This article was written by Linda Comp-Noto, Division President
As communities prepare to re-emerge and jump-start their economies, infrastructures to safely reopen without causing another wave of COVID-19 are imperative. According to Crystal Watson, a senior scholar with the Johns Hopkins Center for Health Security, contact tracing is the best tool we have to manage the epidemic on an ongoing level. It can help prevent future waves or surges and offer some degree of confidence in a go-forward strategy.
In this second installment of our four-part blog series outlining the healthcare services contingencies for the new normal, we are examining contact tracing as a key strategy for preventing further community spread of COVID-19.
Contact tracing is one of the oldest public health tactics and comes down to good, old-fashioned detective work. Contact tracers follow a spider web of exposure as it spreads from person to person. Each presumptive carrier of the virus is identified, isolated, and asked to provide details about locations and contacts so those exposed can be notified and directed to self-isolate. Closely monitoring and alerting anyone coming in contact with an infected person will ensure they get proper care and treatment, and will prevent further transmission of the virus.
While this strategy hasn’t been widely implemented in the COVID-19 response due to the quick surge of the epidemic and insufficient tests to identify virus carriers, it can now be introduced as part of the longer-term strategy for slowing and reducing the rate of infection.
To defeat COVID-19, we must rapidly decrease exposure to the virus. However, because of the huge amount of information that contact tracers end up discovering, manual contact tracing can be very time- and resource-intensive. To complicate things further, the pathological properties of COVID-19 have not been firmly established yet. This means that even minimal encounters have to be included and tracked.
In the US alone, it is estimated that between 100,000 to 300,000 new workers would be needed to assist with the enormous and unprecedented task of contact investigation and containment. With 20-40% of cases remaining asymptomatic, manual contact tracing can be slow and offer the potential for overlooking cases. Furthermore, manual contact tracing is reliant on human processes, memory, and potential error leading to tracking inconsistencies and oversights.
Other challenges of manual contact tracing include incomplete identification of contacts, inefficiencies in paper-based reporting systems, complex data management requirements, and delays between steps from transmission, to contact identification, to isolation.
Although contact tracing can be successfully implemented without digital technologies, implementation on a large scale can be better managed through the use of digital tools, offering an opportunity to strengthen contact tracing capacity for COVID-19.
Outbreak response tools are designed for public health response personnel involved in contact tracing activities and outbreak investigations. They encompass the management of complex relational data of cases and their contacts through electronic data entry of case and contact information. The Go.Data software application, created by the World Health Organization (WHO) and partners from the Global Outbreak Alert and Response Network (GOARN), was designed specifically for field workers and has already been implemented in many countries.
Proximity tracing tools, also known as proximity tracking tools, use location-based (GPS) or Bluetooth technology to find and trace the movements of individuals to identify people who may have been exposed to an infected person.
Symptom tracking tools use applications designed to routinely collect self-reported signs and symptoms to assess disease severity or the probability of infection due to COVID-19.
However, while digital tools may improve the quality of data sharing and analysis, they still can’t fully replace manual contact tracing.
Because of the complexity of the illness, the human ability to assess symptoms, detect asymptomatic carriers, and flag other possibilities for compromised health and onward spread is crucial to the success of contact tracing. The World Health Organization observed during the Ebola outbreak that “Persons who conduct contact tracing should have investigative skills to find and track all potential contacts, and the ability to analyze the evidence. They also need to be flexible and empathic with the cases, contacts, and their families in order to build trust and good community relations.”
In times like this, when individuals are suspicious of state intentions and interventions, are exposed to misinformation, or are concerned about personal data security, human engagement can create opportunities to build trust, especially when local norms, values, and concerns are addressed with respect and empathy. Additionally, compassionate and connected contact tracers can play an important role in allaying fears of positive diagnoses and supporting other aspects of mental health.
According to Safra Center at Harvard, “the level of testing and supported isolation we need depends on how effectively we can trace people’s contacts, warn those contacts about their exposure, test them, and isolate those who are COVID-positive.” For purposes of disease control and suppression, the great value of contact tracing, together with testing and supported isolation programs, is that it will protect citizens, prevent repeated shutdowns, and contain the virus until a vaccine is available.
With a high-tech, high-touch approach, Teleperformance can augment and support public health efforts to ramp up contact tracing by humanizing the process to drive more effective outcomes. At Teleperformance, we believe that the human element enabled and supported by the best technology, remains highly essential in the new normal.