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One of the most intensely debated topics in the U.S. since the start of the coronavirus pandemic has been testing, specifically whether the country is doing enough testing to accurately track the outbreak. Health experts agree that testing capacity is critical, but they also point to another element in an effective virus response that hasn’t gotten nearly as much attention: contact tracing.
Contact tracing is the process of tracking down anyone who has come into contact with an infected person, letting them know they may be at risk and telling them to isolate themselves so they don’t pass it on to more people. Effective tracing can break the chain of transmission and limit isolated outbreaks before they spread into the broader community.
Experts agree that a robust tracing system will be a key part of containing the virus in the U.S. as lockdown restrictions are gradually lifted. The Trump administration’s coronavirus plan calls for national contract tracing, but the programs are being carried out by individual states.
New York Gov. Andrew Cuomo said his state will hire an “army of people” to trace the contacts of positive cases. Estimates suggest the U.S. will need anywhere between 100,000 to 300,000 contact tracers to successfully contain the virus. In addition to human tracers, some tech companies have developed apps to aid contact tracing using phone data.
Why there’s debate
A major reason why epidemiologists believe contact tracing will help fight the coronavirus is because it’s worked in the past. In the 1940s, the U.S. government enlisted an elite cadre of highly trained health experts to track a pervasive outbreak of venereal disease. Since then, contact tracing has been a key element of efforts to combat a variety of pathogens, including smallpox, AIDS and Ebola. More recently, contact tracing has been a major part of the response of the most successful coronavirus response plans, like those in South Korea and Germany.
With proper investment, the U.S. has the opportunity to mobilize a nationwide corps of contract tracers, public health experts say. Though tracing can be complex, it requires no special skill or experience, meaning the country has a vast potential workforce of recently unemployed workers who could be hired.
Despite its potential, some experts express doubt that the U.S. can carry out an effective contact tracing program. Without a nationwide plan, tracing programs have been left up to the states, leading to a patchwork of systems across the country. There’s also concern that the country is too late in getting tracing systems up and running. According to research by NPR, there were 11,000 tracers working in the U.S., and most states’ plans for future hiring fell well short of estimates of how many tracers would be needed. Others say the U.S. still doesn’t have the testing capacity to identify asymptomatic cases of COVID-19, a step that’s necessary before tracing can begin.
Even a properly staffed system could be overwhelmed by the size of the outbreak in the U.S., especially if lifting lockdown restrictions leads to a surge in new infections, some experts fear. The effort may also be hampered because years of persistent robocalls have made people reluctant to answer calls from unknown numbers. Those who do answer may consider questions about personal health as a violation of privacy and refuse to answer.
Democrats in the House of Representatives passed a $3 trillion stimulus bill that includes money to fund states’ contract tracing programs. The Republican-led Senate is expected to consider its own legislation to boost the economy when it returns from recess at the beginning of June. It’s unclear whether additional funding for contact tracing will be included in that bill.
Contact tracing is critical to any plan to reopen the country
“If we don’t have extensive contact tracing in every community in America, it’s going to be really hard not to see this virus when we open back up. It’s not a ‘nice to have’ — it’s an ‘absolutely fundamental to have.’” — Public health expert Dr. Ashish Jha to PBS Newshour
Humans are more effective than apps
“The human element of contacting someone on the phone, gaining their trust, having them view you as an ally and accepting your recommendation to self-quarantine and share who they’ve had contact with is very important and somewhat of an art. I’m not sure a tech-based solution could replicate that.” — Contract tracing consultant Steve Waters to CityLab
Contact tracing can provide high-quality jobs to thousands of recently-unemployed workers
“Hiring an army of contact-tracers would also create much needed jobs in an economy that just hit 15% unemployment. There are plenty of talented and capable people who could be given the means to feed and care for their families through this program.” — Dr. Abdul El-Sayed, Detroit Free Press
Even if doesn’t stop every transmission, contact tracing can still do enormous good
“Contact tracing won’t stop all spread of the coronavirus. But just because you can’t fix an entire problem doesn’t mean you shouldn’t fix some of it. Every time contact tracing results in an infected person’s being isolated or a contact’s being quarantined when that person develops infection, a web of transmission is broken.” — Tom Frieden and Kelly Henning, New York Times
Tracing can provide a middle ground between lockdown and unsafe reopening
“We have, broadly speaking, three choices. We could maintain shelter-in-place indefinitely, devastating the economy. We could end it for everyone, leading to more outbreaks and needless deaths. Or we could be strategic — identifying the sick and at-risk through testing and tracing, suppressing outbreaks, building up our public health capacity, and keeping laid-off workers employed until the economy has recovered enough to reabsorb them.” — Tracy Walsh, Bloomberg
Contact tracing can identify infected people before they show symptoms
“[There is] a growing body of evidence that people with minimal or no warning signs like fevers and coughs are a major vector of the disease. That underscores the critical importance of contact tracing. The very goal is to identify people who don’t know they’re infected and encourage them to quarantine themselves before they unwittingly infect others.” — James Temple, MIT Technology Review
Lack of guidance from the federal government is holding back tracing efforts
“This is a war we can win. But, without adequate support for this existing workforce from state leaders, the CDC, Congress and the President of the United States, many more lives will be lost and we will continue to lose ground.” — David C. Harvey, CNN
Contact tracing doesn’t work if there isn’t enough testing
“It’s important to remember that contact tracing doesn’t work in a vacuum. States need to have robust testing capacity; without the ability to find positive cases in the first place, contact tracers can’t do their work.” — Caroline Chen, ProPublica
Coronavirus spreads too fast for tracing to be effective
“Trouble is, a mountain of scientific evidence indicates contact tracing won’t work against the coronavirus. And given the virus’ nature, deploying it earlier probably wouldn’t have stopped the spread.” — Betsy McCaughey, New York Post
Many states can’t afford to pay for a large tracing program
“Some states have the resources to conduct statewide contact tracing. … Most states, though, will need more resources to meet the need for contact tracers. Due to underfunding, many state public health departments won’t be able to meet the demand. And given the projected economic impact of Covid-19 on state budgets, it is unlikely that this will change.” — Jaewon Ryu and Karen M. Murphy, STAT
Tracing will only be effective if the entire country is committed to making it work
“If contact tracing is to be successful, we need more legislator buy-in, and citizen buy-in as well.” — Editorial, The Advocate (Louisiana)
The public may not trust strangers with such sensitive information
“An army of 180,000 contact tracers provisioned with telephone headsets and scripts does not guarantee that anyone will want to talk to them, much less follow their advice.” — Kate Murphy, New York Times
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