Why the U.S. Contact Tracing System Failed (And What We Can Learn from It)

Most of us are familiar with the term “contact tracing”. The purpose of tracing is to find people who have had contact with someone who tests positive for coronavirus. Contact tracers reach out to them to let them know they may have been exposed to the virus. These traced individuals are urged to self-isolate for at least 14 days. Contact tracers can also help educate local populations and help people find a safe place to quarantine.

These disease detectives need people to volunteer their personal information, including their recent whereabouts, so they can prevent the spread of the virus as much as possible. However, many people do not like the idea of giving such information to strangers, and they don’t like strangers calling them. Contact tracers regularly ask tough questions for the greater good, but they also have to put up with a lot of confusion and distrust.

Health experts agree that contact tracing is one of the best ways to manage and prevent future outbreaks, but more resources are needed. Can the country’s contact tracing system survive? What would it take to fix it?

The History of Contact Tracing

The idea of contacting people and tracing the spread of a virus is not new. Similar methods have been used to curb the spread of infectious diseases like Ebola and SARS. It is also commonly used to detect the presence of sexually transmitted diseases.

More recently, several countries have used this method to essentially eradicate the coronavirus from their populations. Germany and South Korea have reported a great deal of success in recent months. Infections and deaths have plummeted in these countries. As new cases pop up, contact tracers swarm into action, stopping the spread before it leads to another outbreak.

However, both countries are much smaller than the U.S. The American people are free to travel across state lines, where different isolation and containment rules take effect.

Why Contact Tracing Failed to Take Off

Contact tracers range from experienced health professionals to volunteers and new hires that have been trained on how to deal with these matters. Nearly every state has started hiring and training contact tracers, but the efficacy of these programs tends to vary dramatically across the country.

Local health officials decry the lack of a national contact tracing strategy. Reports suggest that the White House has been looking to cut as much as $25 million in virus testing and tracing funds from the latest COVID-19 relief bill. Currently, officials are leaving it up to the states when setting up and utilizing these programs.

Many contact tracing teams report a lack of enthusiasm among the general public. Some have been insulted over the phone and others have been hung up on, even as they try to protect these individuals from the virus. Many people outright refuse to give their personal information, seeing the call as a violation of their privacy.

In New York City, just 35% of residents who were called volunteered their personal information over the first two weeks of the program. Contact tracers have also had trouble locating those who may be infected with the virus. Some people may be hesitant to give their locations over the phone.

There is also no way for these tracers to enforce their recommendations. When a contact tracer tells someone they may have been infected and that they need to self-isolate, there’s nothing they can do to make sure the person follows through.

What Does this Program Need to Succeed?

Health experts agree that more information and guidance at the federal level could help these programs take off. If more people were aware of contact tracers, who they are, and what they’re trying to achieve, they may be more willing to answer questions related to their health and follow up with the recommended guidelines.

Many states simply do not have the funds to take on more tracers. Studies show that many fall short when it comes to managing these outbreaks. In Arkansas, the state is trying to get up to 900 tracers, but health officials say they need 3,722 tracers based on recent outbreaks. The same is true in Florida. The state needs around 291 tracers per 100,000 people, but right now they only have seven per 100,000 people.

The National Association of County and City Health Officials says the U.S. needs around 100,000 contact tracers to contain the virus, which could cost around $3.7 billion.

Should we rely on the general public?

Getting more people to trust the system could help with participation, but that may be a tall order, considering just 17% of Americans say they trust the government, according to the Pew Research Center.

We need to contain the virus as soon as possible, so we probably can’t wait for public trust to improve dramatically. Some have suggested turning to private companies as an alternative.

Uber recently announced that it plans to share passenger information with local health departments to boost their contact tracing efforts. The company will give health officials access to their data. They can then make recommendations based on infection rates, such as having the company reduce the number of drivers on the road or banning a user from the company’s services if they have tested positive.

This could help states track the spread of the virus among young people who are more likely to share a ride and leave their houses. The company already has 103 million users inside the U.S.

Health officials may have to lean on the private sector to get these programs off the ground, including bars, cafes, restaurants, and entertainment venues. Social networking tools, like Facebook and Instagram, may also play a role down the line as we try to stop the spread of the virus. Tracers can use these tools to digitally track a person’s location, find out who they were with, and whether they wore a mask or practiced social distancing.

We still have a ways to go in terms of tracking and containing this deadly disease, but we shouldn’t give up on contact tracing just yet. Keep this information in mind and encourage your patients to cooperate with these important programs.