Contact Tracing Is a Time-Tested Method for Fighting Outbreaks But It's Facing New Challenges
The coronavirus is bringing time-tested techniques for controlling the spread of disease front and center.
For decades health officials have been using contact tracing to manage outbreaks of tuberculosis, measles, STDs, and Ebola.
The practice of reaching out to everyone who comes in contact with a positive case is one of the best tools to beat COVID-19.
Contact tracing is nothing new, but it's still worth a refresher about how it works.
Say a restaurant employee tests positive for COVID-19. The restaurant is required to notify the local health department, and then Summit County Public Health commissioner Donna Skoda said, the calls go out.
“We interview that person. We interview the restaurant — find out who has had contact with this person, how long the contact has been, where the contact occurred, and then we start tracking backwards,” she said.
But say the employee’s wife works in a day-care center, now those people are potentially exposed.
Skoda said the lines of contagion quickly get complicated.
“It’s almost like a spider web you’re creating to make sure you find out and minimize the disease risk,” she said.
The next step is an order from the health department.
“We send a formal letter that says, you are either in quarantine or isolation and here are your restrictions and here’s how you can get out of isolation and quarantine,” she said, generally by staying put for two weeks.
Summit County has reported more than 1,500 coronavirus cases since March, and Skoda said around 100 people have been under quarantine at any given time in the outbreak.
Reaching Vulnerable Populations
Contact tracing, though a simple concept, can be challenging, especially among Akron’s immigrant communities.
Elaine Tso, CEO of Asian Services in Action, Inc., said “most of our clients don’t have smart phones and even if they did have smart phones, they have challenges using things that we take for granted like using hyperlinks.”
That means information needs to be conveyed first hand. But language can be another obstacle, she said.
“At Asian Services in Action we have the capacity to provide interpreting and translation services in 55 languages and dialects,” Tso said.
Her agency serves Akron’s Bhutanese refugees, Burmese, Karen, Hmong, Chinese, and a growing number of Congolese immigrants, all of them struggling to understand a bewildering array of closures, state orders, and health care protocols.
Tso said her team luckily has only had to contact trace a handful of COVID-19 cases among recent immigrants.
The key, she said, is building trust.
“Knowing that you can look in the eyes of that person and know that that person has walked in your shoes at some point in the past," Tso said, "That’s very comforting.”
Partners In Health Teams Up
It’s that human element that makes contact tracing effective, according to Katie Bollbach, who directs domestic outreach efforts for Massachusetts-based Partners in Health.
“It’s not just enough to just give folks a call and say you’ve been exposed, please stay home for the next 14 days. 'See ya later!',” she said, noting not everyone can safely take two weeks off work to quarantine.
“There’s a lot of disparity and inequity in terms of ability to do that here in the U.S.,” Bollbach said.
Bollbach has only been at her job for a little over a month. Previously, she directed contact tracing efforts in Sierra Leone during the height of the most recent Ebola outbreak. Her new position marks the first time Partners In Health has worked in the United States.
Gov. Mike DeWine brought the group in to advise Ohio’s coronavirus response and Bollbach said she’s now working with around ten other states and cities.
She said it’s been an eye opener.
“It’s been disheartening to see some of the challenges our public health system has faced here in the United States in rising to meet this unprecedented pandemic.”
Having dealt with a deadly Ebola outbreak in Africa, Bollbach says our best hope to beat coronavirus is widespread testing, contact tracing, treatment, and support for affected families.
“We won’t be able to bring the epidemic under control until all of those pieces are in place, and critically, the contact tracing component across the country,” she said.
There’s another obstacle beyond manpower.
Republicans in the Ohio House moved last week to require written consent before contact tracing, an idea Donna Skoda and health commissioners across the state called dangerous.
The Senate has blocked the measure for now.