When you find out that you have an infectious disease – or that you are at risk of becoming infected – the natural reaction is fear.
In the Russian language, there is no precise word to describe what these people do. In English, they are called contact tracers, which literally means people who trace contacts.
Many scientists believe that these people will now help not only to stop the spread of the coronavirus completely, but at least to prevent its second wave. In theory, officials in most European countries agree. In practice, however, some systems simply do not work.
Despite the ever-increasing number of infected people, Germany, unlike the U.S. or the U.K., did not stop contact tracing – the process of identifying people who have been in contact with infected people – even at the height of the pandemic. Yesterday’s medical students, firefighters, and even military personnel volunteered. It is believed that the work of these people helped Germany cope with the epidemic better than other European countries.
Berlin – the city hardest hit by the coronavirus in Germany. In each of the capital’s 12 districts, a separate team is working to trace the contacts of those infected with the coronavirus. Information about cases of infection is usually provided by laboratories, and initially they give only the name, sex and date of birth of the patient, and sometimes – his contacts. The rest is done by people whose task is to find this patient and the maximum number of those with whom he/she had contact. Municipal authorities – and in Germany this is their responsibility – find the contacts of the infected and inform them of the diagnosis.
At this stage, experts say, local health workers and volunteers often have to act as psychologists – people react differently to this information, they have a lot of questions: what to do now, how to self-isolate, how to inform their boss, how to deal with children who go to school, who will help them buy groceries, whether to call a doctor or go to the hospital?
Volunteers must have a clear understanding of infectious diseases, the novel coronavirus, and how the government system works in the specific region where people can seek help and support. “These people should help you come up with an action plan,” says Emily Gerli, an infectious disease specialist at Johns Hopkins University in the United States who has developed training for people who need to track contacts of the infected. “They should provide an answer to the question: What are you going to do with your grandmother, who you have been taking groceries to all this time, if you can no longer leave the house?”
Volunteers must help the patient develop an action plan. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain: episodes. The end of the story: Podcast Advertising
“When you find out that you have an infectious disease – or that you are at risk of contracting it – the natural reaction is fear,” says epidemiologist Christina Coil, who once worked in the field. “It was very difficult for me to get involved in contact tracing. I tried to deal with different people’s reactions, but each situation was so different… Good volunteers should be patient, courteous, sensitive and flexible. They are true extroverts who get energy and pleasure from interacting with others.
Second step – persuade a person to remember and give the names of everyone the patient has been in contact with recently. This can sometimes be difficult: people do not want to be “snitches” and isolate their relatives and friends. And sometimes they just forget – so volunteers do not limit themselves to just one call. The ultimate goal of contact tracing is to identify all individuals who may have been exposed to the pathogen, convince them to seek testing and treatment, and thereby stop the epidemic.
Christina Coil explains: “In the case of Covid-19, for which there is currently no effective treatment, the goal is to encourage people to get tested and to take precautions that reduce the risk of transmission – in this case, self-isolation. In Germany, local authorities are responsible for tracing contacts of the infected, whereas in the UK this is regulated at national level. Prime Minister Boris Johnson promised that the British system would become the most efficient in the world. Experts relied on by the government have said that in order to stop the epidemic, it is necessary to trace up to 80% of the contacts of infected people. During the first week of the system’s operation, just over 8,000 people were added to the database, but only 5.4 thousand provided information about their recent contacts. They provided the names of another 31.7 thousand people, of whom only 26.9 thousand agreed to self-isolate when contacted by volunteers. Former chief scientific adviser to the government, David King, said the British system in its current form was not up to the task, while opposition MP Ben Bradshaw, quoted by the New York Times, called the system “a complete mess”.
Some volunteers in the UK complain that all shifts are looking at a blank screen. Sarah Penn, a British citizen on a government program, completed her training at the end of May, but has not made a single call since. “My training was eight hours online. There was general information about the NHS [National Health Service of the United Kingdom – BBC], about the coronavirus, about the importance of contact tracing. And a scenario on how to communicate with people, and information on how to respond to difficult questions. And a couple of other scenarios: how to talk to somebody who has lost somebody, how to talk to somebody who has children involved,” says Penn. In fact, there was no communication with specialists during these trainings, there was no one to ask questions to, for eight hours Sarah Penn just looked at slides and videos. Right after that, she was able to pick workdays and start calling people. The first working day did not go well due to technical problems logging into the system. “For the second time, I was able to log in, but I didn’t have any data. I had ten shifts at the moment and I hadn’t made a single call. I just sit there and hit the refresh button on my browser. Obviously, there are more volunteers now than there are confirmed cases of coronavirus,” Penn says. Commenting on another similar case, the U.K. Department of Health said such stories “do not reflect the tremendous work that is being done. The new contact tracing system “is working and will help save lives,” the department said.
