The thinking is that contact tracing notifies people who may have been exposed earlier in their disease course than if they were just left to figure it out on their own based on their symptoms.
In the case of the new Coronavirus, we know that it can take up to 14 days after exposure for symptoms to develop and that people can spread the virus without having any noticeable symptoms. Alerting people to the fact that they may be infected early on can really help slow and prevent the spread.
It all starts when someone tests positive for the new Coronavirus, Crystal Watson, Dr.P.H., senior scholar and assistant professor at the Johns Hopkins Center for Health Security, tells SELF. The lab results from the test will be sent to the person’s doctor as well as the local health department. Once someone is notified that they have a positive COVID-19 test, the health department will get in touch with them, she explains.
The U.S. has definitely been slower to get contact tracing up and running than other countries, Smart says, so, unfortunately, this isn’t necessarily how all cases in the country were handled or even are currently handled (especially in the case of large-scale local outbreaks). But contact tracing is happening now in certain states, like in New York, Michigan, and Maine, and will hopefully extend to the rest of the country soon. The UK is testing the system on the Isle of Wight.
Along with large-scale testing and social distancing measures, contact tracing has emerged as one of the most valuable tools we have in reducing the spread of the new Coronavirus.
But what actually is contact tracing? What does it involve? And what should you know if you’re contacted by a contact tracer? We spoke to a few experts to learn a little more about this crucial public health strategy.
Contact tracing is a well-established public health practice that helps reduce the spread of an illness like COVID-19, Meika Smart, Dr.P.H., assistant professor in the department of epidemiology and biostatistics and the division of public health at Michigan State University, tells SELF.
At its most basic level, contact tracing is the practice of notifying people who may have been exposed to someone who tests positive for the virus so that those people can protect themselves and those around them, thus reducing the spread.
It’s not new; it’s not something that was created specifically to help manage this pandemic, Smart says. Instead, it’s a long-standing strategy that’s been used in previous outbreaks and is used on a smaller scale in the context of sexually transmitted infections, for instance.
That health department employee (who is a case investigator, not a contact tracer, Smart says) will ask that patient how they’re doing and whether they need additional support or access to medical care, supplies, or food. Then they’ll also ask who that patient has been around in the time that they’ve been infectious (starting 48 hours before the onset of symptoms or, for asymptomatic patients, 10 days before their sample was collected for testing), at which point they’ll turn the information over to the contact tracer.
From there, the contact tracer will get in touch with anyone who’s had sustained contact with the patient who tested positive. When doing that, first, they’ll confirm the person’s identity. Then they’ll tell the person they’ve been potentially exposed to the new Coronavirus, and they’ll offer guidance as to how they should behave to try to reduce the spread of the virus, says Smart. This might include isolating from roommates and using a separate bathroom if possible. However, the contact tracer will not reveal the identity of the person who tested positive.
It’s important to note that these contacts aren’t just anyone you’ve had casual interactions with, like someone you passed in the grocery store, Watson says. According to the CDC definition, these contacts are people you’ve had “significant contact” with, meaning that you’ve been within six feet of them for more than 15 minutes. Usually these are people like family members, roommates, and coworkers.
The contact tracer will also share information about the virus, the symptoms to look out for, and the procedure to check yourself daily for possible symptoms. They will also gather demographic information about you, your living situation, and any underlying medical conditions you might have. All of this will allow them to make appropriate recommendations for keeping yourself and anyone you live with as safe as possible.
Ideally, all of the initial contact is made immediately after the first person tests positive. But this is not a one-and-done situation. Contact tracers, case investigators, and other public health employees will continue to check in on you while you self-isolate. If you do develop symptoms, these people will give you information about whether or not you need to be tested and at what point you should seek medical care. And, when the time comes, they’ll help you assess when it’s okay to stop self-quarantining.
Also, for the record, all of this can be done via phone calls, text messages, and emails. Records about cases and their potential contacts are also collected and shared with contact tracers electronically, Smart says. If contact tracers are having a hard time reaching someone or there’s reason to get a test sample in person, that can happen in rare cases. But the CDC advises that in-person communication be a last resort.
If a contact tracer tells you that you may have been exposed to the virus, that is not a confirmation that you have the infection. But it should put you on alert for any symptoms you might develop, Smart says, and you should follow the instructions the contact tracer gives you to prevent spreading the virus as much as possible.
If you don’t have any symptoms, you’ll be told to self-quarantine for 14 days from your last potential exposure to the virus and to monitor yourself for symptoms during that time, the CDC explains. If you do have symptoms, you’ll be immediately referred for testing and medical care and told to self-isolate.
That’s a lot to take in, which is why contact tracers are trained to be sympathetic, sensitive, active listeners and problem solvers. It’s also why it’s so important for contact tracers to be a diverse set of people who can work directly with members of their own community, Watson says. And, depending on your circumstances, you may need some help to actually make it through those two weeks. “If they have to quarantine for 14 days, it’s public health’s job to enable that and get them the supplies they need to do that,” Watson says.
The major issue that contact tracers run into, though, is concerns about privacy, Smart says. In the event that you’re contacted by a case investigator or contact tracer, it’s understandable that you might not feel super comfortable giving your information to them or with the idea that they already have some information about you or your health. This discomfort is very common, Smart says: “People are hesitant to give information – as they should be.” But it’s important to remember that “your information has been given to them by somebody who knows you and wants to save your life,” Smart says.
Also, for these exact privacy reasons, a contact tracer will not be asking you for any new personal information because they should already have it from the case investigator, Smart explains. They should only be confirming information they already have as well as offering recommendations and advice to take care of yourself. Additionally, in some states, efforts have been made to have caller ID show that the call is coming from a state contact tracer so you can feel comfortable answering it even if you don’t recognise the number.
Along with adequate access to accurate tests and social distancing measures, contact tracing will help us monitor and control the spread of the virus. But, unlike those other measures, contact tracing will help us do this in a more targeted way.
“Up until this point, our major tools in reducing the spread of the virus and flattening the curve have been these population-level social distancing measures,” Watson says, including the closing of nonessential businesses and stay-at-home orders. But now that we’re starting to lift those measures, “we need something in their place to manage this in an ongoing way,” she says.
Contact tracing is one answer to that problem because it “helps public health gather data about where the virus is spreading,” Watson says. For instance, if we know that the virus is spreading more slowly in a city overall but we still see an uptick in cases in certain neighbourhoods or among people who work in certain industries, contact tracing will allow us to see that quickly – and act ASAP to contain the spread in those specific circumstances.
As businesses begin to reopen, it will be increasingly important to be able to react to any increase in COVID-19 cases quickly. Ideally, contact tracing will allow us to target the response to the appropriate area only rather than have to put an entire city back on lockdown. This will also help us interrogate information we already have about who is most often exposed to the new Coronavirus, such as low-income essential workers who may not have the option to work from home and who face difficulties in accessing health care.
But the fact that you haven’t been contacted by a contact tracer doesn’t mean you’re completely in the clear. For one thing, right now, the likelihood that a robust contact tracing operation is up and running in your area depends on where you live. But also, for this approach to work, people still need to be taking social distancing and mask-wearing guidelines seriously – whether or not they have reason to believe they’ve been directly exposed to the virus. We also need to have accurate rapid testing for the virus that’s actually available to enough people, something that has been a struggle in the U.S. so far. Remember, this whole process kicks off with a confirmed test result, so we need ample testing to keep it going.
Contact tracing is a crucial step in reopening cities as safely as possible. But it has to work in concert with these other public health strategies – and with the cooperation of the general public – in order to work at all.