Smarter contact tracing, not prolonged quarantines needed

Where I live, in the dead of the night, the distant sound of sirens can still be heard every so often. This has been ongoing for some time now, and without letdown, despite the lockdowns in Metro Manila pushing 10 weeks now.

For every ambulance carrying one positive coronavirus infection case, the threat of contamination under current quarantine restrictions can already be formidable.

Considering that one infected person could have been living and interacting with family members over a span of two weeks before being confirmed tested positive for the virus, a dangerous community contamination may already have started.

And yet, when that confirmed infected person and family members go into isolation, or if appropriate, hospital care, there is little attempt to go beyond the apparent, i.e., finding others who may have come in contact with those infected and suspected of being infected.

As underscored in past columns, we have wasted the last 10 weeks spent in lockdown. More money could and should have been allocated to keeping the infection under control through more effective and efficient contact tracing. This could have mitigated the huge economic losses we are now seeing.

Slow and not smart

This is why the World Health Organization has criticized our efforts at contact tracing as slow. The urgent issue is not the number of contact tracers available, but how a contact tracer (or a team) is able to effectively track down other potentially infected persons.

The Department of Health has recently said that the country is short of 94,000 contact tracers, on top of the almost 40,000 it had hired and deployed as of mid-May. We may not be approaching the strategy of contact tracing smartly.

Note that in New York State, which is the epicenter of the COVID-19 infection in the United States, and where close to 400,000 cases had been reported, the local government is looking at employing 17,000 contact tracers in their future efforts to control the virus spread.

With a population of 19.4 million, New York State is already estimating a contact-tracing workforce that is way over the recommended 30 workers per 100,000 to fight the pandemic set by the National Association of County and City Health Officials.

In the UK, with a population of almost 68 million, a team of 25,000 contact tracers is being organized by June 1 to track those possibly infected by the virus. The UK has the fifth largest total number of reported cases to date, with daily cases still in the thousands.

In data provided by the Association of State and Territorial Health Officials in the US, coronavirus-ravaged Wuhan in China had 1,800 contact investigator teams of five people each deployed as a requisite to reopening. That’s one investigator for every 1,200 individuals for a city of 11 million.

Improved approaches

South Korea has a different approach, where state and local public health agencies support contact tracing activities with support from the Korean Centers for Disease and Control, if the severity or size of the outbreak calls for it.

With nine states and an overall population of 52 million people, Korea’s state medical epidemiologists act as the lead for contact investigation activities, while being supported by local public health staff who conduct data collection and tracing activities.

In Korea, too, contact tracing is aggressively supported by digital aids, such as apps installed on smartphones, so that people who may have come in contact with anyone infected could be traced and notified to go into self-isolation.

Everyone on the list is also monitored daily, sometimes twice a day, by the contact tracers. Testing for infection is also within easy reach by most people, with results available within the same day.

In Singapore, with a population of only 5.6 million people, contact tracing centers provide the service of reaching out to those suspected of infection. A national headquarters manages the reporting and oversight guidance, while national health officials and military personnel make up contact tracing teams.

A specialized team of senior epidemiologists and police investigators serves as referral and escalation support for complex cases requiring further investigation and support.

Not too late

The Philippines is a developing country compared to those mentioned above, but it does not mean that we need more people to do contact tracing, or that we have to set up elaborate “call centers” that will work only with everyone in the population downloading a tracing app.

We just need to be smarter. In the world hierarchy of infected nations, we are already in the top 50, although at the lower rung yet. Still, having just under 15,000 reported cases is something that is manageable if we do things right, and quickly enough.

Prolonging restrictive conditions, be it ECQ, MCQ or GCQ, will again just be wasted days unless there is unified and systematic effort to test and to trace. Otherwise, infections will continue amidst a plunging economy.

Again, it is still not too late.

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Should you wish to share any insights, write me at Link Edge, 25th Floor, 139 Corporate Center, Valero Street, Salcedo Village, 1227 Makati City. Or e-mail me at [email protected]. For a compilation of previous articles, visit www.BizlinksPhilippines.net.