By Deborah Barkin Fromer
Faculty Member, School of Health Sciences, American Military University
Tracking the initial source of an infectious disease like the coronavirus is often difficult due to the scale of an outbreak. It requires painstaking work, lots of man-hours and patience. Fortunately, contact tracing enables epidemiologists to better determine how a disease occurred.
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Contact tracing is detective work done by trained investigators who track down and interview people diagnosed with a contagious disease. They find everyone who has recently been in contact with those ill people in an attempt to prevent further spread of the disease.
The work is largely done by telephone interviews. The contact tracer asks specific questions from a “script” and completes a form, asking people to try and remember more about where they’ve been and with whom they may have had contact. These efforts take time and patience, and they demand much attention to detail as the tracer walks people through their memories.
The History of Contact Tracing
Contact tracing is not new. Contact tracers have been employed by local, state, territorial and tribal public health departments for decades.
In the early 1930s, for example, contact tracing was used in an effort to reduce the amount of venereal disease among American troops. Contract tracing also played a role in the elimination of smallpox and has been used extensively as a control strategy for tuberculosis in the developed world.
In addition, contact tracing was initiated among flight passengers during the containment phase of larger pandemics, such as the 2009 pandemic H1NI influenza. Other diseases for which contact tracing is commonly performed include vaccine-preventable infections like measles and novel infections like SARS-CoV.
The Goals of Contact Tracing
Contact tracing has several goals. They include:
- Reducing the spread of infection by interrupting the chain of infection/transmission
- Alerting professional and personal contacts of confirmed and probable cases to the possibility of infection and offering guidence where needed
- Creating a better understanding of the epidemiology and control of a disease in a particular population
Successful Contract Tracers Require Certain Skills
Contact tracers require specific skills in order to do their work successfully. According to the Centers for Disease Prevention and Control (CDC), the knowledge and skills that contact tracers require include (but are not limited to):
- An understanding of patient confidentiality, including the ability to conduct interviews without violating the Health Insurance Portability and Accountability Act (HIPAA)
- A knowledge of medical terms and principles of exposure, infection, infectious period, potentially infectious interactions, symptoms of disease, and pre-symptomatic and asymptomatic infection
- Excellent and sensitive interpersonal, cultural sensitivity, and interviewing skills to build and maintain trust with patients and contacts
- An understanding of the basic skills of crisis counseling, and the ability to confidently refer patients and contacts for further care if needed
- Resourcefulness in locating patients and contacts who may be difficult to reach or reluctant to engage in conversation
- An understanding of when to refer individuals or situations to medical, social, or supervisory resources
- Cultural competency that is appropriate to the local community
Why Has COVID-19 Been Difficult to Trace?
- COVID-19 can be transmitted before people have symptoms. In order to prevent onward transmission from exposed contacts, these contacts must be identified and quarantined immediately after the case with whom they have had contact is identified.
- There are no proven effective treatments for COVID-19, which makes cooperation between public health officials, cases and contacts all the more important.
- COVID-19 can cause large outbreaks quickly, so even one missed case can significantly undermine control efforts.
Contact tracing is an important part of epidemiologic investigation and active surveillance. According to the National Association of County and City Health Officials (NAACHO), the U.S. will need 30 contact tracers for every 100,000 Americans to assist with the enormous task of contact investigation and handle the COVID-19 pandemic.
In the meantime, we — the ordinary citizens — can do our part by adhering to stay-at-home restrictions to prevent further COVID-19 spread.
About the Author
Deborah Barkin Fromer received a B.S. in biology at the Sage Colleges in Albany, New York and was certified with the American Society of Clinical Pathologists as a medical technologist in 1976. She worked in the clinical laboratory as a medical technologist specializing in microbiology. In the 1990s, Ms. Fromer became interested in public health, returned to graduate school and completed a Master of Public Health (MPH) degree at Wichita State University in Wichita, Kansas.
Ms. Fromer spent several years at the University of Kansas School of Medicine as a researcher in obstetrics and gynecology, and several years as a researcher and teaching associate in preventive medicine and public health. She has taught online epidemiology and public health courses since 2001.
From 2007-2015, Ms. Fromer was an epidemiologist at the Sedgwick County Health Department in Wichita, Kansas. Her work involved electronic surveillance of reportable disease and medical conditions, investigating outbreaks and illness, solving mysteries, and keeping people in the community educated and healthy.