Thread by @Farzad_MD

1/ Last week I posted about automated digital contact tracing apps- lots of discussion since: @CaseyNewton @DKThomp articles, @djweitzner privacy-protective framework pact.mit.edu

now lemme talk about the other kind of contact tracing app

https://twitter.com/Farzad_MD/status/1246038444893261824?s=20

2/ In our report "Achieving containment" we instead ask for "tools that increase the efficiency & ease of contact tracing: enhanced directories, multichannel messaging applications, real-time translation services, symptom reporting & isolation monitoring"

healthpolicy.duke.edu/sites/default/…

3/ Over the past week, I've talked with public health workers actively engaged in contact tracing at local health departments, and smart folks thinking hard about best commercially available tools to help them (HT @dburka @ResolveTSL @bijans)

Here are their "jobs to be done"

4/ WHEN I get a positive lab report
I WANT TO find the person's contact info
SO I CAN make sure they can isolate themselves and elicit their contacts

There's substantial transmission early in COVID infection-> getting infected contacts quarantined before sx is key to containment

5/ Here's the problem- there is not a lot of locating information in a lab requisition

Here's one from @QuestDX for hospital patients: name, sex, dob, address (and of course, hospital info)

For outpatient: SSN, phone# are sometimes filled out. Also lots of insurance info :-)

6/ So public health is often trying urgently to reach FNAME LNAME SEX DOB ZIP- they try to look them up in public health databases, or using google.com

What if they could use the best commercially available tools for getting phone #, emails, addresses, handles?

7/ Public health also needs to know if they are in the hospital- we've built a national infrastructure for querying records from one hospital to another.

What if public health could request the standard clinical document on these patients. We are close!

https://twitter.com/Farzad_MD/status/1245340547931406336?s=20

8/ Next,
WHEN I get all this contact info
I WANT TO reach out to them
SO I CAN conduct an interview

This is inefficient now. try text message, email? leave a voicemail. maybe send letter? send a person?

What if amazing omnichannel communications tech was available to them?

9/ [there's a bunch of management tasks that would be cool to tech-enable too, but second order, like intelligent tasking and routing of cases to contact tracers who would be best suited to establish trust with them- eg by language, culture, past success with certain demographic]

10/ WHEN I reach an index case
I WANT TO get them any needed social services
SO I CAN ensure they can stay in isolation for 14 days

If they don't have a separate room in their home, need food, medicine, or child care then they can't stay in isolation.

health equity=safety

11/ It's hard for a public health worker to connect a person to all the social services they need- including a place to stay

Well, we have a lot of empty hotel rooms, and a lot of former hospitality industry workers who'd be great to help navigate people through this
#stimulus

12/ It gets a bit trickier now, but nothing we can't handle.

WHEN I interview an index case
I WANT TO review their location and travel history
SO I CAN jog their memory of people they may have exposed

kind of like... this?

[reminder- it's voluntary]
support.google.com/maps/answer/62…

13/ trickier yet- eliciting contacts. anyone who has ever tried to book plane tickets for a family of 5 on the phone knows how inefficient and error-prone this would be.

What's a better solution? can we select contacts from our phone (or our social graph on FB, TW) and send it?

14/ So

WHEN I interview an index case
I WANT TO identify all their contacts
SO I CAN reach them and get them to quarantine ASAP

This is the step that we have been building up to, which is going to decrease R(eff) and help us get out of lockdown- safely.

Only works with trust

15/ This can be a HUGE undertaking under normal circumstances, take a huge amount of time.

Fortunately, the number of contacts the average person has on the downswing of the outbreak coming off lockdown will be a lot fewer than it would have been on the upswing.

For me, it's 5

16/ ..and the vast majority of the contacts will literally be an arm's length away from the index case being interviewed.

So WHEN I identify household contacts
I WANT TO talk to them right away
SO I CAN reinforce the messaging for what they are supposed to do now (eg quarantine)

17/ There will be other contacts also- and the same tools we talked about (GET info, REACH them, INTERVIEW them) will help me do that.

We may ask index case if they are willing to be identified or not.

We may give index case tools to do notifications themselves?

#Protocols

18/ For contacts, need to do symptoms monitoring (check temp twice a day?)

WHEN a contact becomes symptomatic
I WANT TO be notified
SO I CAN get them tested and if positive, initiate contact tracing on *them* (GO TO 10)

Could be through fancy telemonitoring devices, or low tech

19/ This is where having home specimen collection available can be super helpful. I would rather not have symptomatic contacts tramping through the city to get tested, or to have delay/ risk of sending someone in to get them tested.

maybe even preposition swabs and mailers

20/ I know there's lots of interest in true OTC home testing, and it would be great for serology if ever possible, but for active infections, I worry that home testing might actually reduce our ability to hear about them, initiate contact tracing? I dunno, maybe that's silly

21/Public health has police powers to REQUIRE mandatory isolation
👇
"By ensuring that coercion is used only when less restrictive alternatives will not work and with due regard for the rights of those detained, the law can foster public trust, minimizing the need for compulsion"

22/ so this has to be approached really carefully, but I *could* see some use of cellphone location to ensure that people who should be in isolation or quarantine are able to adhere.

But again, should come from a place of "what do you need" rather than "why are you a bad person"

23/ I would be remiss not to point out that we need a large workforce to actually do this contact tracing- this has to be funded specifically, and would be terrific use of stimulus 4.0 (or 5.0..6.0)

Hospitality workers, census workers, bartenders, (journalists) would be terrific