The Role of Contact Tracing in Keeping the Curve Flat When done effectively, it can lead to reopening of businesses and increased economic activity.
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As the world continues to battle the COVID-19 pandemic, one resounding consensus from health experts and organizations is that communities and nations need to work together to continue to "flatten the curve." This refers to the bell-shaped curve that outbreaks typically take and the need to lower where the peak of that curve is to ensure that medical facilities are not overwhelmed as they try to provide care. A key strategy for doing this is contact tracing.
What is contact tracing and why do we need it?
Contact tracing is a process that allows medical professionals or other authorized personnel to figure out who has been exposed to a disease and who they've come into close contact with. It's critical for controlling an outbreak because it allows individuals to take preventative measures against infecting others (e.g., self-isolating) and to get appropriate treatments if necessary.
Contact tracing is not a new idea or process. Professionals have been using it to detect possible disease transmission for years, including well-known illnesses like HIV. The difference between contact tracing efforts pertaining to those diseases and COVID-19 is simply scale. This is possibly the first time that healthcare workers and support staff have tried applying this technique to such a large, impacted population.
When officials look at a pandemic from a financial perspective, they consider contact tracing as the fourth of five main areas necessary to restart the economy. (The other four are lowering the infection rate, ensuring adequate medical capacity, ensuring we can test for suspected infections quickly, and continued public education and guidance.) Effective contact tracing can lead to the reopening of businesses and increased economic activity faster than would be prudent with no or ineffectual contact tracing. It also means leaders may have a better sense of whether their region is an infection hotspot so they can weigh economic risks against the potential for illness/loss of life and determine how long to enforce specific health orders.
Implementing contact tracing and respecting privacy can go hand-in-hand
Historically, contact tracing has been conducted by an authorized representative of a public health agency orally interviewing an infected person to ask them who they may have been in physical contact with over a certain length of time. The persons identified as potential contacts ordinarily would not know that they are being named by the patient or have the ability to opt-in or opt-out of the process at the time that their information is given to the health care agency for follow-up.
As public health agencies consider adopting technological means to perform similar functions, there is an increased focus on ensuring that the privacy of both the infected person and their potential contacts is respected.
While lawmakers can and should consider the ramifications of contact tracing on individual privacy, it is important to note that the public health agencies (regardless of whether they are conducting interviews or supplementing those efforts with technology) require minimal information to perform contact tracing. This information is often limited to the contact's name and a reliable method of reaching them for follow-up (such as phone number, email or physical address). The most critical aspect of contact tracing is to get this limited amount of information to the contact tracers as quickly as possible, so that the tracer can notify the patient's contacts of their potential exposure. This, in turn, enables the patient's contacts to make informed decisions about their own health and avoid exposing others. There is no need to capture other sensitive, personal information such as private areas of a person's health, work or habits. There is also no need to retain information once the investigation is over. Contact tracers are trained by public health agencies to avoid capturing or disclosing any personal information that is unnecessary to their critical task. For example, contract tracers are trained not to disclose the identity of the infected person to that person's contacts or to third parties.
Concerns about individual privacy should be balanced against the clear and compelling need to slow the spread of a highly communicable disease across our communities. Because COVID-19 can be spread by a person experiencing no clear symptoms, the consequences of delay can be catastrophic. Contact tracers have a very short window of time to get in touch with individuals before they potentially spread the virus even further. All it takes is one trip to a retail shop for an inadvertent carrier to infect many others. This means that public health agencies should consider using all available, responsibly-developed tools at their disposal to rapidly determine a patient's contacts and obtain the best possible information for reaching those individuals.
Some organizations already have both databases of public information and verification technologies. This makes them well-equipped to help local and state health departments conduct contact tracing efficiently, even for a large number of people, without relying on tactics that raise deeper privacy concerns. This could be a vital step when it comes to mitigating or slowing additional waves of infection.
As an example, we developed our own contact trace report in addition to an online people search in an effort to support capabilities that are assisting public health agencies. These types of tools allow authorized and trained contact tracers to verify certain relevant relationships (e.g., your employer) and basic information (e.g., your address). This can make a big difference in the amount of time a contact tracer has to spend completing a case.
Demand for these types of capabilities is increasing and might continue to do so as the pandemic evolves. For example, some states are already leveraging existing relationships and contracts with providers. Virtually any type of vendor that's designed to do mass contact — a call or support center, for example — may be able to leverage its infrastructure to assist public health agencies in contact tracing work. This kind of vendor has a great opportunity to assist the government in combatting this public health emergency. The challenge is linking the right government decision-makers with the right private sector partners despite the other difficulties and distractions the pandemic creates, such as trying to find an adequate number of ventilators.
For real success, empathy matters too
Technology and increased partnerships can make sure contact tracing has a high level of efficiency and effectiveness. At the end of the day, though, the real challenge is empathy. Contact tracers must work quickly — at the same time, they're delivering bad news, and often, the people they talk to are scared. The more comforting and caring tracers can be in dealing with the people they investigate, the more successful their investigations will be.
Finally, agencies and individual contact tracers must also remember that they are dealing with all demographics. Some might respond to different tracing techniques or tools more positively than others. For example, millennials may prefer texts or Skype calls and senior citizens may want a traditional telephone call. Flexibility in approach and resources might improve both understanding and response.
When it comes down to it, it's about keeping as many people as safe as possible and preventing or minimizing the further spread of the virus. This can be done without throwing privacy out the window and in such a way that the data gathered can help local governments make important decisions about opening things back up. With the right technology and the right approach, we can all work together to flatten the curve once more — and keep it that way.