Tom Williams / CQ-Roll Call Inc. via Getty Images
This is the question everyone is asking: what will we need to get out of this period of extreme social distancing and find a semblance of normal life?
It turns out that the Centers for Disease Control and Prevention have been working on a plan to allow the United States to begin reducing these policies safely. CDC director Robert Redfield spoke to NPR on Thursday, saying the plan is not only based on accelerated testing, but also on finding “very aggressive” contacts from those who test positive for the drug. coronavirus, and a significant increase in staff to do the necessary work.
Contact tracing is the process of finding and contacting contacts of a person who has tested positive for an infectious pathogen. These contacts are then quarantined or monitored, and if one of them is also positive, the process is repeated with their contacts, and so on, until the chain of transmission is interrupted. It is a labor-intensive and time-consuming practice which, for decades, has been a fundamental public health tool for containing infectious diseases.
Contact tracing was used in Seattle and parts of California at the start of their coronavirus outbreaks, but as community spread took hold, many cities and states moved to a “mitigation” approach Like closing schools and other social distancing measures. Now a large part of the country is locked out (with a few exceptions).
To be ready to relax these measures, Redfield said his agency is increasing America’s ability to do more contact tracing. “We are going to need a substantial expansion of public health field workers,” he said. This, along with many tests, is what will be necessary “to make sure that when we open up, we will open up for good”.
The first step will be to expand the tests, especially those that provide rapid results, so that people can be diagnosed quickly. The Redfield agency has received widespread criticism for failing to quickly deliver work tests to public health labs. (Redfield defended the CDC on this point, saying that when problems with the initial test were discovered, “we have figured it out and fixed it. Someone might say it’s shoddy – I don’t think it’s botched. ”) Redfield said that now testing capacity is increasing every day and that he is encouraged to see that point-of-care testing that works within minutes is starting to hit the market.
Then, said Redfield, America will need to increase its capabilities to reconnect with those who have tested positive. “It’s going to be critical,” he said. “We can’t afford to have multiple community epidemics that can turn into lasting community transmission – so this is going to be very aggressive, what I call” block and attack “,” block and attack “. ”
Given the cumbersome nature of tracking contacts, this means calling on many more people to do this work. Since state and local public health departments are unlikely to have the personnel to do so, suggested Redfield, the federal government will have to help. “We currently have more than 600 people on the ground from the CDC in all states trying to help with this response, but we are going to have to amplify that considerably,” he said.
As a reminder, in February, the World Health Organization indicated that in Wuhan, China, to contain this epidemic, “1800 teams of epidemiologists, with a minimum of 5 people / team, were tracking tens of thousands of contacts per day “. And it’s just in one city.
Redfield said it would be “premature” for him to specify exactly how the CDC will do this and how many staff it plans to deploy. But he said an announcement would be made in the near future. “Obviously, if we are to try to get this nation back to work soon after the end of this month, we are far behind in these planning processes right now,” he said.
Other places – such as South Korea, Singapore and Hong Kong – who have been praised for successfully “smoothing the curve” of coronavirus infections have used contact tracing methods that might not fly in the United States due to privacy concerns. For example, South Korea uses a variety of tools such as surveillance cameras, cell phone data and credit card transactions of suspicious cases to facilitate the transmission of cards.
Redfield left the door open to search for contacts in the United States to use cell phone data. “People are looking at all of the different modern technologies that could be used to make contact tracing more efficient and effective,” he said. “Are there more technophile ways to be more complete in monitoring contacts? Currently, these things are being aggressively assessed. “
He added that ultimately it will be up to the state and local public health authorities to determine how to perform the contact search. The CDC is there, said Redfield, to offer technical assistance and “dramatically increase staff.”
The Kaiser Family Foundation recently noted that state and local health services are already well stretched and that “only the federal government can truly restore order and make a coordinated national effort at scale (and at expenses) necessary ”for effective contact tracing in the United States.
Redfield recognized the problem of public health neglect. “The reality is that for decades we have been underinvesting in public health,” he said. “So now is the time for us to reinvest heavily – to prepare excessively. “
Despite the huge tasks ahead, Redfield seemed optimistic in his conversation with NPR, saying he thinks we are nearing the peak of the current epidemic in the United States and should see a decline in the number of cases in the coming weeks. .
“I think we have seen a huge benefit from the social distancing guidelines, and it is really a credit to the American people,” he said.
But he stressed that the Americans could not yet give up. It is clear that “this virus is extremely contagious,” he said, and is moving fast. So, until an effective vaccine is found and made available, our best hope for containing its spread is to fight potential new outbreaks with public health workers on the ground.