I finished the COVID-19 contact tracing course from Johns Hopkins online last Friday. This Monday morning I was surprised to find an article in Wired by a journalist who has taken the same class, an article in the New York Times on the huge numbers of people who have applied to become contact tracers, and the MIT Technology Review had both an item on why contact tracing may be a mess in the U.S., and a piece on what it is like to be a contact tracer.
Sonofagun. Sandbagged by a zeitgeist.
The class was easy but contact tracing is not. When I started taking the class, I thought it might be a nice way to volunteer and do my bit in the pandemic crisis. But as I began to learn what a contact tracer does, I began to have doubts that I am tough enough to be a one. If an opportunity arises, I’ll give it a try, but I am not nearly as confident that I can help as I was before I took the class.
Washington State already has a robust contact tracing program in place. Close to 1400 tracers have been trained. Most are from public health services. Around 400 come from the state Department of Licensing which has been idled by the virus, another 350 are National Guard volunteers. I may still have an opportunity to volunteer because experts estimate 30 contract tracers are needed per 100,000 population, in other words, our state may need another 850 tracers. However, an arthritic C++ coder with no background in healthcare is not likely to be among the best candidates.
Contact tracing has been used for centuries for controlling infectious diseases. Recent victories over the Ebola, SARS, and MERSA epidemics are the result of contact tracing. Social distancing slows the spread, but contact tracing defeats epidemics.
Essentially, contact tracers question each person with COVID-19, discover whom they could have infected, phone each of these, warn them that they could contract the virus, and ask them to stay home until the danger that they will infect others stops.
A number of things make contact tracing a tough job. Sometimes, a contact tracer is the first to tell a victim that they have tested positive. Asking someone to stay home from work and away from their family is hard. Tracers also warn victims of symptoms like shortness of breath, chest pain, or turning blue (yes turning blue) that mean they may die soon if they do not get help immediately. Some people will need help getting food, paying bills, and getting child or parent care. None of this is fun.
COVID-19 has some nasty characteristics. Each infected person appears to infect 2-3 others, some estimates are higher. Hence the soaring number of cases and deaths in just a few months. At present, evidence shows that a person can infect others from 2 days before they get sick. The danger continues until they are well. If you are exposed to COVID-19, it can take as long as 2 weeks for symptoms to appear. In other words, you are a threat to others and should quarantine for two weeks after you are exposed.
Perhaps the scariest part is that you may never show symptoms and still pass the disease to others. Remember the Typhoid Mary story? She was a cook who had typhoid, but no symptoms. She refused to quarantine and continued to spread typhoid, leaving a trail of misery and death. This is why we should all wear masks when we are out and about and close to others. The mask prevents you from becoming a COVID-19 Typhoid Mary.
One of the reasons I feel compelled to volunteer is that the virus is so deadly. Best estimates are that people infected with COVID-19 die 2 to 3 times more often than flu victims. The flu kills 12 to 60 thousand Americans each year. And that’s with a vaccine. COVID-19 has killed over 90,000 in 4 months. Early on, it was said that the virus doesn’t affect children, but cases have turned up in which children get severely sick and a few have died. There is some evidence that death rates increase where more people are infected. That is, in ten square miles where 100 people are infected, 2 or 3 may die, but in the same area where 10 times as many are infected, many more than 20 to 30 die. We have to stop the spread of COVID-19.
As is to be expected in 2020, a robust contact tracing plan is accompanied with a haze of vicious misinformation. Isolation and quarantine, contrary to what is being said in some circles, is not mandatory. A National Guard volunteer may call you, but they are calling to trace your contacts, not to force you into quarantine. If asked, quarantine yourself to protect your family, friends, and neighbors from misery and death from the virus. But no one will force you to do the right thing. The information collected by a contact tracer is confidential like health records in your doctor’s office and your name will not be passed to your contacts.
This is the way contact tracing is done in a free democracy. Places under authoritarian regimes force victims to stay inside at gun point and publicly shame them. Not here.
On the other hand, for the time being, the authoritarians are doing much better than we are against the virus. They will be glad to take over if a free nation can’t handle COVID-19.