Why technology alone can’t track contracts

It starts on the phone. You may have come in contact with someone who has a coronavirus. It sounds like this in a kind voice: If possible, you should self-separate and take Covid-19 tests. The caller is careful not to reveal the identity of the infected person who has passed the path. If they are good at work, they are sensitive to both your fear and the privacy of others.

The voice over the phone is a contact tracer. A person trained to track and notify anyone who may have been exposed to the coronavirus by someone known to be infected.

Contact tracing is being pursued as an important part of the global effort to target the Covid-19 hotspot, delay the spread of the infection, and restart the regional economy. Most experts admit that much more extensive testing and ultimately effective vaccines are needed to really stop the disease. However, by carefully tracking the pattern of vector movements of the human illness that carries it, the jurisdiction wants to be able to direct their lockdown measures to the most at risk individuals, Allows you to resume the resemblance of normal public life.

To resume safely, the United States may need to train and deploy at least 100,000 contact tracers. However, some expect this tedious process to be at least partially automated. Tech companies are jockeying to implement an infection alert system that uses phone data to do some legwork to track recent contacts. Apple and Google are teaming to develop a tool that uses Bluetooth to identify other devices (and the people who own them) approaching them every day. If anyone gets sick, an anonymous signal will be sent to those who enter the orbit, urging them to quarantine or stay home.

Outside the United States, such tracking technology is already in the field. The coronavirus countermeasure system, which is a hot topic in Korea, relies heavily on smartphones that 95% of residents carry. Authorities can use location data, credit card records, and security tape to stitch and share anonymized routes for potential carriers. National Health Service in the UK has introduced Bluetooth tracking apps like Apple and Google. Last week, it became available to 800,000 residents of the Isle of Wight, Over 55,000 downloaded.. Icelandic apps use location instead of Bluetooth data. India requires residents to download the app, Fines or fines for dismissal..

The promise of Big Tech to provide miraculous tools to combat the coronavirus was a recurring theme of US pandemic response: it turns out to be President Donald Trump’s omnipotent nationwide Google test site. Please remember FAQ page only? Or the recent rush to develop and buy a thermal scanner to detect heat in public spaces, Not very good at detecting heat?

With regard to contact tracking, public health professionals warn that technology cannot and should not replace the need for trained illness detectives. They believe that manual tracking of contacts and the human connections they create are still important for any robust tracking response. And now the United States has just begun to collect the necessary infantry.

Convene an army of sick detectives

Contact tracking is an old tool in public health and is often used to warn of potential exposure to tuberculosis, HIV, and other sexually transmitted diseases. However, the scale and speed of coronavirus pandemics offers an unprecedented challenge. Given the rapid expansion of the community, an average of 2-3 people can be infected. The US County and City Health Departments was suggested The jurisdiction has 30 contact tracers per 100,000, or at least 100,000 contact tracers for the entire US population. In support of local efforts, researchers are forecasting an additional $ 3.6 billion in federal funding to pay enough full-time contact tracers to work for a year.

just now, Only about 11,000 contact tracer jobs Thanks to millions of reductions in federal funding of public health programs over the last 15 years, staff is nationwide and local public health departments are able to fill these roles on their own. can not. Downsizing during the recession has also eliminated 50,000 public health roles. Didn’t get back..

According to the NPR, hiring speed and scale vary by state and city, with only one state (North Dakota) being able to meet its estimated needs, while other jurisdictions are rapidly expanding their hiring goals. doing. For example, Massachusetts worked with the Partners in Health organization to train approximately 1,600 people to train, lead, and execute contact tracking efforts. However, the state has just begun to move from a volunteer army to a bank of full-time workers.

Meanwhile, the blockbuster New York plans Hire up to 17,000 people Please contact the state-wide tracer. With the help of the city Public health fund, A New York City leader, Hire 1,000 tracers as soon as possible.. In the first week of May, FPHNYC told CityLab that the resume review process is still underway and could cause additional challenges during onboarding. Originally, the city’s Department of Health aimed to lead the effort by utilizing experts with decades of experience in tracking other infectious diseases. But on the move Criticized by public health expertsMayor Bill de Brascio In charge of the city’s public hospital system instead of. That could accelerate employment, the head said New York Times, When you get in touch, have them connect directly to your test or isolation resources.

