Do-It-Yourself Contact Tracing Is A ‘Last Resort’ In Communities Besieged By COVID-19

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Eileen Carroll, left, sits for a portrait as her daughter, Lily, 11, attends school remotely from their home in Warwick, R.I. on Dec. 16. When Carroll’s other daughter tested positive for the coronavirus, state health officials told her to notify anyone her daughter might have been around. Contact tracers, she was told, were simply too overwhelmed to do it.

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David Goldman/AP

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Tedi Milgrom, a contact tracer for the health department in Washtenaw County, Michigan, calls a person who may have been exposed to the novel coronavirus. Milgrom and her colleagues have been overwhelmed by a surge in COVID-19 cases over the last month.

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Washtenaw County Health Department

Tedi Milgrom, a contact tracer for the health department in Washtenaw County, Michigan, calls a person who may have been exposed to the novel coronavirus. Milgrom and her colleagues have been overwhelmed by a surge in COVID-19 cases over the last month.

Washtenaw County Health Department

«It makes things more confusing,» says Bacolor, the contact tracer in Washtenaw County. «People might be hearing something different from their job or school than they are from the health department.»

Bacolor’s experience was common among contact tracers, says Lori Tremmel Freeman, the CEO of the National Association of County and City Health Officials. She said local health officials had little warning from the CDC about how the quarantine guidance would be changing.

«To just issue [new quarantine guidance] at the federal level and expect it to be implemented across the country really is a disservice to local health departments who have to explain it on top of dealing with the pandemic,» Tremmel Freeman says. «They are scrambling right now.»

Asking infected people, some of whom might be sick, to call their own friends and families — in effect, conduct their own contact tracing operation —is far from ideal, public health experts agree.

«It is a last resort tool,» says Beck, the University of Michigan professor. «It is the best that we can do in the situation that we’re in, but it’s a compromised strategy.»

Contact tracing is more than just alerting people to a potential exposure, so they can quarantine. Part of the process is to do carefully structured interviews with the exposees, to determine if they’ve developed symptoms of COVID-19. If so, contacts of those people also need to be traced and told to quarantine, to prevent the virus from proliferating through successive chains of people in the community.

Trained contact tracers also often ask valuable questions to learn more about how the virus was transmitted from person to person, so that local health officials can piece together an understanding about which settings and activities seem particularly likely to promote spread — in-person choir rehearsals and crowded bars, for example — and which are unlikely to generate outbreaks.

Contact tracing is one key part of a tried-and-true strategy known as «test, trace and isolate.» Public health professor Angela Beck says that the strategy has been used all over the world, and it works — when there are enough people and enough time to do it properly.

Effective contact tracing can help mitigate the economic pain of a pandemic because it means that only people with known exposures to the virus must keep away from work, school and other activities, she says.

But success requires significant investment in public health infrastructure, something that Beck and other researchers say has been lacking for decades in the U.S.

This story comes from NPR’s health reporting partnership with Kaiser Health News.