Is Contact Tracing All It’s Cracked Up to Be?

By Jackie Dinarte

Many cities are rolling back reopening plans, or even returning into lockdown, while COVID-19 cases continue to spike across the country. Cases are still growing in states like Florida, Texas, and Arizona, with concerns that some still aren’t counted, due to widespread testing shortages. New data showing a “startling surge in children and teenagers diagnosed with COVID-19” is also extremely alarming.

We can do several things individually to slow the spread, including self-quarantining, sheltering in place, wearing a mask, and practicing social distancing. To keep a lid on COVID-19, healthcare and government institutions must establish a contact tracing solution that tracks people who test positive and who they may have infected while protecting their data and privacy.

What’s Contact Tracing?

Contact tracing is a public health practice that identifies people who test positive for a disease and those they may have exposed. By alerting people about disease exposure, contact tracing helps disrupt transmission by allowing people to take precautions like testing or self-quarantining.

Historically, this strategy works. For example, contact tracing stopped Ebola in its tracks. It also slowed the spread of smallpox while a vaccine was being created, turned HIV into a treatable disease, and ended the SARS epidemic. Contact tracing resources are even available for people who test positive for STDs allowing them to anonymously inform past partners about possible infection.

So, what contact tracing options are available for COVID-19? During this outbreak, health institutions and governments are working together to call people who test positive, ask who they’ve been in contact with and provide instructions for quarantining and self-isolating. Google and Apple also built an API that uses smartphones to notify people of possible exposure. Other companies are racing to develop stand-alone contact tracing apps allowing users to enter their own information.

The Public’s Response to Contact Tracing

At The DICE Group, we surveyed 150 people to gain a clearer picture of the public’s opinion on contact tracing. Our survey responses come from:

• 44% Pennsylvania
• 53% United States (outside of Pennsylvania)
• 3% From outside of the United States

To get a baseline, we asked users what they thought about COVID guidelines in general. Out of 150 people, we found that:

We also asked respondents about their preferred method for contact tracing:

Based on these results, most people want both options: A self-reporting method through an app or web system and the help of a dedicated contact tracer.

To dig deeper, we asked users if they had concerns with digital self-reporting. Some were apprehensive about leaked personal health information, location tracking, and data protection.

Apple and Google have been working to assure users their data is safe. There’s even been a pressure from organizations like the American Civil Liberties Union to enact stricter legislation before rolling out any technology The ACLU also notes that there is smartphone usage disparity by income, race, and age, which doesn’t help gain a users’ trust.

Adoption rates are also a concern. An Oxford study found 60% of the population must practice self-reporting to end the pandemic. To put this into perspective, Iceland achieved the highest adoption rate out of every country for a contact tracing app, with almost 40% of its population using one that collects GPS data, according to a report published by MIT. But no significant data was showing it stopped the spread of COVID-19.

Digital tracking tools have been vital in controlling COVID-19 in China and South Korea. Still, they come at the expense of user privacy. It’s unlikely a similar system would come to fruition in the United States.

So, let’s say a tool is in development that hits the marks on privacy. Who would users trust to build it? Here’s what we found:

What Successful Contact Tracing Looks Like

During the Ebola outbreak, Liberia’s Ministry of Health established one of the world’s most successful, trusted contact tracing systems. It hired civilians and community members to accompany nurses going door to door to conduct contact tracing interviews. People were more willing to give information to their neighbors than strangers, which helped Liberia identify contacts and halt transmission in record speed.

Liberia kept every contact tracer they’d hired after the outbreak and even scaled up their workforce. So when COVID-19 hit, they were able to quickly retrain employees and send them into the field. Since re-implementing its contact tracing program, Liberia has reported a minimal number of COVID-19 cases.

Can Contact Tracing Work in the United States?

How can we build a successful contact tracing program in the United States? I wish the answer were as simple as “build an app!” But clearly, that’s not the case. We don’t even have a workforce that’s large enough to go door to door interviewing people.

To move forward with a successful contact tracing initiative, the United States must increase its manual contact tracing workforce and create technology to support them.

John’s Hopkins University released a study estimating the U.S would need at least 100,000 more public health workers to perform contact tracing. And that might be a conservative estimate.

Not only do these people need training, onboarding, and tools to do their job. They must also input data manually, so we face human error, time restrictions, and funding deficits.

The following tools could reduce that load:

• Digital training modules for onboarding new tracers quickly
• Automated scripts tracers can follow
• Enrolling in text-based systems that follow up with users
• A self-reporting system overseen by health institutions where tracers can register people over the phone
• A universal caller-ID for contact tracers so people know it’s a health worker calling and not a robot (unsure how to achieve this without imitators, but one can dream!)

And, of course…

• Funding! Government: here’s looking at you.

Now that COVID-19’s second wave is here; we’ve learned what didn’t work during the first one. There’s a wealth of information on how to implement a successful contact tracing initiative. Let’s use the resources we have to establish a contact tracing program, halt the transmission of COVID-19, and put this pandemic behind us.

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Jackie Dinarte

Jackie Dinarte is a UI/UX Designer and Team Lead of The DICE Group’s HumanX Lab. Jackie is passionate about human-centered design and accessibility for all, which is at the forefront of her work. When not working, Jackie is traveling or defending an undefeated title in Quizzo.