Governor Gavin Newtham of California, with 39 million people, seeks to hire 20,000 contact tracers. At this point, CalMatters is About 3,000 Has begun to work and the state aims to train an additional 3,000 a week. San Francisco said it now has an army of about 150 liaison tracers at UCSF working with the Department of Health. Susie Welty, Who normally works for the University of San Francisco’s Global Public Health, recently started supporting the San Francisco Public Health Service’s contact tracking activities. The goal is to scale up to 250 before the city’s shelter is lifted at the end of the month, taking over most of the duty to existing non-working civil servants, such as librarians and court staff. “We don’t have enough contacts now to keep many busy, but things will get open,” she said.

Some third-party efforts couldn’t find direct candidates, but they were able to quickly find qualified candidates. CONTRACE, an organization that started on April 21 to help health departments find and train contact tracers, has already hired and screened more than 20,000 people. Steve Waters, the company’s founder, says he has adjusted his target to 25,000. They pass on information about qualified candidates to the public health center, where they take on employment. “NY / NJ / CT efforts seemed very promising and MA was way ahead of the game,” Waters writes.

The country’s unemployment forecast is projected to reach 20%, so it’s not difficult to find workers available to meet this need. Both jobs and training can be performed remotely. Johns Hopkins Bloomberg School of Public Health 6-hour online Coursera course, Anyone can get it for free.

Trace art

But not everyone is clipped to become a contact tracer. The ideal candidate should be wise, empathetic, and cautious. Public health training is not required, but it is a bonus. Local language knowledge is preferred. “Many contact tracers in the health sector are trained in motivational interviewing skills, cultural abilities and cultural sensitivities,” in collaboration with the New York Department of Health’s Head of HIV Epidemiology and Field Services Program. Said Sarah Brownstein-the leader of the department’s contact tracking task force. “So they have experience knowing how to really understand themselves as well as translating for the public.”

Although the work is done remotely, recruiters are looking for locals who live on canvas or at least understand their culture, customs, transportation network and resource situation. That also helps to build early connections, says CONTRACE ’s Waters. “For example, if you call someone in Louisiana and someone in New York has a deep accent and you’re talking to them in a New Yorker attitude, you could earn that person’s trust more than they sounded like that person. He’s less sexual. Attitude of someone from Louisiana, “he wrote.

Contact tracers do not place their ears on the pavement to occupy cases of coronavirus. Nor is it supposed to track self-reported presumed cases like stories shared on social media. Instead, the process will begin when a new case is notified to the local health department after receiving a positive test result, Braunstein said. Other departments may follow up on cases that were not tested positive but were considered probable by public health professionals. The coronavirus subject is then called by a contact tracer. Contact tracers ask about medical history, living conditions, demographic profiles, and a list of all recent “close contacts”.

Armed with that contact sheet, the tracer picks up the phone and begins dialing. They say that anyone remembers spending more than 10-15 minutes at a time in the two days before the onset of symptoms. (They don’t call Trader Joe you drop in, but if they work for Trader Joe, they call Shiftmate.) More people will get to work in the next two months. On returning, she expects it to rise from 7 to 10. In Massachusetts, the average is close to two contacts, WBUR reported..

Privacy rules don’t allow contact tracers to reveal the identities of coronavirus-positive acquaintances, but Welty says they are trying to carefully determine if they already know someone. This helps the tracer understand when a potential contact has occurred. This affects how long you can isolate a case.

What comes next will vary slightly depending on the jurisdiction. San Francisco, for example, has instructed everyone identified as a close contact to take the test. If positive, you will be instructed to self-isolate for the next 10 days and continue for at least 72 hours after having a fever. Even in the negative, you will be asked to quarantine for another 14 days. In other locations where testing is not available, tracers may instruct you to begin quarantine as soon as 14 days after contact with the case and take the test if symptoms begin to appear.

The work does not stop after these instructions are given. With daily text alerts, or rarely by phone, the contact tracer will check the subject. They ask what symptoms they have, how severe they are, and whether they need treatment.

Emma Ryan works as a volunteer contact tracer in the Boston area, calling out coronavirus-positive cases 5-6 hours per week. (Disclosure: She is also a former classmate at my university.) Said Boston Herald Only about half of the tracer subjects answered in April, Ryan told me he was surprised by the receptive people’s reaction to the cold phone.

