To defeat coronavirus, the U.S. needs an 'army' for contact tracing

Public health experts are warning that in order for the United States to keep people safe from the threat of the coronavirus, the country will need to raise an “army” of citizens to conduct contact tracing in order to identify who has been exposed to the virus.

“We need an army of 300,000 people,” Tom Frieden, a former director of the Centers for Disease Control and Prevention said in an interview with STAT.

What is contact tracing?

Contact tracing is one of three essential steps in a strategy proven effective in halting the spread of viral outbreaks around the world. It consists of interviewing every patient who tests positive for COVID-19, the disease caused by the coronavirus, to determine who they have come into contact with while infected. In conjunction with widespread testing for COVID-19 and the isolation of those who test positive, contact tracing is an essential step in locating individuals who may not realize they have also been infected because they have yet to manifest symptoms of COVID-19, and could be spreading the virus even further.

In 2014, guidance issued by the World Heath Organization during the Ebola outbreak in West Africa, contact tracing emerged as a vital tool in slowing the spread of that virus.

“Contact tracing is defined as the identification and follow-up of persons who may have come into contact with an infected person,” the publication stated.

How does contact tracing work?

Ramping up contact tracing means that new workers or volunteers will be needed to track the spread of the virus. That work consists of a mixture of at-home interviews, either on the telephone or in person and visits to supermarkets or other places of business where an infected person may have come into contact with others.

Because COVID-19 is believed to be spread by people before they show symptoms — or possibly if they never display them at all — establishing a complete list of all the locations a person has visited before being diagnosed with the virus is crucial to alerting others of their risk of exposure. This involves a fair amount of detective work.

“Although some information can be obtained from the patient, much of the information will come from the people around the patient,” the WHO said in its 2014 handbook on Ebola contact tracing.

In Michigan, where, as of Monday, nearly 32,000 people had tested positive for COVID-19, Gov. Gretchen Whitmer announced Monday that 2,000 volunteers had completed contact tracing training.

In San Francisco, just 10 people were employed to conduct contact tracing in the city prior to the coronavirus outbreak. Another 100 volunteers will now be utilized to bolster that effort, STAT reported.

“We are providing the people to make phone calls, we are working on standard scripts, we are working on IT solutions, training, and we are fielding teams of contact tracers,” George Rutherford, UCSF’s head of disease and global epidemiology, told STAT.

Follow-up is also an important part of contact tracing. In May, the North Carolina Division of Public Health, for instance, issued contact tracing instructions for non-healthcare settings stressing that symptoms should be monitored for two weeks for those who have come into contact with a person infected with COVID-19.

“Symptom monitoring should be conducted from the date of each person’s first contact with the case-patient continuing through 14 days after their last contact with the case-patient or for 14 days after the case patient’s isolation ends if in continued contact throughout their illness,” the guidelines state.

Can contact tracing be accomplished using an app?

Tech giants Google and Apple announced last week that they are teaming up on a cellphone app that will help people determine whether they have been exposed to COVID-19. For the system to be effective, however, it relies on users who have tested positive for the disease to enter that information into the app with an anonymous ID. Utilizing Bluetooth settings recently updated on iOS and Android phones, others who may have come in contact with an infected person are then notified via the app on their own phones.

While the app, which the companies say will be run by government health departments, poses questions about privacy, 300 academics signed a letter Monday stating that an app could be an effective tool in slowing the spread of COVID-19.

“Contact tracing is a well-understood tool to tackle epidemics, and has traditionally been done manually. In some situations, so-called ‘contact tracing apps’ on peoples’ smartphones may improve the effectiveness of the manual contact tracing technique,” the letter reads. “Though the effectiveness of contact tracing apps is controversial, we need to ensure that those implemented preserve the privacy of their users, thus safeguarding against many other issues, noting that such apps can otherwise be repurposed to enable unwarranted discrimination and surveillance.”

Countries like South Korea, which reported its first case of COVID-19 on Jan. 20, the same day that the first case was identified in the U.S., have utilized widespread testing along with cellphone tracking and alerts generated by smartphone apps that inform citizens when new cases are reported in their neighborhoods. South Koreans who test positive for COVID-19 are required to download smartphone apps that track their movement and fines are levied upon those who refuse.

While such requirements would likely never be implemented in the United States, Korea’s regulations have proven effective in stopping the coronavirus in its tracks.

As of Monday, South Korea, which has a population of 52 million, had reported 10,674 cases of COVID-19 and 236 deaths from it. By comparison, the U.S., which has a population of 328 million, has so far tallied over 778,176 cases of the virus and over 41,313 dead.

What if the U.S. fails to increase contact tracing?

While substantially increasing the number of COVID-19 tests is crucial to identifying patients already infected with the disease, contact tracing can help prevent the spread before it happens.

“All people are talking about right now is hospital beds, ventilators, testing, testing, testing. Yes, those are important, but they are all reactive. You are dealing with the symptoms and not the virus itself,” Tolbert Nyenswah, who led contact tracing efforts in Africa during the 2014 Ebola epidemic, told the Washington Post. “You will never beat a virus like this one unless you get ahead of it. America must not just flatten the curve but get ahead of the curve.”

Yet establishing a complete portrait of contacts for a single case of COVID-19 can be incredibly time consuming. With President Trump pushing for easing of social distancing guidelines and protesters packing public squares to demand a return to normal life, the risk is that the cases of the virus will again spike.


Click here for the latest coronavirus news and updates. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please refer to the CDC’s and WHO’s resource guides.

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