By Daniel Farber Huang
July 3, 2020
I recently completed Johns Hopkins’ COVID-19 Contact Tracing certificate course offered for free on Coursera.com. Before March I didn’t even know what a contract tracer was, but today I would surmise that the phrase “contact tracing” has been added to the vocabulary of every person living in our COVID-19 world.
Contact tracing helps slow the spread of infectious diseases by identifying people who may have come into contact with an infected person. Typically, public health staff or trained volunteers work with a patient to help them recall everyone whom they have had close contact while they may have been infectious. Contact tracers can alert people who may not have realized they were potentially infected and inform them how to prevent spreading the infection further, including self-quarantine and isolation.
Contact tracing is a standard public health tool used for many deceased to control the spread of many different infectious diseases. According to the World Health Organization, contact tracing was one of the interventions that has helped control Ebola virus disease outbreaks in Africa.
As COVID-19 gained traction across the country, more and more states and health departments were discussing their sudden demand for contract tracers, including trained citizens. National Public Radio reported on April 28 that 44 states and the District of Columbia were planning to expand their contact tracing workforce to about 36,000 workers. Ten days later, as COVID-19 continued to spread across the country, NPR re-surveyed those respondents and the revised demand for contact tracers increased to over 66,000 personnel.
Well beyond those estimates, a bipartisan proposal by health leaders called on Congress to expand the contact training workforce by 180,000 people until a vaccine becomes available.
I decided to take the online 6-hour course out of curiosity. This course was one of the early steps in my desire to understand how COVID-19 will alter our world immediately and longer term.
It was eye-opening.
Founded in 1876, John Hopkins was America’s first research university and today is ranked Number 1 in PUblic Health by U.S. News & World Report. The COVID-19 Contact Tracing course was put together by Emily Gurley, Associate Scientist in John Hopkins Bloomberg School of Public Health, Department of Epidemiology.
Here are some of the important takeaways:
1. What is COVID-19?
COVID-19 is caused by a virus, named SARS-CoV-2. It came from a bat virus that had the ability to infect people. A person can catch COVID-19 when droplets (which can be invisibly small) from an infected person enters the body through their mouth, nose or eyes.
2. What is a Case?
A person who is infected with COVID-19 is called a Case. Someone with COVID-19 is able to infect others up to two days before developing or showing any symptoms and throughout the time of their illness. Reviewing their social media and text messages are one useful way for an infected person to retrace their recent history to determine whom they might have come into contact with.
3. Who is a Contact?
The people that case has come into contact with is called a Contact. A contact is considered to be someone who has come within six feet of an exposed person, was in the vicinity of an exposed person for 15 minutes or more, or could have into contact with the exposed person’s infectious respiratory droplets. Contacts, once informed of their potential exposure with an infected person, should quarantine for 14 days after their most recent date of exposure to a case.
4. Why does Contact Tracing Matter?
Through contact tracing, preventing even just one case of COVID-19 can have a long-term impact on reducing the total number of cases, which is why it’s important for contact tracing to occur as quickly as possible. Technology,such as electronic databases to identify and message close contacts of people who test positive for COVID-19, can make the contact tracing process more efficient.
5. Contact Tracing is Meant to Help Everyone.
Contact tracing is based on the principles of justice. It serves the public good and neither gives preferential treatment nor discriminates among the population. Contact tracers should attempt to identify and trace all contacts, regardless of where they live, who they are, citizenship status or any other aspect of their person.
6. Quarantine versus Isolation.
Quarantine is not the same as isolation. The purpose of quarantine is to separate healthy people who have been exposed to the virus, and therefore, could become infectious, from other healthy people who have not been exposed to the virus. The purpose of isolation is to keep infectious people separate from healthy people. Isolation separates an infected person from others (for example, having a private bedroom and bathroom). Isolation should last for the entirety of a person’s infectious period, which is at least 10 days since symptoms began, and three days after having no fever without using medications.
7. Who is at Risk?
People over 65, with high blood pressure or diabetes, or obese are at increased risk for severe disease, including COVID-19. COVID-19 can still infect anyone, regardless of age, race or other factors. Persistent pain or pressure in the chest, bluish lips or face, trouble breathing or new confusion or inability to arouse are all signs that a person needs immediate medical care.
8. Building Trust is a Key Skill for Contact Tracing.
A contact tracer’s ability to build trust and rapport with a case or contact is one of the most important skills for the job. Rapport is a feeling of mutual understanding, trust, and agreeableness between people. It’s essential that contact tracers work to build a good rapport with cases and contacts to be able get information about contacts and support them in isolation and quarantine.
Beyond the healthcare details, developing trust with the public is likely one of the largest challenges to successful contact tracing.
On July 2, CNN reported that in Rockland County, New York, county officials had to issue subpoenas to 20-something year olds who attended a party two weeks earlier because eight attendees refused to speak with contact tracers.
Rockland County Health Commissioner Dr. Patricia Schnabel Ruppert said, “Most people do cooperate with us, but for the smaller number that do not, they have hung up on us. (They have) given us very small amounts of information and then refused to give anything further. (They) have told us they do not want to nor need to provide information."
The Rockland County subpoenas were punishable by up to $2,000 in fines per day. Ruppert said upon being served, all eight recipients responded promptly.
Speaking with CNN, Ruppert described the challenges her department faces with COVID-19 contact tracing.
“There are those in the community who have been home for a number of months and they are really tired of it. They are fed up and they want to be out.
“They don’t want to have to answer to government, to any health officials. And some people just don’t maybe understand the importance of this, which of course with education we are trying to explain ...” Rupert said.