As the biomedical community works to develop treatments and vaccines for Covid-19, a national strategy of social distancing, broad testing, and isolating individuals with the virus will be required to stop its spread. Contact tracing — identifying individuals who have been infected with the virus and the people they’ve been in contact with — must be at the core of this strategy. It is exactly what is needed for a safe return to a “new normal.”
Contact tracing has historically involved state and local public health departments reaching out to individuals infected with communicable diseases, such as measles or sexually transmitted diseases, as well as to those with whom they have come in contact so they can take the necessary actions to prevent spreading the disease. This works best when we know how a communicable or contagious disease is spread.
Unfortunately, contact tracing as it has been traditionally done won’t be feasible as we begin to reopen society following the Covid-19 pandemic. We need a new approach.
Tom Frieden, the former director of the Centers for Disease Control and Prevention, recently estimated that 300,000 contact tracers would be needed in the U.S. if we are to reopen the country safely. Some states have the resources to conduct statewide contact tracing. Massachusetts, for example, announced it is working with Partners in Health, an organization that has focused on building health systems in developing nations, to hire 1,000 public health workers to perform contact tracing.
Most states, though, will need more resources to meet the need for contact tracers. Due to underfunding, many state public health departments won’t be able to meet the demand. And given the projected economic impact of Covid-19 on state budgets, it is unlikely that this will change.
Against the backdrop of these challenges, public health officials and medical professionals need to develop strategies that extend the framework for contact tracing. We propose a new multifaceted approach that leverages public-private partnerships: Hospitals and health systems can serve as extension of the public health infrastructure by playing the important roles of providing needed bandwidth and resources in contact tracing until a vaccine is available. This infrastructure could be coordinated and subsidized by the federal government and implemented in partnership with state public health departments and local hospitals.
The private sector is already starting to augment public health departments because of the huge number of people needed to effectively contain the virus. Heath systems, specifically, have committed to track their patients and report positive tests, so resources that would be used by public health programs to track those patients can deployed in other ways.
Such a system would work because health systems have deep ties to the communities they serve that enable an understanding of the ways a contact tracing program would be most successful. These community ties foster trust that is essential for this kind of program, which relies on transparency between people and organizations.
Health systems have already developed the infrastructure to manage Covid-19 testing, communicate results, and manage patients who are positive for it in their homes and inpatient settings. Those capabilities are transferable to functions needed for a robust contact tracing program. Partnerships between health systems and public health departments exist already where the department has oversight in areas like labs and infectious disease control.
The Geisinger health system, which we work for, reaches out to patients who have asked about Covid-19 testing because they have symptoms suggesting they might have the virus. A health care worker schedules tests for them and educates them about the importance of isolation until the test results come back. These patients are also asked about close contacts, such as family members, friends, co-workers, and others they might have been in contact with over the previous two days. Health care workers then call those individuals about the need to get tested and maintain isolation until their test results are back. They, too, are asked about their close contacts, and so on, extending the chain. This methodical approach to contact tracing protects employees, patients and communities in support of public health.
Technology may become an important part of any effective contact tracing strategy to create the scale needed to reach the number of people who are at risk for contracting the virus. In other countries, mobile apps using Bluetooth and GPS technology have been deployed to some extent to identify infected persons and their contacts. In the U.S., MIT data scientists and Silicon Valley developers have created similar technology. Apple and Google recently announced a collaboration to develop contact tracing technology.
But as in other aspects of health care, technology is an enabling strategy that augments human interaction, it doesn’t replace it. Some populations, like the elderly, the economically disadvantaged, and other vulnerable groups, may not have access to smart phones. And we cannot overlook privacy concerns when it comes to sharing personal health data.
No solution will be perfect in an unprecedented time that calls for innovation to push us beyond traditional approaches. We know that lives will be saved by deploying innovative, broad-based mitigation, including isolating patients who have tested positive for Covid-19 and their contacts. The ability of the economy to rebound and the number of lives saved will be directly correlated with our ability to stop the spread of the novel coronavirus.
Medical professionals need to stand ready to work with their federal and state governments and other health care systems to create and implement a successful plan that leverages everything that we have in our toolbox.
We don’t know what lies ahead when we begin to reopen the country. What we do know is that it is imperative to stop the spread of Covid-19. To do that we need to augment the public health system to achieve the collective impact of 300,000 contact tracers.
A private-public partnership between trusted health systems and public health departments, enhanced by technology when possible, would provide the most complete solution to reach the broadest section of the population for the essential task of contact tracing.
Jaewon Ryu, M.D., is president and chief executive officer of Geisinger, an integrated health care system based in Danville, Pa. Karen Murphy, Ph.D., is Geisinger’s executive vice president and chief innovation officer.