May 12, 2020 - Health

Why contact tracing may fall apart

Illustration of two photographs of people in silhouette pinned to a wall with a broken string between them

Illustration: Sarah Grillo/Axios

Our contact tracing capabilities aren’t where they need to be nationally, and some experts are questioning whether the old-timey public health tool will ever be successfully used to keep coronavirus outbreaks under control in the U.S.

Between the lines: One of the biggest vulnerabilities in the strategy is that, in the U.S. at least, it relies on public buy-in — something that is far from guaranteed.

  • “You need people to be willing to come forward and say, I'm symptomatic, I have this illness. I'm willing to be traced,” bioethicist Jacob Appel told me in an interview for “Axios on HBO."
  • And public buy-in depends heavily on what care and support people can expect in isolation, Appel said. “Contact tracing isn't simply a matter of finding people. It's setting up for people who can't isolate on their own hotels, food delivery, an entire infrastructure to make that work, which is costly and logistically challenging.”

The big picture: The idea behind contact tracing is that public health officials will track everyone that confirmed coronavirus patients came into contact with while infected. Those contacts, once notified of their exposure, would then isolate themselves.

  • If done successfully, this would quash outbreaks before they have time to spread throughout the community.

Yes, but: The U.S. will need 100,000 contact tracers or more to make this happen. It’s unclear how many we have so far, but it’s certainly less than that.

  • When there are too many cases, it becomes impossible and impractical to trace everyone each patient has interacted with.

And then there’s American nature. On one hand, most Americans have taken social distancing seriously. On the other, they’re already tiring of it, and concerns about civil liberties have been raised.

  • “Testing programs depend on...people being so compliant that they will stay home for 14 days because a health worker told them to. Meanwhile, in Detroit last week a grocery store security guard was shot in the head for asking someone to wear a mask,” Keith Humphries, a professor at Stanford University, tweeted yesterday.
  • And all it takes is a few super spreaders who aren’t following the rules to spread the virus widely. This spread wouldn’t necessarily be contained to their own community.
  • “In a mobile nation, you can’t build a ‘no peeing’ section in the swimming pool,” Humphreys added.

The other side: “I think it's reasonable to expect that while there may be some resistance to tracing and quarantine, the majority of people will accept it,”Jeremy Konyndyk, a a senior policy fellow at the Center for Global Development, tweeted in response, pointing out widespread compliance with social distancing measures.

The bottom line: Countries with authoritarian governments or high levels of social cohesion have successfully used contact tracing, but we don’t have either, Appel said.

  • “The quarantine, social distancing contact tracing model most likely would work better if human nature were perfect — if we could get everybody to do what we hoped they would do,” he said. “I think the verdict is out on whether people will socially distance to do that in the United States.”
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