This is a guest post by summer intern, Marina Zapesochny.
Mask wearing, social distancing and testing are helping bend the COVID curve in the US. Increasingly, local communities and states are adding contact tracing –one of the oldest tools in epidemiology– to break the back of the outbreak. Contact tracing is highly effective for limiting COVID-19, but only if done well. Here are the 7 tips for getting it right.
- Recruit “people persons” as contact tracers
Contact tracers need to have difficult conversations with people all day long. Training helps, but too often the focus is on the technical aspects of the job.
The real emphasis should be on hiring people with the right personalities. That means “people persons.” You know, the folks who like to strike up conversations with strangers at the supermarket or bus stop and ask all sorts of questions about personal matters.
People persons will have a much easier time talking to others than those that lack those skills. CDC training instructions for contact tracers focus only on how to get in touch with people, and how to trace who they have been in contact with. Nowhere does it address how to schmooze with people, how to build trust with them or how to really empathize with them.
- Follow the “Paterson Principle” by building trust at the community level
Building trust is essential in a community where contact tracing is implemented to protect public health while also respecting people’s privacy. People can’t feel stigmatized when they are called about COVID. Spreading awareness that a contact tracer might reach out, and normalizing it by communicating about the program in local forums can make people feel less targeted.
Paterson, NJ is handling contact tracing particularly well. It is the second most densely populated place in the US after New York City. As soon as the pandemic began, Paterson expanded its contact tracing team in preparation. The mayor, Andre Sayegh had the coronavirus and beat it. Following his recovery, he said “I survived coronavirus and so will Paterson.” The mayor himself was contact traced and strongly endorsed the program. The mayor was prepared and open with his citizens. If more cities treated contact tracing this way, trust would grow.
Who answers calls from unknown numbers? With so many spam calls nowadays, most people don’t. That makes it extra tough for tracers. Portland, OR is one of many places struggling with this challenge. People don’t answer the phone and only about one in five are willing to share their contacts.
If local media explained contact tracing better and let people know what to expect and why, people would be less hesitant to pick up and cooperate. Building trust in contact tracers and the security of it in a community is what produces the best results
- Remember: Less is more
Contact tracing only works when cases are rare. The US was caught flat footed in early 2020 with a lack of testing capacity and federal leadership; cases exploded and contact tracing was no longer practical. Now that cases are declining in some parts of the US, contact tracers can be reasonably expected to find all the people the infected few were in contact with and warn them relatively quickly of their exposure. But the only way to get to a low number of cases is for the whole community to take precautions such as social distancing and wearing masks. This makes it possible for contact tracers to do their work. The tracers can then accelerate a virtuous cycle to crush the curve.
- Help COVID apps go viral
Several companies have created apps to assist in contact tracing. However, almost no one is using them. A good way to improve the quality of contact tracing would be to make these apps more mainstream and attractive to users –in other words, help them go viral.
The potential for many of these apps is amazing. If enough people used them the apps could provide alerts when a COVID-positive individual is nearby. But unfortunately, such apps need at least 60% of the population to use them. So, the questions stands, how do you get people to want to download the app? According to Harvard Business Review, the best way to get people to actually use the apps is to follow the Facebook and Uber models: start in a small area, expand it one city at a time and then launch globally.
The current approach to having people download these apps depends on the country. In China it is mandatory and in Iceland in is voluntary, but newsflash, neither is generating enough use of their app!. The Uber/Facebook model sets an exmple for the use of these apps. One of the apps with potential is Contact Tracing by Piusworks LLC. It is a free app with easy to understand instructions. However, the reviews on the Apple App Store lean to the negative side with many of them saying it was “not ready for release.” This is because they released to the general public all at once instead of following the Uber/Facebook approach. If they rebranded and relaunched to just one city at a time the results and reviews would be much more positive.
Uber, itself has played a part in sharing contact tracing information. Uber started sharing information with health departments on both passengers and drivers. The health departments can then track who used Uber services and encourage them to get tested and quarantine. Privacy remains an issue. Such a big company sharing the information of others seems like a violation, but it is covered in the Uber user agreement.
- Keep up the good work!
One call is not enough. It is necessary to follow up with people to get their contacts and sometimes to connect them with support resources. This was especially relevant during the AIDS epidemic. These practices are helpful, but more could be done. Contact tracers should check in with patients, not just for information but also to have a conversation about how the person is doing over time. Even a short conversation goes a long way.
Patients should also be checked on to make sure that they are getting the care that they need (are they in the hospital? did they get tested? are they quarantining?). These steps will reduce the doubt that the public may have had in contact tracers before. But the contact tracers can’t do it all. Partnering with other organizations so that people could get their support quickly and easily would be a fantastic idea for contact tracers. Local organizations already have connections and a reputation in the community. They could help contact tracing organizations develop a reputation with the community as well.
- Leverage the data, lose the bias
Analyzing patterns in the population of infected individuals can yield helpful insights. If people of a certain neighborhood, religious group, ethnic group, etc. are getting COVID more often, that can guide allocation of resources for intervention. Perhaps some people from a certain neighborhood are continuing to get together despite social distancing guidelines, or a religious organization isn’t requiring facial coverings. The important thing to remember when looking into this is to not input any bias or stereotypes, but let the data do all the talking. Singling out groups is a very taboo subject, but finding patterns and using them well can be effective. Another important part of it is making sure that people don’t feel targeted. Targeting people rather than just discussing patterns with them is harmful, because they won’t trust contact tracing anymore. Finding patterns, investigating them, and then informing the groups that are continuing to get sick could greatly reduce the amount of COVID positive cases. It also helps to warn members of those groups that they had a possibility of exposure before they even show symptoms.
- Testing, testing, 1-2-3
Quick turnaround time for test result is vital in contact tracing. The average person comes in to contact with roughly 16 other people each day. If it takes 2 weeks for results to come back and for contact tracers to start reaching out, that number goes way up. Sure, some of the 16 people a day are easily recalled repeats like family or coworkers, but what about the cashier at the local grocery store? Or a friend who met for coffee? The longer it takes for test results to come back, the more people can get infected unnecessarily. Calling this many people would take a lot of time, possibly days, so they wouldn’t be alerted immediately.
Another related challenge is asking people to quarantine until their test result come back. It is reasonable to ask people to quarantine for a day or two until their results are reported, but making people quarantine for 2 weeks with a possible case is outrageous. COVID testing and contact tracing need to work hand in hand to effectively reduce cases. This is what makes partnerships between contact tracers, community organizations and the healthcare system so important.
Growing our contact tracing tools now will also benefit us in the future. When another wave of COVID or a new pandemic appears, American cities and towns will be far better equipped.
August 14, 2020