While contact tracing is an important tool for countries to deploy and use effectively to contain an outbreak, it has not been successfully employed in the U.S. during the COVID-19 pandemic. Countries have struggled with this basic public health measure, but contact tracing remains key to slowing the spread and controlling the increase in COVID-19 cases.

What doctors wish patients knew

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“Public acceptance has been a challenge around contact tracing … because people don’t necessarily want to participate,” said Marcus Plescia, MD, chief medical officer at the Association of State and Territorial Health Officials. In a recent episode of “AMA COVID-19 Update,” Dr. Plescia discusses how states are handling the challenges of contact tracing.

During a recent AMA interview, Dr. Plescia discussed contact tracing and its ongoing roll in slowing the spread of COVID-19.

While “there's been a lot of attention on the vaccine for obvious reasons,” contact tracing is “still seen as one of the core components of how we're going to control the pandemic,” said Dr. Plescia. “Hopefully with the vaccine, and maybe some of the other mitigation strategies starting to take hold a little bit better, it could get to a place where contact tracing will be even more important to value.

“But the challenge with contact tracing would be that when rates get up really high, like they are now, you start to overwhelm the system’s ability to keep up,” he added, noting that “it doesn’t mean we don’t still do it. The more people you find, the more people you can try to isolate or quarantine and, therefore, control the disease.”

However, “we’re at a place where contact tracing is going to kind of dampen the increase that we’re seeing, but it’s not going to stop the increase,” Dr. Plescia said.

“There are a lot of misconceptions and concerns about people's privacy,” said Dr. Plescia, adding that if someone has “been diagnosed with COVID or if they're identified as being a contact, a lot of people have fears that that information could be widely spread or widely shared.”

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Additionally, there are “concerns that their employer's going to find out,” he said. “The important thing with that is, we take that very, very seriously. All of the training programs, probably the number one thing they emphasize is how important it is to respect people's privacy and maintain confidentiality.

“If we don't and if these kinds of things that people are apprehensive about really start to happen, then there's no way we can be effective in contact tracing,” Dr. Plescia added.

“There needs to be some trust that the system is there to help and that we’re certainly not about punishing people or being coercive with people,” said Dr. Plescia. “Ideally, we’re trying to help. Most people, if they have been exposed to COVID, don’t want to then inadvertently go and spread it to lots of other people, particularly people they are close to.”

“It’s contact tracing to help you keep other people safe,” he said.  

Learn with the AMA about what physicians can do to boost COVID-19 contact-tracing efforts.

“All contact tracing is done by talking to people and that’s changing who their contacts are,” said Dr. Plescia, adding that “if one of the people that you report you were in close contact with for a period of time in the last few days was a health care worker … if that was in a clinical setting for a clinical reason, there would be adequate protection.”

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“The job of the contact tracing interviewers is to determine whether there was really contact that puts somebody else at risk,” he said. “If you’ve maintained distance, particularly if you’re wearing a mask and, in the case of health care workers, if you’re wearing an N95 or more substantive mask and a cloth mask, that wouldn’t even be logged in as being a contact.”

Find out why Kaiser is helping tackle large-scale COVID-19 contact tracing.

“We’ve even developed an online course for contact tracing and did a lot of advocacy for it early on,” said Dr. Plescia. However, while he does not know how many states have a contact tracing app “it’s popping up more and more.”

“A few states, like some of the West Coast states, have had more experience with contact tracing,” he added. Unfortunately, contact tracing apps are “still seen as a somewhat limited modality because of public acceptance.”

This is often because, “for some people, it could be a major liability for them if they have to isolate or quarantine because of their job and income,” said Dr. Plescia, noting that “New York City and Washington D.C. are both cities that have been very aggressive and successful with their contact tracing efforts.”

Stay up to speed on the fast-moving pandemic with the AMA's COVID-19 resource center, which offers a library of the most up-to-date resources from JAMA NetworkTM, the Centers for Disease Control and Prevention, and the World Health Organization. 

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