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You’ve likely heard the term on the news as public health workers discuss COVID-19: contact tracing. Often discussed alongside testing, isolation, and quarantine, contact tracing is a common practice for people working in infectious disease and public health.
But this buzzword is unfamiliar to most of us, and is a critically important tool in stopping the spread of COVID-19. Here is a closer look at what contact tracing is, how it’s being employed to help in slowing the spread of the novel coronavirus in El Paso, and why you should care.
What is contact tracing?
Contact tracing is the process of identifying and following up with people who have come into contact with someone who has an infectious disease (in this case, COVID-19).
Typically, once someone is confirmed positive for COVID-19, contact tracers (sometimes called disease detectives) will begin looking for anyone who has come in close contact with this person, and will notify them that they have been exposed to coronavirus.
If someone has been exposed to COVID-19, contact tracers will encourage them to self-isolate, and will check in on them regularly both to ensure they are isolating, and to see whether they develop signs and symptoms of the virus.
The extensiveness of this protocol varies by region and local health authority. According to Sara Cera, health program manager and contact tracer in the El Paso Department of Public Health, contact tracing is “a critical process to ensure we have the best possible chance to control the disease.”
According to Cera, contact tracing has been used as a tactic for controlling the spread of infectious diseases in the past, and was very important during both the SARS outbreak of 2003, and the Ebola outbreak of 2014.
Contact tracing is currently being employed internationally in efforts to slow the spread of COVID-19, with varying tactics and technologies for implementation. While some places (like El Paso) rely largely on telephonic communication to check in with people who have been exposed to the novel coronavirus, other parts of the world have opted for more invasive methods of tracking COVID-19.
Contact tracing in South Korea not only involves patient interviews, but also includes medical records, closed circuit television, cell phone GPS records, and credit card transaction records. Meanwhile Singapore has introduced a mobile app to help in contact tracing efforts, TraceTogether, which uses BlueTooth signals to identify close contact between individuals. However, the increased use of apps to aid in contact tracing has given rise to concerns about privacy and surveillance, as more countries consider employing invasive technologies in order to bolster local contact tracing protocol, and developers work on new technologies to accommodate the heightened demand.
The need for increased contact tracing has become an important sticking point in discussions among policy-makers of how to reopen the economy. State and local public health departments are lobbying Congress to hire 100,000 additional contact tracers (there are currently approximately 2,200 contact tracers in the U.S.), and the CDC has recently announced it will be funding 650 additional health workers in order to bolster tracing efforts.
A new report coauthored by a coalition of bipartisan experts in public health, technology, economics, and ethics, Roadmap to Pandemic Resilience, emphasizes the need for an increased workforce of contact tracers alongside dramatically expanded testing capabilities in order to safely reopen the economy. This report lays out a four-phase approach of Testing, Tracing, and Supported Isolation (TTSI) in order to facilitate long-term pandemic resilience in the United States.
How is contact tracing being used in El Paso?
Right now in El Paso, a 32-person team is implementing contact tracing efforts throughout the city. According to Armando Saldivar, senior public affairs officer of the El Paso Department of Public Health, this team “is composed primarily of epidemiologists, (sexually transmitted disease) investigators, nurses, health educators, and food inspectors,” and is working seven days per week.
The El Paso contact tracing team is supported by a 24/7 hotline maintained by the El Paso Fire Department, with help in monitoring by public health nurses who check in regularly on patients.
Health Program Manager Cera says that thus far, the contact tracing team has been able to keep up with tracing protocol as the virus spreads in the community, noting that “we continue to adjust the size of our team to effectively meet the demands of investigations.”
Right now, contact tracers are only implementing testing among exposed individuals who exhibit signs and symptoms of COVID-19.
However, in a statement to El Paso Matters, City-County Health Authority Dr. Hector Ocaranza clarified that asymptomatic individuals who have been exposed to the virus should self-isolate as well. “It can be assumed that when a member of a household has tested positive, then everyone in the household is exposed, considered to have the virus, and should therefore self-isolate for 14 days.” he said.
What are some of the biggest challenges in contact tracing for COVID-19?
COVID-19 bears unique characteristics that make tracing community spread of the virus difficult. First, people are able to transmit it even when they are asymptomatic or pre-symptomatic.
Many places, like El Paso, are not uniformly testing asymptomatic people who have been exposed to COVID-19, and it can be difficult to enforce self-isolation or quarantine among individuals who are asymptomatic, especially when economic pressures and basic needs impel people to continue moving through public spaces or coming into close contact with others.
Cera describes challenges to contact tracing and containment efforts that she’s witnessed in El Paso.
“People get a little agitated as far as having to stay home for 14 days, not being able to go to work or do their regular routine. Also when they’re advised to be in isolation, if they’re a house of five or six in the household it might be a little difficult to put someone in isolation,” she said.
“Let’s say you’re a mom — I myself am a mother. If I was to become positive, I have smaller children that I have to care for. So it can be complicated sometimes. At those points we just give the patients advice: make sure you wear a mask, you wash your hands, try not to be in contact with people around your house, try to stay away as much as possible. But we understand that sometimes it’s inevitable, you have to be in touch with people.”
An additional challenge to contact tracing is that significant community spread has already occurred throughout the country, with increased evidence that spread of the virus began far earlier than experts initially thought. Furthermore, since there is currently no treatment for COVID-19 that has proven effective, the need for ongoing extensive communication between patients, contact tracers, and medical workers is even greater.
What can El Pasoans do to help local contact tracing efforts?
Staying informed and cooperating with local health directives is the best way to support contact tracing efforts in the community.
According to Saldivar, “cooperation is key. If you have been ordered to self-isolate it is critical that you follow the directive, so as to not potentially expose others. If you have not been contacted by the Department of Public Health, following the Stay Home, Work Safe Order is very important in helping to keep our positive cases low.”
Saldivar notes that sometimes doing nothing is the most difficult directive for people to follow, but simply staying at home and complying with social distancing directives is a key way that El Pasoans can help in slowing the spread of transmission, and ensure that contact tracers are able to keep up with local virus spread.
Cera notes that when community members are more informed about contact tracing and its importance, then they are able to help local contact tracers more effectively.
“I think sometimes people might be a little afraid that we’re calling them, they think they’re in some kind of trouble. But in reality all we’re trying to do is help them. So when they are contacted by a contact tracer or a health investigator, (people should) cooperate and give the full information.” she said.
“The biggest thing that’s going to make our community or El Paso successful in stopping the spread of this infection is working together, cooperation. If we cooperate together, if people are willing to provide the information of those that they’ve been in contact with, then we can monitor them,” Cera said.