The Disease Detectives | Contact Tracing During the COVID-19 Pandemic

Just breaking the chain of transmission could manage the pandemic, prevent second waves, and enable us to get safely back to normal life.

The reason that we know as much as we do about the COVID-19 pandemic is that teams of scientists, medical staff and public health professionals have been working around the clock, around the globe. The scientists are researching the virus and host, setting up clinical trials, working on testing for the virus and vaccines. Doctors and nurses are caring for the patients, testing them for the virus, recording their observations and collecting data.  

The public health experts are the “disease detectives” who identified the epidemic and tracked its origin and monitored its spread. Their analysis of the data triggered the global public health response to the pandemic that would reduce COVID-19 cases, illness and death.

We owe them a lot: Recent computer modeling by scientists in the United Kingdom indicates that without the general measures we implemented in Austria, we could have had over 60,000 deaths.

Now, as the numbers of cases decline, their role changes, and they focus on new outbreaks and use contact tracing to prevent a significant second COVID-19 wave. With new rules that permit increasingly larger groups at concerts, cinema, theatre and other events and that open borders with neighboring countries, we need a robust systematic public health approach for contact tracing. 

Why Contact Tracing Matters

This is the public health ‘disease detectives’ next assignment: To identify COVID-19 outbreaks and superspreader events as early as possible to prevent a massive and deadly second wave. Their principal task is to find new cases and all the people who were in contact with a COVID-19 infected and contagious person. This “contact tracing” is a well-established public health tool that has contained severe outbreaks of measles, SARS-CoV-1, HIV and Ebola. 

But contact tracing must adapt to each new virus, because the type of spread may differ. For example, the SARS-CoV-2 virus disease pattern was very different from SARS-CoV-1 and led to new WHO contact tracing guidelines for COVID-19. 

Perfect contact tracing could mean eliminating the virus. However, identifying only half of the symptomatic cases and tracing half of their contacts could still have a significant impact. Just breaking the chain of transmission could manage the pandemic and prevent second waves, and enable us to get safely back to normal life.

What Contact Tracers Do 

Contact tracing creates an increasingly complex spider web of contacts and clusters of infection that require support and follow-up. The team of contact tracers create a map of transmission as they track the spread of the virus from person to person by asking each coronavirus infected person about their contacts, and then ask those contacts about their contacts, and so on. It is by meticulous tracking of the disease that makes it possible to detect cases early and stop an outbreak. 

This is not such an easy job.  It is difficult for most of us to remember everywhere we went and who we interacted with yesterday, let alone last week. However, skilled contact tracers help potential contacts to retrace their steps as accurately as possible. The process can be time-consuming and intrusive, especially with private interactions. Public health officials do take privacy concerns seriously and are ethically and legally bound to protect the information and only use it for public health reasons. The contact tracer will only inform the contacts of a potential infection and do not reveal the identity of the source. 

Contract tracing also requires excellent communication skills: The multi-lingual contact tracers must be able to explain in language that the average person understands what the disease is, what the risks are of becoming ill themselves or passing the virus on to others. Beyond language, contact tracing also requires knowledge of cultural beliefs and practices that affect trust in the health care system and access to services and any concerns about discrimination.

The contact tracers explain about quarantine measures, self-isolation, testing options and tell them how to protect family and friends. They also provide information about what to do and where to go if the person becomes sick. They help connect people with organizations that can help with support like delivering groceries and other supplies and sometimes can even help to find a place for people to stay in quarantine away from their families.

Effective contact tracing program requires a lot of human resources, time, money, and cooperation – at least 30 tracers for every 100,000 people. If we calculate the population in Austria as about nine million, then we would need 2700 contact tracers in the field. If we consider the cost-benefit ratio with fewer tracers, these should focus primarily on clusters of cases. 

Technology Can Help

Smartphone Apps can assist with accurate contact tracing during the pandemic by automatically alerting people that they’ve been in contact with someone with coronavirus and connects them with the help that they will need. Several countries including Singapore, China, France and Iceland, are recommending (in some cases requiring) that the public download specially-designed smartphone Apps. However, people have to use it, it must work well, and there must be enforced privacy protections.  Some countries use surveillance cameras, but this too has raised privacy concerns. 

We are fortunate in Austria: Appropriate general measures are in place and the public has cooperated to a very high degree. Ideally, it’s important to stay informed about the infection and the different types of symptoms as we learn more about COVID-19. Stay current about the daily situation of the pandemic in Austria – follow the coronavirus updates in English on the Metropole website and worldwide at the WHO or one of the other organisations. 

Tips for helping with COVID-19 contact tracing:

  • Inform the hotline if you think that you were in contact with someone with COVID-19
  • Inform the hotline if you believe that you have COVID-19 and ask for a test
  • Self-isolate if you were in touch with someone with COVID-19 and be sure that your family is protected
  • Write down what you remember of your last two weeks with particular attention to where you went, how long you were there and who you met
  • Be open and honest about your contacts to the contact tracers
  • If you can, inform your friends or colleagues that you are concerned about the contact

Public Health Agencies in Austria

At the EU level, public health measures are coordinated by the European Public Health Association (EUPHA), of which the Austrian Public Health Association, is a part (Österreichische Gesellschaft für Public Health, ÖGPH). Then there are the Division for Public Health at AGES – Austrian Agency for Health and Food Safety Ltd., the Center for Public Health at the Medical University of Vienna, and finally,  the Austrian Public Health Institute for Health Promotion, Quality Planning and Research (Gesundheit Österreich GmbH, GÖG) connected to the Ministry of Labour, Social Affairs, Health and Consumer Protection. 

Dr. Michelle Epstein
Michelle Epstein is a medical doctor graduated from the University of Alberta in Canada, who has specialised in Internal Medicine at the University of British Columbia and Allergy and Clinical Immunology at Yale University. Since 2004, she has been a Lab Leader at the Medical University of Vienna’s Division of Immunology.

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