A vaccine is likely our best bet for stopping the spread of COVID-19. But since that’s still likely a long way off, one of a few next-best strategies for slowing the transmission of the coronavirus is contact tracing.
You’ve probably heard the term “contact tracing” a lot lately in conversations about controlling the novel coronavirus pandemic and lifting lockdown restrictions. However, you may be a little unclear on what contact tracing actually means.
Fortunately, we have you covered. Here’s what you need to know about this crucial part of reopening:
Contact tracing involves tracking the origin of an illness and making sure people take proper measures if they’ve been exposed.
As one of the most tried and true disease control measures in public health, contact tracing has been used to stop the transmission of disease for decades.
Operating a bit like detectives, contact tracers are tasked with interviewing a sick person ― in this case, someone who has tested positive for COVID-19 ― to identify all the people they’ve been in contact with during the period where they were likely to be most infectious, and then quickly reaching out to those contacts to let them know they’ve been exposed. Contact tracers always maintain privacy, never identifying the infected case to their contacts.
But contact tracing doesn’t simply stop after a contact tracer lets someone know they have been exposed to someone who has tested positive for COVID-19. Contact tracers also support people by helping them safely quarantine and access testing ― both of which are key in preventing further transmission of the disease, experts say.
“Contacts are provided with education, information, and support to understand their risk, what they should do to separate themselves from others who are not exposed, monitor themselves for illness, and the possibility that they could spread the infection to others even if they themselves do not feel ill,” the CDC notes on its website.
Contacts of the person who is sick are also encouraged to socially distance for 14 days following their last exposure to an infected case, monitoring for symptoms throughout. If any of the identified contacts develop symptoms or test positive, the contact tracer will repeat the process to identify and get in touch with their contacts.
“The concept is simple but it is challenging to put into practice. You can’t always talk to the sick person or their contacts, and you are always fighting the clock to do the work before the next generation of disease occurs,” said Brian Labus, assistant professor in the School of Public Health at University of Nevada Las Vegas.
This tactic has been used time and time again to help control the spread of infectious disease, playing an important role in the eradication of smallpox as well as in the control of sexually transmitted infections, measles and tuberculosis.
“It serves the purpose of warning people who have been exposed and also breaking the transmission chain, which contributes to the overall control of the outbreak,” said Adam Karpati, senior vice president of public health programs at Vital Strategies.
Contract tracing helps break up community transmission.
Contact tracing is one of the best tools we have to reduce the spread of COVID-19. It helps us break links in the chain of transmission so we can stop, or at least slow, the spread of disease. The more contacts that can be identified and the more links that can be broken, the easier it is to reduce transmission.
As states and cities look to lift social distancing guidelines, strong contact tracing programs will play an important role in identifying new cases and minimizing further spread of the disease.
“But it has to be done at the right scale and with the right level of intensity and speed,” Karpati said. “When done like that it can have a strong effect.”
More broadly, contact tracing also gives health authorities clues about how the disease is spreading among our communities and can help them identify scenarios where the disease is spreading on a large scale among a workplace, homeless shelter or another setting with potential for widespread transmission.
“It’s really important in understanding where a community is in terms of the transmission of the virus,” said Lorna Thorpe, director of the division of epidemiology in the department of population health at NYU Langone Health.
We need thousands of contact tracers in order for the system to work.
Ramping up contact tracing is no simple task ― the National Association of County and City Health Officials projects we will need 30 contact tracers for every 100,000 Americans, which equates to at least 100,000 total. Though this number could easily change depending on the number of cases: Regions with more patients will need more contact tracers than areas where the disease isn’t spreading as quickly.
Having a sufficient amount of contact tracers is key to acting quickly and effectively reducing the spread of the virus.
“The challenge is that we only have a few days to find people after they have been exposed, so surges of cases place huge demands on the system in a short time,” Labus said.
You need a specific skillset to be hired as a contact tracer
“Good contact tracers are part nurse, part health educator and part detective,” Labus said. “We can easily find people with one of these skill sets, but it is difficult to find people that have all of them. Call center workers haven’t been trained in medicine, nurses aren’t trained to be detectives, and police officers aren’t trained in health education.”
Contact tracers need a broad skillset that includes interviewing, engendering trust, understanding symptoms and the spread of the disease, cultural sensitivity, empathy, resourcefulness and attention to detail. Contact tracers also need to be able to effectively communicate with people who speak various languages and come from all walks of life, which could include being cognitively impaired or marginalized in some way.
“The key is to be well-trained and professional in how you approach people, how you engage people and how you maintain their trust,” Thorpe said.
Contact tracing is an important public health tool, but it doesn’t come without challenges or limitations.
If a contact tracer gets in touch with you, they’ll usually ask for the names of people you’ve been with for a prolonged period of time. The exact definition of “prolonged period of time” can vary, but usually means 10 minutes or longer.
For some people, recalling these contacts can be pretty tricky. Sure, it may be easy to come up with a list of people you live or work with, but there are scenarios that might not be easy to remember. For example, many essential workers interact with a significant sum of people throughout the day. And as social distancing restrictions lift, the amount of contacts each of us encounter each day is likely to grow.
The next challenge is that many of us rarely pick up our phones unless we’re familiar with the number. Blame it on conditioning from a few too many spam calls, but refusing to answer a call from an unknown number inserts a pretty significant roadblock when a contact tracer is relying on that phone call as their primary method for getting in touch with you.
“The current context is tricky in that the general public is wary of phone calls in general from people they don’t know,” Thorpe said. “They often screen calls and don’t answer calls that they’re not familiar with.”
When contact tracing for other illnesses, it’s not uncommon for a contact tracer to visit someone’s home if they’re having trouble reaching them, but since COVID-19 is highly contagious, this isn’t as much of an option right now.
Another problem is that most people in the U.S. simply aren’t familiar with contact tracing and its importance, and others lack trust in government or public health. For either reason, people may not be open to speaking with contact tracers, which can inhibit a contact tracer’s ability to do their job.
“In different levels across the country, there is a general loss of trust in government,” Thorpe said. “And so we will have to build that trust through effective communication messaging campaigns.”
Experts are still learning about the novel coronavirus. The information in this story is what was known or available as of press time, but it’s possible guidance around COVID-19 could change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.
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