As the novel coronavirus continues to rage throughout the United States, many public health departments are facing an overwhelming number of individuals to trace and care for. With the help of person-to-person contact tracing organizations like Partners in Health (PIH) and CONTRACE Public Health Corps, infected persons are able to have human conversations, ask questions in real time, and build a trustworthy connection. These groups are working to humanize COVID-19 infection and testing data, and provide thoughtful, culturally-appropriate information through person-to-person contact tracing.
As we’ve discussed before, there are serious concerns and risks to privacy with digital tracing. Digital surveillance tracing is also missing the trust factor. “The program is intended to be a supportive community initiative, where the autonomy remains with our community members,” said Matt Reynolds, a contact tracer for the Massachusetts COVID-19 Community Tracing Collaborative (CTC). “This is important for maintaining the trust of the public and thus the success of the program.” Outlined below are several reasons for cities and local governments to invest in person-to-person contact tracing. Local governments who do so can:
Provide Social Care Resources
The CTC is a partnership between the Massachusetts Department of Public Health and the global nonprofit PIH. Right now there are hundreds of contact tracers working from 8am to 8pm, seven days a week. Units are composed of both initial case investigators and the follow-up contact tracers who call contacts for each positive case and check in on COVID-19 positive individuals during isolation. And every unit has one or two Care Resource Coordinators who focus on addressing the social needs of individuals who are isolating (positive cases) or quarantining (contacts). These coordinators are geographically segmented, so they can use local knowledge to help connect people with the appropriate resources in their communities. Reynolds said that this assistance can include “applying for unemployment and/or rental assistance, medication deliveries, isolation/recovery sites through the Red Cross, connecting them with primary care physicians, or possibly just scheduling more frequent check-ins if they may find themselves without sufficient social support during their isolation or quarantine period.” However, the most commonly requested assistance is for food delivery.
Prioritize Data Privacy
Privacy is prioritized in the human-to-human contact tracing. In Massachusetts, the statewide epidemiological system tracking positive cases is only accessible to the local health boards. Any cases that exceed the local health department’s capacity are sent to the separate CTC system; only then are the contact tracing units able to see them. A case investigator will call to check on the COVID-19 positive individual, determine any care resource needs (like medication delivery or rental/unemployment assistance) and add their contacts into the secure system to be called by the tracers. All of this is highly secure, and privacy protocols are an ongoing part of tracer education. By contrast, there are many examples of COVID-19 location surveillance apps being hacked or leaking personal data.
Bring Jobs to Distressed Communities
The many new job openings for contact tracers can help meet the needs of the growing number of unemployed workers during COVID-19. CONTRACE Public Health Corps is a company that aims to recruit and “deploy an army of 100,000 qualified contact tracer applicants to help fight COVID-19.” Steve Waters, CONTRACE founder, is very intentional with matching contact tracers with their local communities. This is for two reasons; one, they will have the appropriate cultural literacy to build trust with callers. But two, Waters wants to specifically direct jobs to distressed communities, which have been hit the hardest by both the virus and the economic crisis. Ideally, he wants states and localities to allot a certain percentage of tracer positions to people from those hardest-hit communities. Some cities, like Baltimore, are already directing contact tracing jobs to newly out-of-work residents.
Mitigate Surveillance Fears
There are many reasons to be concerned about how contact tracing apps are conducting mass surveillance. Beyond the standard privacy fears, this is especially poignant when the hardest-hit people are immigrants and communities of color. Reynolds described it as “pretty staggering how disproportionately immigrant community members are represented in the individuals we are calling. I can say without a doubt that I’ve made more calls in Spanish or using the interpreter line (for Portuguese or Cape Verdean Creole, mainly) than I have in English.” This means that many communities with high rates of COVID-19 need communication about contact exposure, but are understandably hesitant to install tracing apps from either the government or private companies.
Matthew Leger, the senior director of strategy at CONTRACE and Data Smart City Solutions writer, worries that the tech based contact tracing apps will never be adopted at scale, which constrains their effectiveness. And Waters pointed out that “another reason to be optimistic but skeptical of tech-only solutions is because of communities without smartphones.” Person-to-person, trust-building phone calls that can provide additional social support are crucial to reaching these groups and reducing rates of infection.
After roughly six months of dealing with the novel coronavirus, person-to-person contact tracing is still a recommended best practice for combating the virus. In recent weeks, Massachusetts has decreased the size of its contact tracing workforce; in part this is because virus cases have declined in the state and local health boards have increased their tracing capacities, but there are also towns that are concerned that the CTC was not efficient enough to trace the virus at the speed they needed. However, the tracers that are still working in Massachusetts and around the country are committed to improving the service — and committed to the patients. “We are often following entire families at once, and it has been a privilege to be invited into the lives of these families,” said Reynolds. “We will continue to do what we can to look after our most vulnerable communities.”