The Elements of Successful Contact Tracing

Contact Tracing

Contact tracing is a public health strategy that, with active collaboration, produces positive results relative to infection control and spread. But the public’s preconceived notions about contact tracing are less positive. Fear of oversight and overreach, misunderstanding, apathy and pandemic fatigue are some of the feelings that many associate with it. This makes a deliberate method of contact tracing imperative: one that combines the proven process with a human approach.

Background and basics of contact tracing
John Snow, an English physician, first described the elements of contact tracing in the mid–1800s. The components start with an understanding of how the agent that causes the disease is transmitted. Once this is determined, all those that an infected person has interacted with are identified, traced, monitored and isolated through an incubation period of the infectious agent to confirm whether or not transmission has occurred. All suspected or confirmed infections are isolated. An outbreak is considered resolved once two incubation periods elapse without any new cases being identified.

Snow’s hypothesis that the Broad Street pump was the key source of London’s cholera outbreak in 1854 was a relatively simple question to test; only those residents who used that water source were at risk of being infected because cholera is water borne and not transmitted between people. In comparison, COVID-19 is transmitted from person to person, and this, coupled with today’s easy movement of people within and between cities, makes for a more difficult transmission link to break. However, the fundamental value of contact tracing in controlling outbreaks has remained for more than 150 years.

The challenges of contract tracing today
Today, people establish close contact with many others every day and each of these people, in turn, are in contact with still more, creating a rapidly expanding network. The novel coronavirus has been difficult to contain because those who are infected can be contagious for days before they display symptoms, and some infected people may never show symptoms at all. These challenges, combined with misconceptions about the contact tracing process, make it important for institutions to have a contact tracing plan and process in place before employees and students return.

The elements of successful contact tracing during COVID-19

  • Speed– Because the virus spreads rapidly, contact tracers must move quickly and reach individuals to cut off new branches of infection. Because speed is a must, a team should handle contact tracing responsibilities, rather than an individual.
  • Confidentiality– A contact should be informed where they were exposed to the novel coronavirus, but never by whom. It is important that a contact–tracing team understand and adhere to confidentiality and privacy guidelines.
  • Specificity and Clarity– One of the most common questions about contact tracing is, what exactly defines a contact? The CDC defines a close contact as someone who was within 6 feet of an infected person for at least 15 minutes, starting two days before the infected person began experiencing symptoms. It is a big ask to request that someone stay home for 14 days, so it is important for a contact–tracing team to be thorough, but also not to cast too wide of a net. Contact tracing is not an all–or–nothing scenario. A May 2020 study using a model based on the Boston metropolitan area found that as long as 50% of symptomatic infections were identified and 40% of their contacts were traced, the resulting reduction in transmission “allowed the reopening of economic activities while attaining a manageable impact on the health care system.”
  • Empathy– Receiving a call from an individual saying you may have been exposed to a dangerous virus can be a scary experience for anyone. In addition, many people are now tired of staying home, and may find the news daunting, as it requires them to isolate for two weeks. A human element is critical in helping people to receive and process this information well. Within the two–week period, the isolated individual must receive wellness check-ins to ensure his or her wellbeing.
  • Trust– Contract tracing truly depends on trust. It can only be successful with voluntary cooperation. People are less likely to give information to a stranger. Contract tracing is most successful when completed by a person who communicates a sense of trust and establishes rapport. It’s also an incredibly important task that can literally save lives, so it should be entrusted with a team that understands the process and is trained to carry it out correctly.

Contact tracing has been used successfully to fight infectious disease outbreaks around the world, from the 1930s when it helped stop a syphilis outbreak in the United States to 2014 during the Ebola epidemic in West Africa. Contact tracing, conducted by an empathetic team that instills trust, is key to safely reopening schools and businesses.

written by Dr. George Astrakianakis

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