It was what seems like years ago that I locked myself in my basement sick with COVID-19. It was way back when when the numbers were all going up, no one knew how to make a homemade face mask, and most people had never heard of Zoom. While I was down there in my basement feverish and achy I had an experience that I did not put a lot of thought into at the time. I was too bewildered and overwhelmed by the state of the world to pay too much attention but one phone call I received may turn out to be the secret to safely opening our society up again.
I got a call from the Maryland Department Of Health and, since it was so early and there were so few cases (I had Coronavirus before it was cool), I actually spoke with the head epidemiologist and head nurse. I was asked several questions about the nature of my illness. These lovely public servants asked what my symptoms were, when they started, and how they had progressed. They also asked me to recount all the people I had interacted with in the prior week including who I think got me sick. They asked me to contact anyone I had interacted with and tell them I was sick. I was an easy case for them because I had already done that. I even published this website and told the world I was sick. This experience is called ‘contact tracing’.
Every expert agrees that after the virus calms down it will come back and continue to do so in waves until we have an effective vaccine.
Every expert agrees that after the virus calms down it will come back and continue to do so in waves until we have an effective vaccine. We are nowhere near the infection rates needed to achieve herd immunity even in the most affected areas of the country. How bad things get when infections start to spike again will depend on how you, I, and the various government and public health institutions respond. The first line of defense is testing. You can’t work to stop the spread of the virus if you don’t know where it is(for my take on testing issues read this). The next step after identifying who is infected is identifying who they may have spread the virus to and getting them in quarantine so they cannot spread the virus further.
Remember people can get infected and be asymptomatic for several days before they get symptoms. Many get no symptoms at all. People are most contagious in the few days before symptoms occur and from the moment the virus enters the body the clock is ticking. If those who have been exposed can be identified at this crucial juncture and prevented from infecting others it can stop the spread before it gets out of control. Contact tracing is the first and most important step before things go exponential.
One of the exemplars of the effectiveness of contact tracing is the state of Alaska. Despite its vastness and lack of infrastructure, health officials there have contact-traced every single reported case of Covid-19 since the outbreak began. Alaska has the third lowest per capita rate of infections. Their methodology can be read in more detail here. They have hired nurses that call the infected person and ask them a list of questions with the goal of first building a timeline of their illness to figure out when they were most contagious. They then attempt to get the patient to recall each and every person they came into contact with during their infectious window including the name and contact info. The contact tracers then contact that person and tell them they were exposed and should quarantine. It doesn’t have to be nurses, anyone can do it.
It has been estimated that we will need 300,000 people nationwide to act as contact tracers.
In some countries there has been more widespread use of technology to do this automatically. This has been employed in more autocratic countries but in free and democratic nations it raises issues of balancing privacy with public health.
Just remember how fast this virus spreads. If we want to open up our society again we must have a way to identify those who are sick and exposed to prevent us from ending up back where we were when this all started.
Relieving restrictions without having adequate testing and contact tracing could be disastrous. This whole mess started with one person. There are currently thousands of actively infected people in our communities, many of whom don’t know they are contagious. You don’t need to be an expert in public health to know what will happen if we cannot identify those who have been exposed and have them quarantine. You only need to review the news reports from the past 3 months. It has been estimated that we will need 300,000 people nationwide to act as contact tracers. Unfortunately, in the years prior to this pandemic budgets for health departments have been cut and contact tracers were let go. There needs to a massive hiring process. The good news is that this job can be done from home. Sadly, there are many people looking for work who could fill the positions. Hopefully the jobs will only be needed for a short time.