COVID-19 Surveillance and the Difficulty of Contact Tracing

published on August 2, 2020

There's a lot of talk about mitigation measures right now to prevent a second wave of Copan 19 of course that assumes a first wave is ended and in some places that's not clear this has resulted in plenty of discussion about contact tracing but not as much about

Surveillance this week's video has been adapted from a piece of my blog the incidental economist written by dr Meredith mattone and Deanna Marshall from policy lab at the Children's Hospital of Philadelphia they assert

That it's time to talk about the importance of surveillance measures and they propose a precision public health approach to pair such measures with targeted contact tracing that's the topic of this week's healthcare triage

as communities reopen across the country strategies for preventing another wave of widespread kovat 19 transmission are top of mind arguably contact tracing is the approach receiving the most media

Attention and around which many states are mobilizing and we've talked about it a lot here at healthcare triage contact tracing is a highly effective cornerstone of infectious disease mitigation that is regularly deployed to

Help control diseases like HIV influenza and measles a version is even used to identify the source of foodborne illness outbreaks but these scenarios may not be overly generalizable to our current Tsarskoe v2 reality we should be talking

More about surveillance to improve early detection of potential outbreaks protect vulnerable populations and use testing resources smartly first we may lack testing resources and coordinated state level testing procedures to render

Contact tracing a viable method of population level transmission mitigation saggin the evidence to support contact tracing strongly suggests it is most effective in places where the number of circulating cases is low this doesn't

Describe much of the country third Cove it has both a long period of infectiousness and a pre-symptomatic possibly asymptomatic spread this makes contact tracing difficult because its success relies on an individual's

Ability to recall contacts while contagious including prior to feeling ill fourth while evidence suggests contact tracing and associated quarantine policies do not require a hundred percent compliance to be

Effective compliance will present inequitable burden to individuals and under-resourced communities these challenges are real but contact tracing must be done the scope and focus are likely best served among medically

High-risk populations and knows an employment or residential settings with high exposure risks and maybe not as part of an effort to mass test and trace the general population so what can we do supplement with surveillance first

Implement an enhanced surveillance model featuring syndromic and participatory methods we can adapt and leverage current public health surveillance for influenza combined with standardized reporting of a hospitalization data

Basically we monitor health system reports of phone calls from patients not feeling well visits to the doctor etc etc and watch for concerning spikes it works we can supplement this with participatory disease surveillance which

Involves individuals actively reporting illness symptoms through a website a text messaging survey or engagement with community health workers there are promising examples of web-based reporting platforms for influenza

Surveillance in Europe and Canada participatory surveillance systems have detected outbreaks earlier than traditional surveillance can be anonymous to some extent and can be successful without even close to

Universal participation larger employers and schools may also opt to implement other surveillance metrics including absence monitoring or smart thermometer use and this information could be coordinated with health departments

Additionally direct outreach to communities like refugee or homeless populations can help expand these efforts to individuals who may be unlikely to seek health care those with limited English proficiency and those

With limited internet or phone connectivity a community-based approach using a bola response employs community health workers to identify symptoms through door-to-door visits and enlist trusted community leaders or

Institutions to help collect data this approach has been effective with as little as 40 percent participation second we could double down on prioritize testing for high-risk populations focusing testing on

High-risk groups maximizes the benefits of testing and contact tracing further there are efficient testing approaches like pooled testing to preserve critical supplies and minimize the number of tests needed third we

Consider community-level quarantine protocols it's essential the communities be nimble in moving into brief periods of local mitigation procedures like closure of non-essential businesses during outbreaks state and local

Policymakers should use surveillance and testing data to make real-time decisions about whether or not to enact these protocols in areas with lots of cases this kind of targeted entry into community level mitigation may produce

Fewer and shorter periods of closure an approach that relies on strategic use foundational public health operations is likely to meet the challenge of resource constraints without compromising quality or perpetuating inequality it's not too

Late for states to enact such approaches to protect against another wave of kovat 19 hey you like this episode you might enjoy this previous episode on dexamethasone toilet plumes and rising kovat gases we'd also appreciate if

You'd like and subscribe down below and if you go on over to patreon comm slash healthcare triage and consider supporting the show help us get through this pandemic we'd like to specially thank our

Research associate dose Evans Josh keister and Michael chin and of course our surgeon I'm also

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