There is no silver bullet for defeating COVID-19. This is true in spite of the recent regulatory approval of two highly effective vaccines. It could be a year or longer before enough Americans are vaccinated to provide true “herd” immunity. In the meantime, bringing the pandemic under control in the United States will continue to rely on testing and the application of evidence-based public interventions: mask wearing, physical distancing and contact tracing. These time-tested approaches are key to interrupting the spread of infectious agents like coronavirus.
In the United States, scientists and public health officials, as well as many political leaders, have repeatedly encouraged mask wearing and social distancing. Much less attention has been paid to the critical role of contact tracing in slowing the pandemic. This omission is sidelining a major weapon in our battle against COVID-19. Unlike mask wearing and social distancing, which involve an individual’s simple decision to act (or not to act), contact tracing requires more players and steps. It takes skilled interviewers, sophisticated data-collection tools and the resources to monitor and support those who are asked to isolate or quarantine. Most crucially, it requires the participation and cooperation of the public.
In typical contact tracing, someone from the state or local health department conducts a phone interview with a person who has tested positive. The interviewer verifies basic information, such as name, age and address, asks about symptoms and their onset, and then tries to determine whether the infected person has come in close contact with anyone during the period they were likely infectious. The person is asked to isolate for a minimum of 10 days. Interviewers also reach out to close contacts, encouraging them to quarantine. (Until recently, the quarantine period was 14 days, but the Centers for Disease control has shortened this to 10 days, as long as the contact remains symptom-free, or seven days, if the person tests negative at least five days after the start of quarantine.)
Five months ago, I took a job working as a contact tracer in Maryland. Most people I reach out to are helpful and pleasant, and many express gratitude for the information and sympathetic ear I provide. But a significant number do not answer the phone. Caller ID makes it easy for infected individuals and possible contacts to simply choose not to pick up. Even if they answer, they may decline to participate in the interview. And COVID-positive individuals who do share information may not share completely. For example, some decline to identify contacts out of concern for the privacy of family members or friends. Others have told me they plan to inform those they have been around about their status, and thus the health department does not need to be involved. This well-intentioned gesture, unfortunately, makes potentially infected individuals invisible to pandemic-control efforts.
A major part of the problem is that contact tracing is a black box to most Americans. It certainly was to me before I started this job. This lack of awareness, combined with prevalent mistrust of government and scientific expertise (as well as reasonable concerns about sharing one’s own or another’s personal information), is diminishing the ability of contact tracing to slow the pandemic’s spread.
What can be done? One valuable step would be to broadly share with the public truthful, positive information about contact tracing and its role in protecting health and saving lives. Different messages may be needed for different audiences, and skilled translation will be required to reach non-English speakers. The campaign should be coordinated in a way that ensures consistency among national, state and county efforts, while allowing for customization based on local conditions.
Marketing and communications experts should help guide the initiative. Industry and foundations can join government, providing financial support and access to their networks and influence. Messaging through social media and television will be essential, but other outreach should be considered: regular press briefings; mailings of fact sheets to every home in America; and signage on buses, trains and in airports. Messaging at the neighborhood level can be mediated by community-based organizations, such as grocery stores, restaurants, and churches. As appropriate, spokespersons — sports figures, newscasters, entertainers and trusted locals, such as clergy and firefighters — should be enlisted.
Implementing an ambitious initiative like this will require significant funding. Balanced against the value of lives lost to the virus and the impact of the pandemic on our economy, however, such investment should be a no-brainer. Few states currently make available data useful for judging the effectiveness of contact tracing efforts, so setting and announcing goals and publicly sharing information about progress toward the goals will be important. Combined with successful messaging, such transparency can help renew public trust in our institutions and restore our faith in each other as we move toward a post-COVID world.
Greg Pearson (firstname.lastname@example.org) is retired and working part-time as a contact tracer in Maryland.