Tracking COVID-19: Low-Tech Contact Tracing Remains A Crucial Element

The average person with COVID-19 has 2-3 close contacts. [Ohio Department of Health]
The average person with COVID-19 has 2-3 close contacts. [Ohio Department of Health]
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Contact tracing is not new in the world of public health, but the process of tracking the spread of viruses has become more well known, as officials work to trace the spread of COVID-19 and identify trends. 

Right now, there are nearly 3,000 COVID-19 cases in Cuyahoga County, according to the Ohio Department of Health’s website.

Health Commissioner Terry Allan said there’s a lot that goes on behind the scenes of that number, because for each case, there are an average of two to three close contacts that have to be monitored and isolated.

“The report comes in on a person, we contact them and we then find out where they had been 48 hours before they had symptoms,” Allan said. “The idea is that somebody’s sick, we need to identify them as quickly as possible, so they’re not moving around the community and spreading it.”

Public health officials ask the person if they went to work, if they rode any public transportation, if they went to the store or anywhere else. For most people staying at home, their “close contacts” are just the people they live with, but public health officials are looking for anyone who might have been closer than 6 feet apart, usually for longer than 10 minutes. Some people are still going into work or taking trips that put them into close contact with others.

“For every person that stays home, a chain of transmission is broken, and you’re reducing potential for community spread,” Allan said.

Dr. Amina Egwiekhor works as one of about 50 contact tracers for the county. She said there’s a big difference in the number of close contacts people had before social distancing started compared to today.

“Initially, when we first started doing contact tracing, a lot of people had a lot of networks,” Egwiekhor said. “Just the normal, day-to-day things that you do. You interact with friends, you go out to go grocery shopping, you may go to work, after work you may stop somewhere else. But now as the pandemic has kind of progressed and the message has gotten out about social distancing, we are starting to see smaller and smaller numbers of contacts for people who are COVID positive.”

But Allan said that number may go up soon as the state reopens, which means they need more contact tracers.

Contact tracing is important to stop the spread of COVID-19, but Allan said this is a system that public health officials have used long before the new strain of the coronavirus.

“Infectious diseases spread. We can’t stop them. What we can do is we can reduce how much it spreads by controlling them, and contact tracing is a tried and true public health tool that we’ve been using for 100 years,” Allan said.

He said it’s one of the most effective things we can do to make sure there aren’t surges that overload the hospital system.

Allan said right now, one of the most important aspects of contact tracing is identifying clusters, like in jails and nursing homes.

“This cluster investigation piece is probably the most important component. That can start a brushfire of community transmission, and so we’ve tried to suppress those clusters.”

If a cluster forms, Allan said they work quickly to identify who is sick, and separate healthy people from sick people. Then, they isolate sick people to decrease the spread.

Infectious disease specialist Dr. Keith Armitage of University Hospitals agreed that contact tracing is one of the most important tools we have in stopping a virus’ spread, but he said some people in the U.S. see it as an infringement of their rights.

“It’s a balance between individual rights and society’s rights,” Armitage said. “As a society we’ve decided in the past that the greater good called for contact tracing to eliminate things like tuberculosis, syphilis.”

He said some countries just use cell phone data to track citizens and see who might have been exposed to COVID-19, but both he and Cuyahoga County health commissioner Terry Allan said that’s unlikely to happen here in the states, even though tech companies have offered tools to public health departments.

Allan said in Cuyahoga County, they are lucky to receive help in contact tracing from medical school residents, but not every county is as lucky.

“I know the state is proposing to hire contact tracers at the state level that could then show up and assist in rural counties or counties that need more help.”

And even with Cuyahoga County’s resources, Allan said they are still working to hire more people or attract volunteers to help, because time is a crucial part of the equation. They have been working every day since the pandemic began to track COVID-19 spread, and Allan said they still have a long way to go.

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