Contact Tracing- Fossella: Improve Contact Tracing First to Save Lives, Taxpayer Money
Fossella: Improve Contact Tracing First to Save Lives, Taxpayer Money
Among top health professionals it's no secret contact tracing can be a highly effective tool to limit the spread of infectious diseases. Contact tracing has been a vital part of public health for decades, helping limit or eliminate measles, Ebola, HTD's (including HIV), and many other nasty contagious diseases.
It's also not uknown that contact tracing is currently not working, at least in the United States. That is, it's not for COVID-19.
There are several compelling reasons:
—Our current tracing system has been simply overwhelmed;
—Ineffective tracing methods having been pushed on untrained, ineffective tracers; and
—Our less-than-stellar testing system, specifically the overly long time it currently takes for too many of us to receive test results.
With 40 years of experience in successfully dealing with the public on sensitive, health-related issues along with the arrival of new, accurate and rapid tests, we believe it is time to prepare and launch an effective contact-tracing 2.0.
Congress knows the potential benefits of contact tracing; through the CARES Act, health departments, nationally, hired tracers to ramp-up operations.
Of course, for the reasons enumerated above, it just didn't work.
There are new efforts in Congress to spend billions to increase contact tracing.
Let's improve contact tracing first so we can save lives and taxpayer money.
For contact tracing to work well, we must get to as many people as possible, as quickly as possible.
In theory, a positive case is contacted within 24 hours of diagnosis and asked to list her contacts of anyone she has spent 15 minutes with, recently. She is also asked to self-isolate.
The tracer notifies the "close contacts," and requests that they self-isolate.
In practice, however, the positive cases and their close contacts too often continue to go about their business, infecting others and spreading the virus.
To begin with, we need to increase the number of contact tracers.Nationwide, the number of contact tracers needed is approximately 204,000, yet there are an estimated 60,000 tracers performing the job. That is less than 30% of the needed amount.
Completed calls are too long. Why? Because too much information exchanged between a contact and a tracer.
Also, contacts are not made to be a true part of the solution.
At a minimum, every positive case should be urged respectfully to notify close contacts and to alert the contacts to expect a call from a tracer. Equally important, the positive case should encourage cooperation with the tracers.
There are several other reasons that the programs are not working well.
—It is difficult to get people on the phone;
—People do not like to share information with a stranger, let alone sensitive personal health information;
—Positive cases that are reached are either reluctant to share or unable to remember all close contacts;
—Calls are often too long exchanging too much information; and
—Cell phone numbers are more important than phone landlines, yet availability is lacking
Local health departments, in some cases, were able to obtain contacts from17% of the people they interviewed. In addition, tracers fail to get 90% of the contacts to give detailed interviews.
Contact tracing 2.0 must begin with a promise and premise of Resolution With Respect.
Everyone involved needs to not only provide empathy and support, but also be smart about how we success is measured. This success cannot be measured by who made the most calls.
Instead, we need an outcome-based model to measure whether we're successfully solving the problem.
The model would include the following:
—Are we reaching people telephonically?
—Are we providing and and getting relevant information?
—Are we communicating well enough with positive cases?
—Are we encouraging all involved to participate, to contact others, and to cooperate?
—Are the calls too long?
—Are we effective?
—Are we stopping the spread of COVID-19?
If we are truly serious about stopping the transmission of COVID-10, we must do what is right and fix what is broken. Let's launch Contact Tracing 2.0 — now.
Fmr. Congressman Vito J. Fossella represented and served New York's the 13th Congressional District 1997 2009. He was the lone Republican from New York City. He now serves as senior vice president at RTR Financial Services (a healthcare receivables firm).
Dr. Ram Raju who was CEO of New York City Health and Cook county Illinois Hospital Systems (two of the largest public health systems in the United States co-authored this article.