The volunteers’ job is to trace the virus’ path from person to person. As in the U.S., for example, volunteers in the NHS program are paid for their work – slightly more than the country’s minimum wage. In the United Kingdom, for example, a group of retired doctors in the city of Sheffield have created the country’s first system for tracking contact with COVID-19 patients without government support. Contact tracing has proven effective in countries that have successfully managed the pandemic, such as South Korea and New Zealand. Doctors in Sheffield are confident that without a functioning system in place, it will be impossible to prevent a second wave and manage potential new outbreaks as quarantine restrictions are gradually lifted. “I am sure that in order to respond to outbreaks of infection in a timely manner, it is necessary to involve local authorities. First of all, we are not in China where you can just order people not to leave their homes. So it’s important to have people you can talk to who understand. And we are close by and can provide support and help with things like delivering food – because we are asking a person to isolate themselves for 14 days,” says Bing Jones, the group’s founder. “We had problems at first – we couldn’t get through. But since we live here, we can just walk down the street and knock on the door. By John’s calculations, 20% of the people in the city who tested positive for coronavirus did not respond to phone calls, but did respond to letters that volunteers simply dropped in their mailboxes. “And even though we have no authority, we cannot say, for example, we are from the government, so you have to listen to us. But we can say, ‘We live a few blocks from you, and we think it’s important. We are willing to help you,” Jones explains. As the group began its work and volunteers began talking about it in town, many local general practitioners agreed to cooperate and began providing information about cases of the disease themselves.
The group of volunteers in Sheffield acknowledges that they have no authority: “We cannot say we are from the government. But we can say: we live a few blocks from you. “One of the main problems in the UK is that the whole process is government-controlled and too centralized. Local authorities and general practitioners have not been empowered,” says Jones.
Contact tracing is not a fiction of the coronavirus era; health professionals in many countries use this tool in the case of HIV, tuberculosis and hepatitis. “Over the years, we have come to understand that the most important thing is to train people to communicate with the sick. These people need to have exceptional interviewing skills to connect with patients. Of course, there are various applications that can provide people with similar information and even track it. But applications are an additional resource, and I don’t think they can replace the human factor,” says David Holtgreave, a health expert at the University of Albany, USA.
So-called digital contact tracing, using applications or mobile operators, is used in many countries in conjunction with the work of volunteers and specialists, or instead of them, as is planned in Russia. When Bing Jones and his colleagues call Sheffield residents, they always ask the question, “Are you willing to participate in this project? “If someone says no, we are obliged to end the conversation. But that rarely happens. Many people at least initially agree to participate,” says Jones.
The most common problem for volunteers in Sheffield is related to the Data Protection Act. It often happens that people are asked to list the co-workers that the sick person has had contact with at work. We often make phone calls and hear: “I would like to give the names of five people with whom I regularly communicate at work, but I have discussed this with the manager and have been told that I don’t have the right to do so”. In Berlin, where Dr. Lucas Muray works, a team of volunteers and health workers are working to lift the quarantine restrictions.
One coronavirus-infected person at school – one week’s work for the contact tracing team. “People in Berlin started to think that the situation was improving, that there were already fewer cases, but for us, in a situation where schools are reopening, having one or two infected people in a class means a whole week of work. We have to contact the families of each child and the teachers,” he says.
Muray believes that there may even be an increase in work now. He explains that about a month ago, the team was dealing with about a hundred new cases a day. Each of those cases had an average of about five contacts. Now, there are only about five cases a day, but each of those five could have hundreds of contacts. “So not much has changed for us, especially when it comes to schools, hospitals or nursing homes. Sometimes a person can have up to 300 contacts, and for us that is like a snowball behind which is a bunch of potentially infected people that we have to call, check on their well-being, send for testing, and isolate.” The Robert Koch Institute trains special volunteers, known in Germany as scouts. These people are trained and then sent to regions with specific problems, such as staff shortages. The scouts are paid, but their help is free to the regions. For example, the federal government sent 65 scouts to Baden-Württemberg to work in the region for six months – mostly medical students. In the U.S., Emily Gerli, an infectious disease specialist at Johns Hopkins University, and her team have developed special training for people who want to help with contact tracing. The training takes six hours and is conducted online. “States are now hiring people to track contacts, but many have no knowledge of infectious diseases, so our course gives people a general idea of what they are dealing with. This is just the first step,” says Gerli.
Good volunteers should be patient and know how to communicate with people in difficult situations. According to her, such people should be detectives, social workers and psychologists at the same time, but most importantly – they should be able to communicate. But in most cases you have to rely on the honesty of your interlocutors. “No initiative will work unless people have confidence in the health system. It’s like vaccination – it protects us all, so we accept it and get vaccinated. It is often said that the main purpose of contact tracing is to prevent a second wave of infection. Lucas Murai does not really believe that this is possible: “I still think there will be a second wave. We just wanted it not to hit us in the spring. But I think it will happen in the fall. So our task is to break the chain of infection. In Berlin, it is considered acceptable for one patient to infect another, but the third and fourth infections are a problem. For now, the system is coping, largely because there are enough tests to confirm the diagnosis and isolate the person as quickly as possible. “Our goal is to limit the capabilities of the virus,” says David Holtgrave, a health expert at the University of Albany. “If you’re infected but not in contact with anyone, you’re not going to infect anyone.”
So our job is to make contacts before infection occurs.” The problem is that many states and many countries, including European ones, are just beginning to establish the system. Is it not too late? “Yes, it is too late. It should have been done much earlier. But does that mean we should fold our hands and not try to stop the spread? I think we should try,” says Emily Gerli of Johns Hopkins University.
Epidemiologist Kristina Coil is convinced that contact tracing can be stopped when specialists see that the R0 (the basic reproduction number, also known as the “infectiousness indicator”) of the coronavirus has dropped below 1.0: “This means that each new infected person infects, on average, less than one healthy person. When the R0 is less than one, it can be said that the outbreak is coming to an end.