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Worth reading in the New Yorker about a five part response to coronavirus: distancing, tracing, testing, isolation, and treatment https://www.newyorker.com/science/medical-dispatch/its-not-too-late-to-go-on-offense-against-the-coronavirus">https://www.newyorker.com/science/m...
You might also read this news report on NZ& #39;s contact tracing experience, and even the actual report
https://www.stuff.co.nz/national/health/coronavirus/121130191/coronavirus-new-zealands-contact-tracing-system-for-covid19-was-overloaded-audit-finds
https://www.stuff.co.nz/national/... href=" https://www.health.govt.nz/system/files/documents/publications/contact_tracing_report_verrall.pdf">https://www.health.govt.nz/system/fi...
https://www.stuff.co.nz/national/health/coronavirus/121130191/coronavirus-new-zealands-contact-tracing-system-for-covid19-was-overloaded-audit-finds
NZ (pop ~ 5 million, so like a medium sized state) has gotten new cases down to ~10/day after a month-long lockdown that was more stringent than in most of the US: national parks closed, police checkpoints and patrols to stop travel and social gatherings. We& #39;ll leave that aside.
But they& #39;re going to have another 5 days in lockdown to make sure the contact tracing system is ready when people go back to work, and stores start to re-open. The report gives a good sense of what went slowly (not wrong) in a pretty-well governed country.
1. The tracing workforce was small (they hired lots of people)
2. The tracing computer systems had to be updated (they did)
3. Tracing units were dispersed across 12 regional units (they basically nationalized it in a hurry)
4. People didn& #39;t answer their phone
2. The tracing computer systems had to be updated (they did)
3. Tracing units were dispersed across 12 regional units (they basically nationalized it in a hurry)
4. People didn& #39;t answer their phone
Highly like that factors 1-3 are common in US public health systems. Lets assume US states can organize state tracing systems with hundreds of staff in a hurry, and do as well as NZ in scaling up their databases to manage cases + contacts.
4. People didn& #39;t answer their phone: Remember that contact tracing is asking a [possibly sick] person who they& #39;ve been in proximity to over the last few days, and getting their contact details so health authorities can call *or visit* to test and isolate the contact.
So then you& #39;re asking a [possibly sick] person for the contact details of these folks. Dispense at this point with any illusion that contact tracing can preserve privacy (minimize privacy loss is more realistic). Cases forget phone numbers, and cases don& #39;t know phone numbers.
Here& #39;s what NZ did in the space of a couple of weeks for their nationalized contact tracing service: the "new contact tracing system ... was linked up with contact details held in the National Health Index."
NZ has a national health system, most people are enrolled with a primary care physician, and have a unique ID (that few regular people actually know, totally unlike a US social security number). Doctors have contact details, so the national contact tracing center could get them.
So even to get human contact tracing off the ground, a state should be able to create a database of lots of their residents& #39; names, phone numbers, and addresses. Again think of the privacy implications, and how to deal with them.
And then people don& #39;t answer their phone: Here was a very basic (but perhaps understandable, they were working in a hurry) mistake they made in NZ. Phone calls displayed those weird 4 digit numbers you sometimes get when a call center calls you.
So now the outbound calls are being programmed to show a local number as the caller, and missed calls will be followed up with text messages. Some basic mistakes but also some structural advantages for NZ: they know your mobile phone number, and where you live (via health index)
There are some hard to replicate parts of what NZ did: it& #39;s an island (good defence against new germs) with its own currency (they can borrow more easily than US states) and strong executive power (the government just gave the Ministry of Health the money)
But there are absolutely things to learn including the difficulties of getting contact tracing up to scale quickly. It took them a month in NZ with an already centralized health system, and a near-universal database of contacts.
The impression one gets from the report is that a system that worked OK (there was a measles outbreak in NZ recently) in normal times was slowing down significantly with covid-19 transmission.
https://www.health.govt.nz/system/files/documents/publications/contact_tracing_report_verrall.pdf">https://www.health.govt.nz/system/fi...
https://www.health.govt.nz/system/files/documents/publications/contact_tracing_report_verrall.pdf">https://www.health.govt.nz/system/fi...
Another recommendation that& #39;s worth noting is that until a vaccine is developed there will be ebbs and flows in how much work there is in contact tracing. So some sort of flexibility is necessary.
There& #39;s clearly advantages in centralization in parts of the process (getting a database of residents& #39; contact details, phone calls), but also some potentially very local parts of the follow-up like "arranging home isolation".
A visit from your local public health office official to start self-isolation is probably going to be more effective than a remote phone-call from a central state office. All of this is possible in America too, but it takes people, money, and learning from what has worked
Until there& #39;s a pharmaceutical vaccine social organization is our vaccine. Thousands of contact tracers (NZ has about 1/1000 people) and some software are cheaper than mass unemployment, and available sooner than universal testing (fin).