“Everyone is very positive about talking or answering questions about what they like, with or without diarrhea,” she said. “People also seemed quite ready to help. [they know that] One of the reasons we collect information about our symptoms is to better understand how they manifest in different people. “

There is no app for this

The interpersonal skills needed to build this relationship are one of the reasons why public health professionals are skeptical of using technology to replace manual tracers.

“The human element of contacting someone over the phone, gaining trust, treating you as an ally, encouraging self-isolation and sharing with whom they have come into contact is very important, and somewhat artistic. That’s what Waters said. “I’m not sure if technology-based solutions can reproduce it.”

Early in the coronavirus outbreak, Singapore’s contract tracking efforts Selected for praise by the World Health Organization.. Nearly 6 million city-states are actively acting to contain the virus and have supplemented a vast network of human tracers with the trace app TraceTogether. But since its launch in March, One-fifth of the residents Download it, Singapore recently The number of cases increased rapidly.. There was a new outbreak Raised in the dormitory where the migrant workers lived, Welty said that such an app didn’t help. Instead, the Singaporean human army intervened.

Oxford University researchers suggest Please note that a minimum of 60% adoption is required for a tracking system to be effective. Among all the countries that use technology as a tracking supplement, MIT Techology Review found Icelandic apps Highest hiring rate, 38%.. In a country with 364,000 people who had significantly flattened the curve, the app was “not a game changer,” officials at the follow-up report told MIT.

Jason Bey, Singapore’s product leader for the Trace Together app, makes it even easier Medium post“When asked if we’re ready to replace manual contact tracking with Bluetooth contact tracking systems in place or in development anywhere in the world, we say unconditionally the answer is no.”

The potential for technical corrections may even be dim in the United States, where privacy concerns are more widespread. based on Voted by Washington Post University of Maryland, Many Americans don’t trust technology companies to public health information, even though they’re guaranteed not to store location data or store it in a centralized location. 3 out of 5 respondents reported being “impossible or unwilling” to use such a system, with most placing greater trust in public health than Big Tech .. Only 41% of people who own a smartphone say they are willing to download the app.

This is not stopping the new patchwork of coronavirus tracking apps emerging at the local and state levels, BuzzFeed News reportThis could introduce new incompatibilities between health departments and further undermine coordinated country response of all kinds.

In addition to the challenges, many communities that are particularly vulnerable to US viruses (migrant workers, homeless people, and undocumented migrants) cannot access devices connected to the Internet, Welty. Says. They may also have more reasons to hesitate before sharing movement patterns with entities that fear they can pass them on to government.

Even though the app could find a potential contact and ask the same set of automated questions, there are certain subtleties, such as when Welty carefully investigates the subject to determine when the contact occurred. It cannot be reproduced. Human tracers can also provide additional public health information, she says. For example, if a subject was told to stay at home, but answered that they would need to continue working for their family, Welty would provide her name and address to the city and provide her with food, cleaning supplies, and even a diaper. will send.

“We really need to be able to provide the services they need to be separated,” she says. This kind of supportive action helps build trust in the region as a whole. Testing positivity at a much higher rate From a white resident.

“People also need guidance on where to get resources and how to communicate with their employers. Dr. Emily S. Gurley, Epidemiology Epidemiology at Bloomberg School’s Global Health Center. “At the end of the day, this effort is to help people in difficult and frightening times.”

But technology can be an effective ally in the Battle of Covid-19. According to Braunstein, users willing to opt-in digitally can use the app to record the results of daily temperature checks and alert the public health department of the need for service. Tracers like Ryan can use assists in locating cold leads. Most of the people she contacted in the recent shift had been tested three weeks ago, which made it very difficult to remember and spot someone who had seen them during their symptoms. Ryan says one woman’s office could follow her procedure using an internal CCTV video as soon as she found a positive test result. By the time Ryan called, he was at the brunt of the chase.

Since the Ebola outbreak in 2014, there have been many changes since West African contact tracers sat in centralized call centers and visited door to door to find the subject. Today, technology can continue to advance technology without associating health data with GPS coordinates. “There are many ways technology can support public health features. It helps them get faster, which helps them organize their data, which makes cases and contacts faster about their signs and symptoms. Can help you deal with, “Gurley said. “Technology has always been supportive, but it never replaces public health functions.”