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As U.S. states begin reopening, health experts are calling for massive investment in contact tracing — identifying and notifying people who have come into close contact with someone who has tested positive for the new coronavirus.
Although President Donald Trump claims that the country is ready to contain local coronavirus outbreaks, some experts disagree. Many states also don’t yet have the resources needed to make contact tracing work effectively.
Lisa M. Lee, PhD, associate vice president for research and innovation at Virginia Tech, says contact tracing is an “essential part of preventing subsequent infections during an epidemic,” especially with the vaccine against the coronavirus months away.
Contact tracing starts with a person testing positive for SARS-CoV-2, the virus that causes COVID-19.
It can also be done for suspected cases, as when someone shows symptoms of COVID-19Trusted Source, such as cough or shortness of breath.
A trained public health worker interviews that person to help them recall all the people they’ve had close contact with while they were infectiousTrusted Source.
A close contact is someone “who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before illness onset until the time the patient is isolated,” according to the Centers for Disease Control and Prevention (CDC)Trusted Source guidelines on contact tracing.
This time span is needed because of the way the coronavirus spreads.
“Part of the problem with the coronavirus,” said Lee, “is that it can be transmitted before a person has symptoms, before they feel sick, or even if they have very mild symptoms.”
Public health staff notify — either in person, over the phone, or electronically — close contacts who may have been exposed.
These people are encouraged to stay home and maintain social distance — at least 6 feet — from others until 14 days after their last exposure.
They’re also asked to check their temperature twice daily and monitor themselves for symptoms. In some areas, they may be tested for the coronavirus.
To protect privacy, close contacts are not told the name of the person with the virus they may have come in contact with.
Hong KongTrusted Source was able to manage its initial outbreak through contact tracing, testing, and social distancing, without resorting to strict lockdowns.
Contact tracing also helped South Africa flatten its curve quickly. The country deployed 28,000 contact tracers to track the spread of the coronavirus.
But contact tracing is no small task, especially in areas with more active coronavirus infections.
Just imagine all the people you come into close contact with during everyday activities such as shopping, riding public transportation, going to a restaurant or movies, or even just out for a walk in your neighborhood.
As of last month, the United States had only 2,200 contact tracers, according to the Association of State and Territorial Health Officials.
However, a recent report from the Johns Hopkins Bloomberg School of Public Health estimates that an extra 100,000 workers will be needed to make manual contact tracing efforts work across the United States.
The price tag for this? $3.6 billion.
Several cities and states are already ramping up their contact tracing capacity, including San Francisco, Massachusetts, and New York.
Given the sheer size of the problem, high-tech approaches to contact tracing are also being explored.
Last month, Apple and Google released contact-tracing tools. Their approach involves apps built by public health organizations, plus updates for iOS and Android.
People who test positive would enter their diagnosis into an app. This would use Bluetooth technology to identify people who had been in close contact with them during their infectious period.
The app would notify those close contacts of a possible exposure. This would happen anonymously in order to protect people’s privacy.
Used this way, technology could enhance the manual contact tracing efforts of public health organizations.
“Think about the last time you went to the grocery store,” said Lee. “You were probably within 6 feet of someone who you don’t know. So you wouldn’t even know how to tell a contact tracer how to get in touch with them.”
However, app-based tracing won’t replace manual contact tracing entirely.
For example, only 42 percent of Americans 65 and older own a smartphone, according to a 2017 Pew Research Center poll. This age group, though, makes up 8 out of 10 COVID-19 deathsTrusted Source in the country.
Adoption of the technology would be another issue. If only a small segment of the population installs the app, manual contact tracing will be needed to fill in the gaps.
Dr. Lisa Miller, an epidemiology professor at the Colorado School of Public Health at the Anschutz Medical Campus, cautions that contact tracing is just one tool of many that can help contain the virus.
That means until a vaccine against the coronavirus is available, we should still be social distancing, washing our hands regularly, not touching our face with unwashed hands, and staying home when we’re sick.
“It doesn’t mean that people can stop all the other things that they’ve gotten quite used to,” said Miller. “But contact tracing will be an additional tool that will add to the control measures that we’re able to implement.”
Contact tracing also needs to be deployed in a way that helps all communities. We’ve already seen that certain African American, Latino, homeless and other populations have been harder hit by COVID-19.
Part of helping these communities is making sure that there’s sufficient testing available, because contact tracing starts with a positive test.
But “it’s not just testing,” said Miller. “We have to keep vulnerable communities in mind throughout the entire process of contact tracing.”
For example, do people in a community have access to technology being used to track contacts?
Or if English isn’t their first language, can they understand and follow the guidance of public health experts?
Lee says household or community resources are another thing to keep in mind.
If people are being asked to self-isolate, they need to have adequate food and medicine so they don’t need to leave their homes.
Also, they need to be able to physically distance from others in their household, which isn’t always possible in a multigenerational or multifamily household.
This is where public health organizations need to step in, for the good of not just the local community but the entire country.
“We have to bring the resources into the community that people need in order to comply with what we’re asking them to do,” said Lee. “That is such a critical point. We will not succeed unless we do this.”
