EDITORIAL: Contact Tracing, For Fun and Profit

Daily Post readers who might be feeling discouraged… hankering for the economy to get back on its feet, or laid off from their job and stuck at home helping their kids complete their online homework, or depressed at the thought that an effective, thoroughly-vetted vaccine is still at least nine months away… might find themselves tempted to apply for a job as a contact-tracer.

As states and cities begin to relax their ‘social distancing’ requirements, and as places dedicated to business and social gatherings start to open their doors again, we are almost certain to experience COVID-19 ‘spikes’ — clusters of viral infections that threaten to resurrect the whole lock-down scenario. This pattern is already being seen in some of the Asian countries most successful in ‘flattening the curve’ — Singapore, Hong Kong, South Korea, and Taiwan — as they opened their doors to international travel and found travelers from the US and Europe re-importing the virus.

Travel is not our friend, in the current situation. Archuleta County has been surprisingly free of infections — only 8 confirmed cases and no reported fatalities — but we assume that travelers from other parts of the country could easily bring new infections with them. And the virus appears to spread very quickly, once social distancing is relaxed.

Enter, the contact tracing, one of the only confirmed ways of controlling of the pandemic. Some citizens, however, might view the process as an invasion of personal privacy. More about that later.

Reporter Michael Roberts wrote an article on May 1 in Westword magazine that touches on the importance of contact tracing:

…right now, contact tracing is far from a commonplace practice in Colorado, and a story shared with Westword shows how its relative rarity can result in a terrible outcome.

A few days before before Colorado’s Sterling Correctional Facility in Logan County announced a rather uncontrolled outbreak of COVID-19 among prisoners and staff, the prison released some low-risk inmates into what is know as ISPI (Intensive Supervision Program-Inmate) — wearing an ankle monitoring device and restricted to his apartment from 6pm until 6am. Some of the inmates were released because of health issues that made them high-risk during a pandemic.

One of those released inmates visited with a friend at his apartment. A week later, the friend called the inmate “to tell me that he and 138 people had come down with the virus.”

“I am worried that I may have the virus and don’t have the resources to get tested,” [the inmate] says. “I have been staying at home except going to grocery store, but I wear a mask and gloves and practice the safe distance away from others. Can you guide me where to be tested?”

Had the Sterling inmate unintentionally infected 139 people? You can read more about this story on the Westword magazine website.

We wish the inmate the very best luck getting tested, in a country short on testing supplies. But we wonder — how many of the 139 people who later came down with the virus were tested and asked to quarantine? Can contact tracing be a viable solution?

From an April 21 story in the Colorado Sun, written by John Ingold:

In 2016, a case of measles popped up in the Denver metro area — just one case. Health officials across five different organizations jumped on it, sending out workers to learn more about the patient and where he had been. Then they reached out to all the people who had interacted with him and figured out whether they contracted the virus. By the time the officials were done, they had interviewed 311 contacts of the patient and invested more than 750 hours. The investigation of that single case cost nearly $50,000…

“Testing only has this epidemiological benefit when you couple it with the tracing and the quarantines that go along with it,” Gov. Jared Polis stated at a news conference last month. Without effective contact tracing — coupled with readily available testing — it would seem nearly impossible to prevent the resurgence of infections within a given community, once the local economy ‘reopens’.

From that Colorado Sun article:

Dr. Rachel Herlihy, the state epidemiologist, said the goal is to be able to track and investigate 500 cases a day statewide. To reach that mark, public health agencies across Colorado are currently hiring dozens of new workers and drafting existing ones into an army of shoe-leather epidemiologists fighting COVID-19…

The public health benefits of contact tracing appear to date back to at least 1937, when U.S. Surgeon General Thomas Parran first recommended it as a method to combat the spread of syphilis. More recently, it was employed effectively during an Ebola outbreak in 2014. Neither of those two diseases is as contagious as COVID-19.

The Centers for Disease Control and Prevention (CDC) attempted to implement contact tracing this past February, when only 14 cases of coronavirus had been identified in the US. But due to a slow federal response and a widespread lack of testing kits, the disease quickly spread beyond the CDC’s containment effort. At that point, contact tracing was abandoned as a control technique, and ‘social distancing’ became the preferred method to “flatten the curve” and prevent hospitals from being overwhelmed with COVID-19 patients.

Testing has since ramped up, and with the nation’s success at social distancing, the numbers of new infections appear to be declining in most places.

Ready to become a contact tracer? This week, the Johns Hopkins Bloomberg School of Public Health launched a free online course to train you — yes, you — in the fine art of contact tracing. The course is required for the thousands of contact tracers now being hired in New York, but it’s available for free to anyone who’s interested.

The tracer’s job is to track down anyone who might’ve been infected by a person recently diagnosed with COVID-19 so those contacts can quarantine themselves and prevent further spread. From CNN.com:

It’s an involved process, but public health experts say the US can’t safely reopen without it. A study from the Bloomberg School’s Center for Health Security estimated the US will need at least 100,000 contact tracers to stymy Covid-19 before reopening. The five-hour course covers the tracing basics: How to interview people who’ve been diagnosed, identify their close contacts and support them during quarantine, to name a few. Students will mock-interview, consult with Johns Hopkins faculty and simulate ethical dilemmas on the job, the university said in a statement…

About those ethical dilemmas. Here in the US, a person’s medical information is considered private, and that privacy is protected by federal and state laws.  From CNN:

“To protect patient privacy, contacts are informed only that they may have been exposed to a patient with the infection,” the CDC says. “They are told not the identity of the patient who may have exposed them.”

I can imagine that would be an uncomfortable conversation.

“We need to tell you that you may have been exposed to COVID-19.”

“Really? Who might have infected me? How close was I, to this person?”

“We can’t tell you that. We can only tell you to quarantine inside your house for 14 days.”

“Very funny. You’re joking, right?…”

Bill Hudson

Bill Hudson began sharing his opinions in the Pagosa Daily Post in 2004 and can't seem to break the habit. He claims that, in Pagosa Springs, opinions are like pickup trucks: everybody has one.