Why contact tracing isn’t the COVID solution we’ve been waiting for

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The cost of doing too little

Underinvestment in contact tracing can do more than just leave some people hanging. Much of the data city officials cited to inform their process of new targeted shutdown efforts came from information gathered during case investigation interviews — but with so few positive cases reached by tracers, collected data may have created an incomplete picture on which to base these closures.

On October 20, for example, the Commissioner of Health, Dr Farley, reported that the number of positive cases surveyed who said they had entered an office had increased by around 10%, prompting him to recall people to work from home whenever possible. But with data derived from such a small fraction of cases, it’s hard to know whether these trends reflect actual transmission patterns.

It can also undermine trust in government if tracers are not equipped with tools to enable them to provide real support. When contact tracing was used for other illnesses, such as syphilis or tuberculosis, there was an incentive to participate, said Bruce Davidson, who worked as a tuberculosis czar in Philadelphia in the 1990s. In these cases, he said, tracers had something to offer the patient.

“You meet the person confidentially, and you say, ‘Look, I’m going to test you, at no cost, if you have this, I’m going to cure you, at no cost, and if you have this, I’m going to test the people that you have.know…and get them to safety,” said Davidson, who is a pulmonologist now based in Washington state.

“So everyone we contacted for TB, they said, what is there to lose? For this disease, all you can say is that you must quarantine yourself for 10 days. And everyone you know and have been around has [to] too much.”

The mall on the campus of Penn State University Park. The school has seen a spike in the drop in coronavirus cases. (Min Xian/WPSU)

Case managers, not just case monitors

A contact tracer in the Philadelphia area, whose identity WHYY News agreed not to reveal because they weren’t authorized to do interviews, said the number of cases had recently skyrocketed. In the summer, their team would have a meeting before a shift started, and sometimes the boss would say he hadn’t had many new cases, so most of the calls would be contacts or follow-ups. These meetings have since ceased because there are so many calls to be made.

“We used to start calling at 9 a.m. and stop calling at 8 p.m., and now we start calling at 8 a.m. and finish calling at 9 p.m.,” said the tracer. “I’ve certainly worked into the evening, and I’ve never had a situation where I didn’t have a case to work lately… I rarely hear anything lately about, ‘Oh, we’ve ended.'”

Calls can sometimes be difficult, for example when the contact tracer is the first to tell people that they most likely have COVID-19.

“I’ve definitely had people who needed a moment after learning they were positive, to digest and deal with it: people practically crying on the phone, or even people crying on the phone, realizing that ‘they’ exposed friends or family members who could get sick,” the worker said.

In addition to contacting people who may have contracted the virus from someone who tested positive, contact tracers can be essential resources for people who need to quarantine but need help with groceries or rent, mental health support, or an official letter from the state to show their employer why they need to stay home.

Contact tracers also sometimes work as case managers, said Kailee Leingang, a contact tracer for the North Dakota Department of Health and a nursing student.

“You are the person they call before going to the hospital to try to find out if they should go. Often it was me who told them: ‘You have to go to the hospital, call at advance, tell them you have COVID 19,” she said.

Philadelphia resident Matt Katz tested positive for COVID-19 and had to isolate himself from his family (left to right) son Reuben, daughter Sadie and wife Deborah Hurwitz Katz. (Emma Lee/WHY)

At the moment, she is managing about 50 cases. Like Philadelphia, the number of cases in North Dakota has increased so much recently that as of last month, she and other contact tracers are no longer calling people who may have been in contact with people who tested positive.

“It’s scary, because it puts a lot of responsibility on this positive case,” she said.

She worries about people who have symptoms so horrible they don’t want to make calls, or people who don’t want to tell their friends that they also need to quarantine.

Partly because of the support tracers offer in interactions like these, epidemiologist Emily Gurley has argued that it would be much worse if contact tracing stopped altogether.

“We must always remember: even if the cases increase, it does not mean that it could not be worse; it could certainly be worse.

Gurley created a free online course and helped develop tools for public health officials and people running contact tracing programs to learn how to estimate the impact of their programs and how to improve them.

In Philadelphia, Katz understands that health departments are strapped for money and cases are rising, but for him it’s about trusting leaders to keep their word and keep people safe, which includes investing in public health and contact tracing.

“It’s not trivial, but we’re all in this together,” he said. “Individuals have to wear masks in public places, and the government is part of that bargain – they have to do what they’re supposed to do.”

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