According to the CDC, contact tracing is a critical element in preventing the spread of the COVID-19 virus. According to a Wall Street Journal article, one study suggests the country will need to hire 184,000 contact tracers to meet the demand.
States are already ramping up their contact tracing programs, spurred on by millions of dollars in federal funds dedicated to this purpose. One relatively small state is spending $112 million on its contact tracing program that includes hiring 700 people to interview by phone infected residents who will identify those with whom they might have come in to contact while they had the virus. The callers will then contact those who might have been exposed to advise them of their exposure and provide them with possible courses of action to protect themselves and others.
This seems like a slow, expensive, and potentially ineffective way to identify people who may have been exposed to the virus. First, it will require time to train and deploy qualified tracers. A hiring notice for one state requires only a high school diploma or its equivalent, but also asks that high school graduates have additional qualifications:
- Ability to exhibit a professional, positive attitude and work ethic.
- Excellent interpersonal skills required and ability to interact professionally with culturally diverse individuals during a time of crisis and distress.
- Ability to show empathy to distressed individuals.
- Excellent organizational and communication skills.
- Ability to handle confidential information with discretion and professionalism.
- Proficiency with computers.
- Experience in social work or public health is preferred.
CDC guidance on contact tracing provides that the following non-exclusive skills are required:
- An understanding of patient confidentiality, including the ability to conduct interviews without violating confidentiality (e.g., to those who might overhear their conversations).
- Understanding of the medical terms and principles of exposure, infection, infectious period, potentially infectious interactions, symptoms of disease, pre-symptomatic and asymptomatic infection.
- Excellent and sensitive interpersonal, cultural sensitivity, and interviewing skills such that they can build and maintain trust with patients and contacts.
- Basic skills of crisis counseling, and the ability to confidently refer patients and contacts for further care if needed.
- Resourcefulness in locating patients and contacts who may be difficult to reach or reluctant to engage in conversation.
- Understanding of when to refer individuals or situations to medical, social, or supervisory resources.
- Cultural competency appropriate to the local community.
This is a lot to ask of young inexperienced workers. According to the same Wall Street Journal article, only 20,000 of 150,000 applicants passed the assessment after taking 6 hours of free online training offered by the Bloomberg School of Public health.
The Today Show reported that librarians are currently doing some of this work. While they may be excellent contact tracers for now with the libraries closed, they will be increasingly unavailable as libraries reopen. Indeed, while the pool of all workers may be more skilled now, they too will disappear as they go back to their old jobs or find new opportunities in a reopened economy. The remaining candidates will need both significant training and a detailed script.
Even the best contact tracers are likely to miss a lot of contacts. An infected person may have been at the grocery store or a convenience store or on a bus or subway. A contact tracer cannot possibly identify those who came in contact with an infected person in those locations. Only very specific encounters can be traced. Early in this pandemic, I was contacted by the office of an infected person with whom I had come into contact to let me know he had been in the hospital with the virus. That’s the easy case; his office probably just checked his calendar.
Technology may be able to provide a faster, less expensive, and more effective solution. As the Today Show report noted, multiple technologies are evolving that can help with contact tracing. These involve cell phone apps that trace where a person with the virus may have been.
Privacy concerns can be minimized by voluntary use of these technologies by an infected person whose cell phone could then identify others he may have come into contact with. An analysis of the data from the cell phone could then lead to others who were exposed. It seems unlikely that a person who has unknowingly been exposed would object to receiving a notification of potential exposure. That is all the human contact tracers are doing; they are just doing it one phone call at a time and trying to navigate the interpersonal communications issues of a potentially sensitive subject.
Like so many technological developments, these contact tracing technologies can help to bypass much of the manual human effort. As a result, potentially exposed people can be identified more quickly, and more of them are likely to be identified.
The country needs a faster and better way to do contact tracing. The federal government will give states billions of dollars to spend on contact tracing. States should use that funding on technologies that do what human contact tracers do, but just do it better.