Thread by @fascinatorfun

Can Coronavirus Contact Tracing Survive Reopening?
Learning lesson: Liberia: Ebola

“Because we could not spare doctors or nurses, we hired social workers and schoolteachers as contact tracers—people who were respected in the community.” newyorker.com/news/us-journa…

“Welch recalled long meetings with village and tribal leaders, to identify trusted and influential people to hire as tracers. “

They got that contract tracing was more than minimum wage bums on seats.

And it was more than asking people to self isolate.

There was a daily check.

In a very poor country with a population of 5 million, they employed 10,000 contact tracers.

And put their success in containing Ebola down to contact tracing.

It seems to me there needs to be a lot more humility at Government level about learning from the poorest countries.

“When epidemics strike the poorest countries on earth public-health professionals often succumb to what he calls “clinical nihilism”—the conviction that the number of cases is too overwhelming for doctors to treat, and that the only realistic approach is to contain the spread.”

As covid-19 cases began to proliferate throughout the United States, Farmer said, “a lot of us predicted that there would be containment nihilism instead”—that governments would give up on even trying to control the disease and plan for herd immunity instead.

They were right.

“Containment nihilism”

Yes.

Farmer explained, “In its worst form, it’s basically just, ‘Let the immune system take care of it.’ ”

But not in Massachusetts whose Governor called on him for help.

Increasingly COVID management seems to be a question of fundamental values.

“It’s almost as if there are 2 different rates of transmission—one outside of households and one within households,” Kim told me. “In Wuhan, the lockdowns were effective on transmission outside of households,” he said. But plenty of transmissions were still happening within homes

“So lockdown was not going to be enough.”

I shall keep repeating that unless both the Government & the public take isolation much more seriously (including in the family/shared household setting) then I don’t see how we can get a grip on it.

That involves monitoring & support

It also involved the state providing a helping hand.

So, drawing on experience from eg. Malawi, in Massachusetts they divided the roles into three job bundles.

Case investigators would quickly call people who had tested positive for the virus and interview them extensively about their contacts, beginning forty-eight hours before they first noticed symptoms.

Contact tracers, the largest group, would call each of those contacts, ask them to isolate at home for fourteen days, and then follow up frequently, to make sure that they were doing so and to check for any symptoms.

The third group, care-resource coördinators, were effectively social workers, appointed to help people solve problems—how to get food, find a place to stay, or manage addictions—that might prevent them from being able to isolate themselves.

Of course, as long as one has a Government determined to play down the risks, the unknowns, ignoring the long tail and non-fatal consequences it makes it much harder to instil how necessary tracing and careful isolation is.

For most here in the U.K. Covid is “get on with it”

Massachusetts State has a population of about 7 million.

Think of London.

They wanted to employ people who knew their own communities and the intent of the project in part was to create a culture where communities could work together to heal themselves.

Here in the U.K. by centralising contact tracing, pursuing a culture war on public service, largely cutting out local public health and GPs, it feels as if the Government is sending a very very different message.

No wonder England contract tracers were directing contacts to NI Test centre. They were not sufficiently part of the cumminitu they were contacting to know that it was a mad suggestion.

This is Massachusetts ⬇️

The Massachusetts team attracted people with superb qualification.

Someone who had worked for a decade with CDC and wrote a manual on contact tracing sexually trans misstep disease.

An Amhust Graduate with 9 languages working with his own community.

In Chelsea Massachusetts , covid-19 was so widespread that, when researchers took blood samples from two hundred people walking at random near city hall, they found that thirty per cent of them had antibodies to the virus.

Multiple living is a big issue.

So is trust.

Careful questioning and joint problem solving is necessary to try and find workable solutions to stop the spread within homes.

Using the right tone of voice and a common language helps build trust.

Follow up supports compliance

How many people, worried about their jobs, will be reluctant to be open about their state of health and their contacts?

Delays between needing a test and getting a result were too long. 3-4 days.

Here, in the UK we have no published data on timeline from request for test to result.

Nor for result to transfer to the tracing service.

This is a key metric and tracers need to be indentifying contacts from days before a person who tested positive actually became symptomatic.

New York is trying to prepare, but later than Massachusetts

“We have this enormous outbreak, we’re working really hard on it, there’s a lot you can do to control it—but, look at this, we’ve got unlinked spreading in the community, and that means it could explode.”

Frieden said. The American response, in his view, was characterized by “this kind of lack of seeing the essence of what’s important.”

Meanwhile, back in Massachusetts, the Amhust graduate with 9 languages often calls immigrant homes full of people who work as caregivers, need to earn money, but are also being asked to stay at home.

So logistics in how to provide essential support is part of his work.

“What people really want is to feel secure”.

They struggle with a fear of eviction, how to feed the baby, how to keep their job, get groceries, medication (and pay for it).