I completely agree with @kj_seung (a great person to follow by the way). Pessimistic takes on the value of #TestTraceIsolate are easily interpreted as "don't bother." But there are so many reasons why it is a critical feature of our response. A thread. 1/11
First and foremost, conversations tend to focus only on tracking down contacts to break chains of transmission. This is too narrow a view of its value. What else does it achieve? Targeted education & testing, symptom monitoring, helping people isolate, gathering data. 2/11
The core of the strategy is hiring and training teams of community health workers, whose value goes beyond the detective work of tracing. Want people with confirmed infections to stay home? Make sure they have food and medicine. 3/11
Want to make sure those infected people don't spread the virus to their family and friends? Help them find a place to safely isolate, or help them arrange for someone else to care for their elderly parents. 4/11
Want to make sure those infected people get medical care if they suddenly take a turn for the worse? Educate them on how to monitor their symptoms. Check in with them to see how they are doing. Help them arrange transportation to the hospital. 5/11
By working closely with people, community healthcare workers can identify gaps in our systems. Are there areas where testing is hard to access? What are the barriers preventing people from safely isolating? 6/11
Contact tracing also collects hard data on how infections are occurring. This helps us understand which settings are high- and low-risk, which is critical for informing targeted policies to minimize economic impacts. 7/11
Criticisms of #TestTraceIsolate: It isn't fast enough. It doesn't scale when community transmission is widespread. It is hard.
Counter-arguments: There are no silver bullets, but every bit helps. It's easier than the alternatives of lockdown or a massive outbreak. 8/11
Counter-arguments: There are no silver bullets, but every bit helps. It's easier than the alternatives of lockdown or a massive outbreak. 8/11
#TestTraceIsolate is also part of the long-term strategy. Once a place is able to get numbers low (NYC, for example), it needs a system to prevent flare-ups. It takes time to hire and train these teams, so we should start the hard work early. 9/11
Finally, unemployment is an important feature of population health. Hiring community health workers is a type of jobs program. The response in Massachusetts has been overwhelming, with way more applicants than positions. 10/11
So a call to academics to reframe the discussion about #TestTraceIsolate to include the many other reasons why investing in large teams of community health workers can help keep us safer. It may be hard, but it is important. 11/END.
