Contact tracing will be one of the most critical weapons in a community’s public health arsenal, so the faster governments deploy digitally driven systems, the sooner they’ll understand the full impact of the spread -- and will be able to go on the offensive against the virus to protect their citizens.
“Contact tracing” is a new phrase for many Americans, but not for governments. In non-pandemic times, it is a complex but essential process to monitor and control any infectious disease – and one that can be managed by a small number of trained health care experts doing the work by phone. These experts identify anyone who has tested positive for a communicable disease, verify where they’ve been and to whom they might have spread germs, then reach out to those at-risk contacts to encourage them to quarantine or seek medical care for their own symptoms – all the time respecting the privacy of the people they contact.
Contact tracing has been credited as a major driver of stopping SARS in 2004, and there is little doubt that it will prove equally as critical for the current COVID-19 pandemic, where asymptomatic transmission has been a significant cause of infection. But the extraordinary demands of COVID-19 also mean that the current manual approach is no longer feasible. To keep up with the sheer numbers of infections and to protect all at-risk citizens, governments must rapidly scale and expand their processes. To do that, contact tracing must become digital while still protecting the privacy of citizens.
We’ve been working closely with a number of state and local governments as they work to keep their citizens safe by modernizing the contact tracing process. Here’s what we’ve learned are critical elements for a digital contact tracing system that works:
Technology must be at the heart of the solution: Today, contact tracing is a numbers game: The more people that opt-in and participate, the more lives will be saved. Houston, which is battling one of the fiercest outbreaks in the country among its 2.3 million residents, quickly realized the impact of switching from a manual to a tech-driven process based on the sheer numbers it could reach. Within the first week of deployment, more than 2,000 queries went out to individuals who had potentially been exposed, saving the human contact tracers hundreds of hours of outreach and interviews. The city also added 2,000 additional contacts that human contact tracers had not been able to connect with after weeks of trying.
“With manual processes, if you’re trying to reach out to hundreds of people each day, you’re not going to get to all of them,” said Mohammad Anjum Taj, a senior IT project manager for the Houston Health Department. “So if you think people have been exposed, and if you're reaching out to them two weeks later, or a week later, then it's already too late.”
The process must be purpose-built for the community: While the philosophy of contact tracing will remain the same across geographies, an effective program must consider the skills and resources of its organization. The health department in Michigan’s Ottawa County (which has a population of nearly 300,000) knew the number of people who tested positive for COVID-19 would grow exponentially – and yet, the nurses charged with calling high-risk contacts still had their normal jobs to do. So they built out a system that automated patient engagement.
Instead of calling each potentially infected person every day, close contacts of a COVID-19 patient receive a daily text or email from the health department for 14 days asking them to share their current health status and any developing symptoms. If they don’t respond for three days or mention they’ve been experiencing symptoms for at least two days, the system triggers an action for one of the nurses to follow up.
On the first day the system was live, 31 people responded. That saved five hours of staff time. Within a few weeks about 370 people were responding per day, and by the end of May alone, cases and their close contacts had reported their daily health status about 5,000 times, saving over 800 hours of staff time.
The solution must recognize and respond to citizen concerns: Ultimately, contact tracing only works with individual participation, so any digitized process must account for the concerns and conveniences of the public:
- It must be easy to use: An effective contact tracing program should use technology to strip out every layer of friction that could stymie participation. This includes offering a variety of contact methods to meet citizens where they are – via email, text or phone call – and making the question form brief and straightforward.
- It must be accessible to all citizens: A digitized and automated approach can help local governments overcome language and literacy barriers that could block effective tracing. Individuals who prefer a language other than English should be automatically assigned a human contact tracer for assessment. The initial outreach should also allow contacts to verify the information that was submitted about them. If it’s correct, they should stay in the automated system, but if anything is off, a human contact tracer should correct their record.
- It must consider privacy concerns: Because the contact tracing process manages confidential health data, people must understand that their privacy is being respected. Coupling an automated, opt-in form with a government’s standard privacy practices can help achieve this. In Houston, people can share locations they have visited and individuals with whom they have come into contact in a simple, opt-in form – sharing only the information they choose. The solution helps the city notify impacted individuals and instructs them on next steps so they can take the appropriate safety measures while maintaining individual confidentiality.
The U.S. is still in the thick of the battle against COVID-19, and the coming weeks are sure to be critical to defining our success at slowing and managing infections. Contact tracing will be one of the most critical weapons in a community’s arsenal, so the faster governments deploy digitally driven systems, the sooner they’ll understand the full impact of the spread -- and will be able to go on the offensive against the virus to protect their citizens.
The process won’t look the same in every community, but the most effective contact tracing systems will be digital and automated, and protect people’s privacy.