Articles, Revolutionary HIT April 15, 2020

What to Think About Once We Start Containment

by Barry P Chaiken, MD

As the number of cases of COVID-19 decreases in communities, public health officials will move from mitigation to containment techniques to further control the pandemic. This shift in focus requires a broad program of contact tracing to identify people who have been exposed to COVID-19 cases. Those exposed will strongly be encouraged to adhere to a 14-day self-quarantine to limit possible spread of the SARS-CoV-2 virus.

Monitoring of case rates, exposure rates, conversion to COVID-19 cases, and geo mapping of both cases and contacts will prove crucial in effectively deploying contact tracers and assessing the success of the overall tracing effort. Dashboards, drawing data from multiple sources including testing labs, provider organizations (e.g., EMRs), social media outlets, and telecommunication providers, will inform public health officials as to the current status of the pandemic in their communities. In addition, contact tracers will use these dashboards to efficiently complete their work (e.g., minimize their travel) while monitoring the success of their effort.

In addition, these dashboards will indicate whether a shift back to mitigation strategies – physical distancing – is required, allowing that decision to be made early to limit the spread of the virus.

South Korea uses smartphones and other means to track the movement of citizens and identify which of them had interacted with recently diagnosed COVID-19 patients in the few days before diagnosis. South Korean culture facilitates the acceptance of such tracking allowing it to greatly impact the spread of the pandemic within that country.

Will Americans allow themselves to be tracked via their mobile phones, credit card transactions, and CCTV video the way it is done in South Korea? Not likely as Americans have more privacy concerns than South Koreans and our laws go further to protect privacy.

As an alternative to the invasive methods used in South Korea, we could deploy a contact tracking app. It will need to be vetted by an independent organization trusted by most Americans. During this time of distrust of institutions and partisan politics it is hard to imagine what organization would fill that role, but optimism should reign, and a trusted entity will emerge.

To be most useful, the tracking app must default to all-day tracking. In addition, it needs an on/off switch so tracking can be suspended for a user set length of time. Giving control to the app user will generate greater acceptance of the app and allow tracking of more people than one that only allows continuous tracking. There are many reasons both legal and illegal for which people will turn off tracking for a block of time.

As for the tracking idea, don’t underestimate the American people. While some governors ridiculed the need for social distancing, their citizens nevertheless practiced it and helped reduce the number of cases and deaths in their states. Americans have a history of achieving what other countries cannot. I am hopeful that this pandemic will be another moment that we achieve what only a short time ago seemed impossible, controlling the pandemic and allowing some semblance of normal to emerge.

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