There has been much talk of contact tracing as an important tool of COVID-19 risk assessment, but many people don’t understand what it is, how it works, what some challenges are and who’s been doing it well.
What is contact tracing?
According to the CDC contact tracing is: “The process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission. When systematically applied, contact tracing will break the chains of transmission of COVID-19 and is an essential public health tool for controlling the virus.”
This involves identifying people who may have been exposed and then following up with them from the point of exposure. This may sound simple but figuring out everyone a person has been in close contact with is very challenging. And the larger the numbers of people who have been exposed or contracted the virus, the more monumental the task.
Dr. Hugonnet from the World Health Organization explains “You need a system to identify cases, a functioning laboratory, a system to feedback data, people to identify and follow-up with contacts, provide support if they need quarantine, and treat them properly. This amounts – at a minimum — to three days of work per COVID-19 patient. It all adds up.”
Why is contact tracing important in the workplace?
So, why is contact tracing important for the workplace? It is an effective strategy to interrupt disease transmission within the workplace. It accomplishes this by separating people who have, or may have, COVID-19 from people who do not. As many people who have COVID-19 may not experience symptoms or may be shedding the virus before experiencing symptoms; this is vital.
These measures have been used by health departments of different levels all around the world for years to slow or stop the spread of infectious diseases. Most recently contact tracing has been used to stop the spread of SARS, MERS and Swine Flu, among others.
What is the contact tracing workflow?
Contact tracing involves identifying close contacts of those with confirmed positive tests or probable COVID-19 patients. Close contacts are defined as any individual within six feet of an infected person for 15 minutes or more.
These are the steps involved in contact tracing:
COVID-19 patient interviewed
Patient identifies contacts
Contacts triaged for assignment
Contact notified then if testing available and
Contact tests positive, then they are instructed to self-isolate, are referred to a medical provider if necessary, and referred to support services.
Contact tests negative, then contact is followed up with as contact quarantines for up to 14 days from exposure if deemed a close contact.
Problems with contact tracing
Unfortunately, as important as contact tracing is, it quickly becomes complicated and time-consuming. It also becomes increasingly difficult to muster the appropriate resources as cases rise. If it isn’t done within 24 to 48 hours of a positive case, it becomes almost impossible and is also no longer as effective.
We’ve seen this happen all across the world, especially in the west where COVID-19 has spread the most. In England, one in eight people who have tested positive have not been reached, 18% of those who are reached provide no details for close contacts. In the US, more than half of those with positive test results provide no details when asked. And this was not during the first wave in the spring but in November as case numbers quickly were rising.
There are many reasons for these failures. Old technology and underfunded health-care systems have not been able to provide the functions needed. Even wealthy nations have had problems hiring enough contact tracers, organizing them effectively or make sure that people are self-isolating.
There also has been distrust of both health authorities and technologies used in effort to control the pandemic. Without the data, researchers find it hard to draw lessons and suggest best courses of action. Countries with no restrictions on movement will end up needing to trace more contacts than a country with some form of restrictions or lockdown.
In December 2020 Nature Magazine explained: “In reality, failures occur at every stage of this test–trace–isolate sequence. People get COVID-19 and don’t know it, or delay getting tested. Positive results can take days to be confirmed. Not everyone who tests positive isolates when requested. People can’t always be reached for an interview or don’t provide details of their close contacts. And not all contacts are reached, or are willing to comply with quarantine orders.”
As we have learned more about the virus and technology has made getting test results faster, governments have been able to improve their virus response.
Successful use of contact tracingand learnings for occupational settings
Many of the countries who have been successful in controlling the spread of COVID-19 have been able to do so due to their previous experience with other infectious disease outbreaks like SARS and Swine Flu. This includes such countries as Taiwan, South Korea, New Zealand and Japan. Most of these countries cracked down on the disease early and were able to utilize personal data such as mobile-phone signal tracking to ensure compliance and the tracking of purchases and/or CCTV footage to help recreate patients’ movements and identify possible contacts. But these actions bring up concerns about legality and privacy.
With the COVID-19 pandemic, the December 2020 Nature Magazine has noted “A handful of places stand out as exemplars of successful contact-tracing — including South Korea, Vietnam, Japan and Taiwan.” with resultant significantly lower infection rates.
It has also been more common among these countries to have people quarantine at designated quarantine facilities. But most countries do not have this option and many people’s living circumstances make it difficult to isolate. In the United States it is estimated that as much as one in five households lack the space needed for an effective quarantine.
It’s also important to consider culture. Many Asian countries are used to masking when ill or in case of the spread of an infectious disease. There is also a culture of understanding the necessity of such measures, trust in the system in place and less misinformation is circulated.
Even as vaccines begin to roll out around the world, contact tracing is going to remain an important tool to get control of and eventually eliminate the danger of the spread of COVID-19. At Integra we will continue to stay up to date on best practices and communicate best options to all our employees, partners and clients.
Case investigation and contact tracing is a specialized skill. To be done effectively, the CDC guidelines state it requires people with training and medical supervision.
Occupational contact tracing will review in-depth clinical aspects in a timely manner (under 48 hours), regarding potential workplace close contact. The level of detail reviewed with regards to particular workplace issues such as: shared tools, common workplaces, use of masking or personal protective equipment or protracted close quarters labour; is highly likely to be above and beyond what current stretched public health resources are capable of, resulting in reduced workplace transmission tracking of COVID-19 virus.