An inside look at contact tracing

Contact tracing is the hot new thing! As we described in a previous post, IGHS faculty and staff are at the forefront of national efforts to contain COVID-19 through contact tracing – identifying people who have been in contact with those who have COVID-19 and instructing them to isolate so they don’t infect anybody else.

To recap: At the start of this effort the San Francisco Department of Public Health didn’t have the capacity to do all that needs to be done to stay a step ahead of the novel coronavirus that is upending every aspect of city life. So, the department tapped IGHS experts with long resumes building capacity for public health officials around the world to train San Francisco city workers from other departments to do the work.  

Contact tracing sounds simple, so why can’t we get these efforts up and rolling around the country? Well, after logging a couple shifts as a contact tracer, I’m here to tell you, it’s not that simple.

The reasons why say a lot about the challenges of global health work and about why economic disparities translate into health disparities. 

Consider this: Quarantine – which is what they call isolating someone who’s been exposed but doesn’t show signs of being sick – lasts two weeks from the last date of exposure to the coronavirus. If someone lives with the COVID-positive person, that means they need to know the last date that person had symptoms. What was I to tell the woman whose husband first got sick a month prior and was still not exactly better? Was he still symptomatic? When was he last contagious? I opted to have the on-call doctor call her, but that takes time and money.

What about the COVID-positive mother who needed to isolate herself so as not to infect her three-year-old daughter?

What can we tell people who don’t have anyone to shop for them or pick up their prescriptions? San Francisco is ahead of most cities in its willingness and ability to provide social services for the sick and quarantined. But the city is scrambling to nail down the details, and the eligibility requirements and the process is changing a bit each day. Each time they change, every contact tracer has to adapt.  

One man was exposed to multiple people in his house who have COVID-19. One housemate identified him by a nickname and the other by his full name, so he had two case files for him. When he tried to access food support, he gave his full name, but they had only his nickname. This was – amazingly – resolved by a medical student doing her first shift of contact tracing.

This work can be scaled up, but it will always be labor intensive, and it will always require people who are clever and persistent problem solvers and have a healthy dose of empathy. And in many places, most of them will also need to be fluent in another language because recent immigrants make up a big percentage of the low-paying jobs that keep groceries on the shelves and nursing home patients bathed and fed.

It would be easier if those essential workers all had the time and money to take ESL classes. It would be easier if they didn’t have to live with 5, 10 or 15 housemates to make rent. It would be easier if everybody had paid sick leave so they could continue to afford food and medication when they’re required to stop going to work for quarantine. It would be easier if everyone who’s been laid off as a result of the pandemic had already received enough education and training to dive right into problem solving using unfamiliar software. It would be easier if everyone had a regular doctor and could access testing and medical care. It would be easier if we could refer everybody to the same place for testing, and not to an array of private and public providers. It would be easier if the government could provide food and medicine for everyone who is required to stay home. The pandemic has shined a spotlight on the thinning American safety net.  

At times, it’s hard to remember why it’s so difficult to achieve the straightforward goal of global health – bringing proven care to more people. An inside look at how a tattered safety net can complicate even seemingly simple plans refreshes one’s memory. If only we can act on that insight as we move forward, we might manage to do more effective global health work and to improve U.S. health outcomes as well.