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‘Massive numbers of people’ needed to do contact tracing

State governments across the country are hiring thousands of people as contact tracers to track the spread of COVID-19 and to help bring it under control. The data collected from contact tracing can help researchers better understand how the virus spreads, and what mitigation methods work. ProPublica reporter Caroline Chen joins Hari Sreenivasan with more.

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  • Hari Sreenivasan:

    There's been a lot of discussion about contact tracing to help curtail the spread of the coronavirus outbreak. But in this era of advanced technology with global tracking and digital locators, the process for tracking the virus may require old-school techniques.

    ProPublica's Caroline Chen took a deep dive into contact tracing and joined me recently to discuss what may be coming.

    Caroline, let's talk about contact tracing. This is not that new an idea. But it's very different in how much we need it today.

  • Caroline Chen:

    Yeah, absolutely. We have been actually using contact tracing for decades and decades for many different types of diseases, including STDs like HIV and syphilis and for diseases like tuberculosis. But the big challenge right now is just how big the coronavirus outbreak is. So what the US needs right now is massive numbers of people to do contact tracing.

  • Hari Sreenivasan:

    And is this a job where they're going to have to go door to door because people are concerned that, hey, I don't want to actually be a contact tracer if I'm going to have to go meet people who are sick?

  • Caroline Chen:

    No. So this can all be done over the phone. And in fact, these can be remote jobs. So a lot of the states that are hiring people right now, this is a job that you can do from home.

  • Hari Sreenivasan:

    That's great.

    Now, there's also been conversations about, for example, apps that would do this. What's the difference between if you were contact tracing in an app or what does a contact tracer do over the phone?

  • Caroline Chen:

    Yeah. So maybe let's start with how traditional contact tracing works and how a lot of public health departments are going to do this. So public health departments will get information from labs on on positive patients. And so they'll get that information, say, you know, that Bob has gotten a positive test. So they'll call Bob, hi you know they will check up on how Bob's doing and and what his symptoms are. And then also ask, hey, you know, can we review with you who you've been in touch with?

    And this the CDC guidance right now is two days before you started to get symptoms, because that's the period in which you were probably most infected. And the definition of a contact, according to the CDC right now, is someone who you were within six feet of for more than 15 minutes. And then they'll ask, you know, do you remember people's phone numbers?

    You know, this is why they're called disease detectives as well. That's another word for contact tracing. You really have to do some sleuthing here and they'll get that information and then start contacting these people who are close contacts with Bob.

    Now, they don't ever actually give out Bob's name, though. So there is this level of anonymity where they'll call Wednesday, Jane, and say, hey, Jane, we have information that you were within close contact of someone who tested positive for the virus and ask Jane to then be in quarantine for 14 days.

    Now, you asked about apps, and I think that digital apps are still something that's being explored at this point in time. But the idea there is that, you know, if a number of people, enough people downloaded an app that they could without taking down your location data so then later on, let's say if I voluntarily key in the information that I tested positive that there had been an anonymous log of which phones had been within a certain distance of each other. But at this point, these are still being explored.

    And I think the main thing that the experts who talked to me said is that these would be most useful if this technology was working hand in hand with public health departments as a supplement as opposed to something that was working sort of off on its own independent of public health departments.

  • Hari Sreenivasan:

    So give me an example of the scale of contact tracers that we would need to pull this off considering that our data shows that there are still new infections officially recognized and diagnosed ones that are happening every day.

  • Caroline Chen:

    One statistic that's really stuck in my mind is that the city of Wuhan, China, had a has about 11 million residents. And at the peak of their infection, at one point, they had 9,000 contact tracers. And that's a ratio of 81 contact tracers per 100,000 residents.

    Right now in the US so if you take Massachusetts saying that they want to hire a thousand contact tracers for their state, that would be about 14.5 contact tracers per 100,000 residents. So that's a much lower ratio. I think the highest that I've heard is California says that they would hire up to 20,000 contract tracers so that would be in the range of about 50 contact tracers per 100,000 residents so it is still not up to Wuhan levels, but much higher.

    So basically, I think the takeaway is we need a lot more.

  • Hari Sreenivasan:

    What do I need if I want to be a contact tracer or considering there are a lot of people that are unemployed right now that might be looking for work that they can do from home. This sounds pretty good. What kind of qualifications do I have to have?

  • Caroline Chen:

    A lot of experts have said that you really don't need more than a high school diploma. In terms of the actual basic contact tracing work, though, of course, you would need to report to somebody who has a lot of public health experience in terms of leading the teams or of course more complex contact tracing, working say in a nursing home or a more tricky situation.

    A lot of people have compared to, you know, census taking type of jobs. It's sort of a civil level of education. And I've looked, you know, state by state different states have different requirements. So I would say you really probably want to go look at your specific state's requirements.

    But I think, you know, what really struck me when I was talking to people who have done contact tracing work and I've talked to people who have organizations that do work in Liberia, I've talked to epidemiologists who have worked in Bangladesh, who have worked in in the US in Baltimore, is the hardest part of this job is not just data collection, but really empathy and getting trust from the person on the phone because you're calling someone and oftentimes you're giving them really bad news. You're telling either you're infected or you've been in close contact with someone who's been infected. And it's a real shock.

    And the thing that states really need to think about is you're not there to, like, just extract information from someone, but you're there to then equip and enable someone to be able to comply with what they then need to do, which is stay at home for a relatively long period of time. So someone might say, I'm the only breadwinner in my household or I can't get groceries or I need medication. So you need to have social services engaged. You need to have this person trust you and understand why it's so important to break the chains of transmission.

    And so really, people need to be trained in communication. Do that job well alongside being able to gather good information.

  • Hari Sreenivasan:

    Caroline Chen of ProPublica, thanks so much.

  • Caroline Chen:

    Thanks for having me.

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