On 30th April, South Korea reported no new domestic cases of COVID-19. It was a major milestone for a country that, in late February, saw almost 1,000 new cases a day. South Korea’s trajectory is an especially potent point of comparison because the first confirmed COVID-19 case in South Korea and in the US were reported on the same day — 20th January.
A large part of the country’s success in containing the spread is thanks to contact tracing. Used alongside mass testing and social distancing, it has allowed the country to control the virus without lockdowns or closures of all non-essential businesses. Now, as cities like New York see a slowdown of daily confirmed cases, health departments across the nation are hurrying to hire a massive number of contact tracers that experts say are absolutely necessary to prevent a second wave of infections from devastating the country. Ahead, we’ve outlined what exactly a contact tracer does, and how you can potentially get involved.
What Is A Contact Tracer?
Contact tracing has been used for centuries to help track down sources of infectious disease and help prevent spread. In the 1800s, contact tracing led to the discovery that a London outbreak of cholera could be sourced to a single contaminated water pump.
Dr. Mari Armstrong-Hough, an assistant professor at NYU School of Global Public Health, has participated in contact tracing efforts to curb the spread of tuberculosis in several countries. “Public health experts have used it to control lots of respiratory diseases, including SARS, MERS, and tuberculosis, which is what I work on,” she says. And now, contact tracing will be used to help contain the COVID-19 pandemic. “To move forward, we have to do two things: test and trace. We need to dramatically scale up testing to identify new cases and we need to trace the contacts of every reported case.”
Contact tracing, in short, is like a detective meticulously connecting the dots on an intricate pin board of suspected cases. A large part of the detective work is talking to people on the phone — asking a lot of questions but also answering a lot of them too. According to Armstrong-Hough, these are the five steps used in traditional contact tracing:
Step 1: “Identify a person who has been clinically confirmed to have COVID-19.”
Step 2: “Use a structured conversation to identify that person’s epidemiologically relevant contacts.” This would be people they've had close contact with — like coworkers, people they live with, and people who have been less than six feet from for more than a few minutes.
Step 3: “Reach and communicate with each of those contacts to provide information, resources (including testing), and guidance about preventing transmission.”
Step 4: “Keep in touch with each contact to monitor symptoms until they receive a negative test result or the quarantine time frame passes.”
Step 5: “Work with contacts to identify their own epidemiologically relevant contacts, tracing a second generation of contacts.”
It’s apparent from these steps that contact tracing is hard work. “Traditional contact tracing takes time because it depends on a series of person-to-person conversations,” says Armstrong-Hough. A group of tuberculosis researchers in Vietnam has recommend that COVID-19 tracers may need to reach out to up to three generations of contacts, not just one. “But good contact tracing can happen fast, and it can happen at scale —especially with the help of mobile technology.”
This less-traditional form of contact tracing is what’s been used in South Korea over the last few months to great success. It hasn't just helped with determining accurate whereabouts of a confirmed patient — technology has also kept the population more informed, thanks to an app that sends phone alerts when someone is within 100 meters of a location a confirmed COVID-19 patient has visited. In the US, Apple and Google are working on their own contact tracing tech that would similarly send alerts to your phone if you’ve been in possible contact with someone confirmed to have COVID-19.
It’s important to note, though, that apps aren’t a replacement for the traditional work of actually reaching out to a contact and having a conversation with them. “Apps can help facilitate faster tracing, but they do not replace contact tracers,” says Armstrong-Hough.
Contact tracers not only interview people who may have been exposed, asking them questions about their living situation, race, date of birth, and any current symptoms or other health factors that help determine whether they are high or low risk — they also offer information on how to obtain testing, and resources so that patients can quarantine effectively. They provide intelligent human support to people that apps can't replace.
Why Is It Important?
Contact tracing is important because prevention is the ideal scenario in managing COVID-19. We’ve seen what a stark difference the combination of social distancing, aggressive testing, and contact tracing has had in major urban areas. NYC, a city of about 8.4 million people, has had 170,534 confirmed COVID-19 cases at time of writing; Seoul, a city of about 10 million people has had just 637 confirmed cases. Contact tracing saves lives, and it would also give us the ability to ease the lockdowns that have led to so much economic suffering.
But what experts note about contact tracing is that it’s really only feasible when you have a relatively low number of infections. Once there are too many infections, it becomes nearly impossible to reach out to every confirmed case and track down all of their contacts. It’s why having an army of trained contact tracers ready to get at the root of another COVID-19 wave is so crucial to avoiding more tragedy.
A less obvious reason why contact tracing is important is that it gives an authoritative human voice during a frightening and often isolating pandemic. “Person-to-person contact tracing has benefits beyond just interrupting transmission: contact tracing can provide basic education about the disease, improve early symptom recognition, facilitate safe care-seeking, and directly link contacts to resources and testing,” says Armstrong-Hough. “Above all, it's a concerned, trained person calling another person to provide information and guidance during a time when isolation, uncertainty, and misinformation are rampant.”
How To Become A Contact Tracer
Becoming a contact tracer requires training — while a script can help guide your interviews, you can't just read off of one. Given all the responsibilities of the job, it’s good if you have some kind of background in public health.
“In general, anyone with a high school education, good communication skills, and a commitment to helping can be trained to contact trace,” she says. “This is important, because it means that the people who carry out contact tracing can be recruited directly from the communities they will serve.”
Most states are currently in need of more contact tracers. New York City Mayor Bill de Blasio has stated that the city is looking to hire 1,000 contact tracers as soon as possible, and New York state may hire up to 17,000. In California, Governor Gavin Newsom has said that he wants 10,000 contact tracers working throughout the state. Texas is hiring almost 3,000. Experts say that nationwide, we may need at least 100,000 contact tracers to help stem the spread of COVID-19 effectively. To find these job openings, you search on job boards like Glassdoor or Indeed, your state health department’s job board, and through health organisations like Partners in Health.