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The Covid-19 pandemic has exacerbated the work of social services workers already caring for low-income clients impacted by social determinants of health (SDoH). People threatened by Covid-19 tend to share the same risk factors experienced by SDoH stressors, often as a comorbid condition. These include asthma, diabetes (kidney disease), lung disease (smoking) heart disease, liver disease (alcohol and substance abuse), obesity, and those older than 65 (group/nursing homes).
Contact tracing is emerging as a crucial part of the pandemic solution. According to a Johns Hopkins Bloomberg School of Public Health report issued on April 10, contact tracing will:
1: Save lives;
2: Reduce the COVID-19 burden on the U.S. health system;
3: Help ease strict social distancing measures;
4: Confidently make progress toward returning to work and school.
A recent contact tracing analysis from the Shenzhen Center for Disease Control found that contact tracing (in combination with extensive testing) reduced the number of days for disease identification to three days from five days. The study reviewed 1,286 contacts of 391 COVID-19 patients. With earlier detection, contagious individuals can be quarantined sooner to slow the spread of the disease. The study also concluded that 8.9 percent of patients were “super spreaders” and caused 80 percent of infections among their contacts.
Contact Tracing Strategies
The U.S. Center for Disease Control (CDC) states: “Identifying contacts and ensuring they do not interact with others is critical to protect communities from further spread. If communities are unable to effectively isolate patients and ensure contacts can separate themselves from others, rapid community spread of COVID-19 is likely to increase to the point that strict mitigation strategies will again be needed to contain the virus.” Specifically, the CDC lists four key concepts for contact tracing:
- Trace and monitor contacts of infected people. Notify them of their exposure.
- Support the quarantine of contacts. Help ensure the safe, sustainable, and effective quarantine of contacts to prevent additional transmission.
- Expand staffing resources. Contact tracing in the U.S. will require that states, tribes, localities, and territories establish large cadres of contact tracers.
- Use digital tools. The adoption and evaluation of digital devices may expand the reach and efficiency of contact tracers.
Recently, the Massachusetts Institute of Technology published five recommendations for initiating successful contact tracing. The MIT report noted that contact tracing is a “time-tested investigation method “proven in recent outbreaks of measles, HIV, and Ebola.” MIT notes that virtually all medical professionals, including the U.S. CDC, identify contact tracing as part of a “three-pronged plan (along with testing and isolation) for returning the world to normal.”
“I don’t think we can overstate the importance of contact tracing,” says Seema Yasmin, Director, Stanford Health Communications Initiative and a former CDC investigator who focused on epidemics. “It’s been at the cornerstone of every major epidemic investigation from SARS to Ebola and beyond.”
MIT Outlines Steps for Contact Tracing Success
According to MIT, to succeed proper contact, tracing strategies should:
1: Hire 100,000 manual tracers. Trained medical professionals must contact anyone with a COVID-19 diagnosis and follow-up with the up to 100 other people with whom they have been in contact. Such work is labor-intensive, and there are not enough tracers currently in place. As a comparison, New York City, the hardest-hit region, has a population of 21 million people but fewer than 1,000 contact tracers. Wuhan, China, where the pandemic originated, has a population of 11 million people with 9,000 contact tracers at work.
2: Protect Privacy: With the obvious appeal and availability of such technology as Bluetooth and GPS, Apple and Google (which account for 99 percent of mobile phone apps) are rapidly developing an app to assist the public health sector with contact tracing. However, privacy advocates and civil liberties groups have concerns that companies and governments could abuse such active phone-to-phone sharing. Apple and Google are taking steps to mitigate such misuse, which is a good reminder for social service providers and contact tracers to establish and follow privacy protocols in whatever methods they deploy.
3: Ensure that tracing covers as many people as possible: No matter what technology is adopted by a social services provider, in the end, success is dependent upon human contact tracer. Eight out of 10 Americans don’t own a smartphone, and only 42 percent of Americans 65 or older – at high risk for contracting and dying from COVID-19 – do. Human contact tracers will still have much one-on-one legwork to do to be effective.
4: Accept that technology alone cannot solve the problem: In Taiwan, there have been just 428 confirmed cases and six deaths from COVID-19. While the country is an advanced technology-use nation, the frontline of the country’s successful effort has been attributed to human contact tracers, supported by technology.
5: Do it now: Even with the apps still in development, thousands of contact tracers will need to be trained. States and agencies need to act now with contact tracing.
“We’ve got to really understand exactly what we’re doing, who the people we’re dealing with are, what their concerns are, and what works best in identifying and isolating infections, and quarantining those who may have been exposed,” says George Rutherford, professor of epidemiology at the University of California, San Francisco. “That’s the name of the game.”