. and Dean. “Linking testing and tracing to vaccination may seem obvious,” the two write, “but the reality is it is not happening nationally”.

In an interview with WebMD, Seung said public health officials should consider another CDC-recognized contact tracing approach. This is called the source investigation, and it involves examining the movements of patients 14 days before the onset of symptoms and identifying interactions with people, places and events that may have been at. the origin of the infection.

“Instead of trying to find out who [the infected person] may have been infected within the past 48 hours, “he says, the question is” Where do you think you got infected? Camp? Nursery? A bar?”

Benjamin J. Ryan, PhD, an environmental health specialist and clinical associate professor of environmental health sciences at Baylor University in Waco, Texas, knows that contact tracing is important. But, he says, it can be particularly difficult to identify everyone who may have been exposed.

One solution, he suggests, is to use Bluetooth devices and advanced data analytics. Participants would wear the device as a condition of entry to an event or facility. It would identify other people approaching within 6 feet of another person for a total of 15 minutes of contact. The device would deactivate once people left the area. Then, if attendees later tested positive, the venue could give public health officials a limited list of close contacts, rather than the list of the thousands in attendance.

Understand the culture, linguistic differences

“Contact tracing is fundamentally a trust-building exercise,” says Emily Henke, executive director of the Oregon Public Health Institute (OPHI). She is also the director of the local office of Tracing Health, a partnership between OPHI and the Public Health Institute that focuses on promoting health equity.

It is difficult to build that trust if the contact tracer does not understand the language or culture of the person they are calling.

The Tracing Health approach, says Henke, is about matching their 293 contact tracers, culturally and linguistically, with the people they call.

“We also see this as an investment in the economic recovery of communities of color,” she said, with 72% of her workforce being black, indigenous or of color. The members of his team speak 52 languages.

“When you speak the same language as someone else and share their culture, you are better able to meet their needs,” says Vadim Gaynaliy, a contact tracer at Tracing Health who is fluent in Russian and english.

Without needing an interpreter, he more easily earns the trust of the people he calls, he says.

Efforts to speed up contact tracing

Approaches to contact tracing vary by state. Some states have their own employees who do this, others contract it out, and some states partner with other organizations.

With the rise of the Delta variant, many states are redoubling their efforts.

In Arkansas, where the 7-day average number of cases rose from 173 at the end of May to more than 2,000 at the end of August, contact tracing is also on the rise.

“When the case volume was lower, the staffing was also changed to match the lower workload,” says Danyelle McNeill, spokesperson for the state’s health department. “Now that the volume of cases has increased, providers [that the state contracts with] are adding staff to meet the increasing workload. “

With funding being an issue for many public health efforts, partnering with universities may be a solution, says Ryan, the environmental health specialist. “Explore the universities and ask the universities to research the contacts in partnership with the county,” he says.

How many can contact tracing assistance?

“Any amount of contact tracing can help break chains of transmission,” says Amesh Adalja, MD, senior researcher at the Johns Hopkins Center for Health Security in Baltimore.

No expert would dispute this, but the lack of funding is a permanent obstacle, he says. “Public health infrastructure is something that has been underfunded and undervalued for decades,” he says, so it’s a surprise to many people who are struggling now.

Adalja laments the lack of cooperation at the start, when many phone calls from contact tracers went unanswered.

“It was likely the result of the privacy policy and conspiracy theories that were injected into the response early on,” he said.

Even though the Delta variant is more than twice as contagious as previous variants, according to the CDC, contact tracing can help reduce transmission, Ryan says.

Research on earlier variants found that good contact tracing could lead to a 3- to 4-fold reduction in the virus’s “reproduction number,” or the number of secondary infections, according to Ryan. So he would expect the same reduction for Delta, but of course the overall reduction in drivetrain wouldn’t be as large.

“Remember we are not going to [a goal of] zero COVID. We are trying to remove the level among the unvaccinated. “

Enough exhaustion to go around

Contact tracers aren’t the only ones running out, says Henke. Many of the people his contact tracers call are too.

“They are exhausted and overwhelmed,” she said. “It definitely affects the vibe they bring to those phone calls.”

Even so, says Henke, “What makes a good contact tracer is someone who can be there for that person and move the conversation forward, to help them understand that there are supports for the contact. to help.”

Pérez, the LA County contact tracer, sees some progress over last year.

“I feel people are more willing to help,” she said

It’s a welcome relief from his experience last year, when family members sometimes urged COVID-positive patients to hang up and stop giving him the information requested. She also feels less stigma.

“They are more comfortable telling their contacts themselves,” she says.

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