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Contact tracing may be ‘old-fashioned public health,’ but it works

Officials in Northern California’s Santa Clara County now say two residents there died of COVID-19 in early and mid-February -- weeks before what were believed to be the first U.S. fatalities. Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention and now CEO of health initiative Resolve to Save Lives, joins John Yang to discuss how we can contain the virus’ spread.

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  • Judy Woodruff:

    Even as some states are preparing for limited reopenings in the coming days, there are new warnings about a potential second wave of infection and illness later in the year.

    And there are new findings about how the virus was spreading in the country earlier than we realized.

    John Yang looks at these new developments and their significance.

  • John Yang:

    Judy, officials in Santa Clara County in Northern California now say that two residents there died of coronavirus in early and mid-February. That's weeks before what had been thought to be the first U.S. deaths.

    Dr. Tom Frieden is a former director of the Centers for Disease Control and Prevention. He's now CEO of an initiative called Resolve to Save Lives, which works to prevent epidemics and heart disease.

    Dr. Frieden joins us by Skype from New York.

    Thank you very much for being with us, Dr. Frieden.

    These two cases in February in Santa Clara County, officials there say they have no indication that they — these people traveled, so, apparently, it was contracted through the community. What are the implications and the significance of these earlier cases?

  • Thomas Frieden:

    What we're learning is how widespread the infection has been.

    It's a web of infection that we're seeing throughout many states of the U.S., and we're learning more each day. We're learning, for example, from the genetic fingerprints and footprints of this virus how far and wide it has spread.

  • John Yang:

    Does this have any implication or tell us anything about where we are now, and perhaps any suggestions about how we should be moving forward?

  • Thomas Frieden:

    One of the things that's clear is that this is a highly infectious virus, and that many people don't show symptoms.

    That makes it even harder to control, but still possible. There's a lot we can do to be safer. And the more we do now, the sooner and more safely we can come out. That means boxing it in, doing the testing, isolation, contact tracing, and quarantine, that box, to get the virus in smaller and smaller clusters and cases, so that we can come out more safely.

    The longer we wait to do that, the longer we will have to stay inside or the more risky it will be to go out again.

  • John Yang:

    There has been so much talk about testing, but you also talk about contact tracing, tracing the contacts of people who have the virus.

    Talk about that. And is that — in some cases or in some elements, is that as important, more important as broader testing?

  • Thomas Frieden:

    All four aspects, testing, isolation, contact tracing, quarantine, that box, they're all essential. If any corner of that box is weak, the virus can get out.

    Contact tracing is a tried-and-true method of public health. It means going to a patient, talking with them, earning and gaining and maintaining their trust, helping them remember who they may have exposed, helping them find the contact information of those people, and then warning those people that they may have been exposed, and then connecting with those people for every day throughout their quarantine to see if they're feeling OK, if they're not, to get them tested, if they are, to reassure them until they can finish their quarantine.

    It's old-fashioned public health, but it works. It's hard work, but it's how we can return to a new normal as soon and safely as possible.

  • John Yang:

    It's hard work, and it's also labor-intensive; is that right?

  • Thomas Frieden:

    It is. And while there may be some newer technologies that can make it a bit more efficient, I don't think we're going to get to the place where you can just look at your phone and figure out who you might have exposed or who might have given you an exposure to the virus.

    That's an interesting idea. It's unproven, scary. But what we do know is that talking to people, understanding who they may have been in touch with, and then using that information to warn people who have been exposed, that works.

    It works for tuberculosis. It works for sexually transmitted infections and other infections, public health. It's done every day of the year all throughout the U.S. It's not just anyone who can do contact tracing. It takes excellent people skills. It takes the ability to understand the medical aspects of the situation, confidentiality, crisis counseling, referral for further services.

    It's a skill, a specialized skill.

  • John Yang:

    How concerned are you about what's being called the second wave, perhaps this winter, especially if it were to coincide with the seasonal flu?

  • Thomas Frieden:

    Any time we come back out again, we are at risk of seeing a resurgence of COVID disease.

    Even New York City, where we have had a terrible epidemic, with more than 15,000 people killed, that's as many as were killed in a whole year of the great influenza pandemic of 1918. This is the worst health threat in a century.

    And yet, even so, most New Yorkers aren't immune, haven't been infected, and it could get much worse. That means we need to loosen the faucet on physical distancing gradually. We need to do it in stages, because, when you loosen once, it may be three or four weeks before you see the spread of the disease from that loosening, if it happens.

    If you do it in a faster pace, you could have a roaring infection that rages through society, that kills people in your nursing homes, that endangers health care workers, and that's very hard to reverse.

    So, it's not just, unfortunately, a question of a second wave. It's the question of multiple waves that we're at risk for if we don't emerge from our sheltering in place very carefully, gradually, protecting those who are most vulnerable, using hand sanitizer, using other ways to physically distance, so we reduce the risk.

  • John Yang:

    Dr. Tom Frieden, thank you very much.

  • Thomas Frieden:

    Thank you.

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