Let’s face it – contact tracing has always been difficult. First, its goal is to reach as many people impacted as possible. Yet it’s unrealistic to expect to reach 100% of any exposed population. Beyond that, the contact tracing process itself is much more complicated than simply hiring people to trace the movements of those exposed.

Despite its complexity, contact tracing is the best available method to decrease disease spread. Amid a global pandemic, it’s crucial to understand the importance of contact tracing, how it works, and the roles that people, knowledge and technology play in its success.

4 pillars of contact tracing

Historically, contact tracing was a three-pronged stool that required coordination and collaboration among:

• Investigators from the public health department (PHD).
• Contact tracers – people who physically perform the contact function.
• The public – people who are asked to participate in contact tracing efforts.

Now we can balance that stool with a fourth and much-needed prong: technology.

Technology provides much-needed support by automating cumbersome manual processes as well as improving the tracing workflow (testing, contact tracing and isolation). Technology, in fact, supports all segments of the contact tracing process. Both PHD investigators and contact tracers can use technology resources to help with the tracing process. This includes using:

• Tools to retrieve longitudinal records from Health Information Exchanges/Health Information Networks (HIEs/HINs).
• Contact tracing software to share data with the Centers for Disease Control and Prevention (CDC).
• Predictive modeling tools to understand outbreak trends and to prioritize tracing and interventions.

The contact tracing job: Multifaceted demands

As we’ve seen in the news, many states are aggressively hiring contact tracers. But this is not a one-size-fits-all role. Contact tracers need a diverse skill set to navigate different populations in the US. Effective tracers need excellent communication skills, an understanding of the COVID-19 virus (impacts and interventions) and when to seek care, knowledge of available community resources, and empathy. And they should be able to handle any number of issues that can arise due to translation misunderstandings or conflicts.

To handle their multifaceted job, contact tracers need a broad scope of knowledge, skills and training. First, they need to be able to communicate with populations in their native language. They must be able to understand clinical terms associated with COVID-19, answer basic questions about the virus and discuss this sensitive topic with a degree of confidence. And they need to be trained to provide clear instructions on quarantine and when to seek care.

Empathy – which should include an understanding of each person's unique situation – is an essential trait for contact tracers. Consider these examples:

• Instructing a vital service worker to quarantine for 14 days after exposure may not be well received. This is especially an issue if intervention would create a significant economic impact.
• Even for the most skilled communicator, it’s challenging to make a case for health and wellness over immediate needs for housing and food.

To cut down on manual efforts, tracers can use contact tracing software to submit the data they’ve gathered to the CDC. But to holistically assist affected individuals, tracers need to understand the resources that are available in communities. Contact tracing software can help in this situation, too – if it includes detailed information on how to respond to frequently asked questions and a list of community resources.

The role of technology for investigators

Investigators from the public health department can review clinical history when interviewing a person who has tested positive. This becomes vital during large outbreaks because it enables tracing and testing prioritization. To support these efforts, many HIEs/HINs are now providing longitudinal records of patient data to PHDs – that is, records over time and across systems. Armed with this information, investigators can review chronic health conditions and socioeconomic factors that may play a role in a person’s response to the virus.

SAS enhances contact tracing efforts through data visualization and analytics software. A contact tracing database consolidates multiple records for individuals, then establishes visual links among those that are positive, their contacts and location sites. Investigators can analyze all tracing data by examining these visual patterns of behavior. In turn, they can quickly identify routine as well as super-spreader cases where the virus is spreading at a high rate.

The value of real-world data for analytics, modeling

Using real-world data with predictive analytics provides information that can be used for:

• Predictive modeling, which shows what is likely to happen in the future.
• Prescriptive modeling, which uses data, algorithms and machine learning techniques to identify the likelihood of future outcomes and to recommend a course of action.

Contact tracing is a shared responsibility

While contact tracing is a proven method, it raises significant concerns around privacy and security. These issues require continued focus and education. According to a poll by Axios and Ipsos Group, 66% of those who responded said they would reject an app developed by tech companies, and even more wouldn’t download one from the US government.

Situational awareness is one way to help the public better understand the purpose of contact tracing and what it means on a personal level. The US needs widespread education about what to expect when a call is received from the PHD. And individuals who are contacted need a clear understanding of their responsibilities.

Individual states can build awareness of the critical role contact tracing plays in managing COVID-19. The campaign for the 2020 Census, for example, could be replicated for contact tracing. At the same time, targeted educational campaigns could explain the need for and use of protected health information.

Contact tracing dependent on collaboration and analytics

As Caroline Chen points out in her article for ProPublica: “Contact tracing, ultimately, depends on the goodwill of a population.” As I see it, analytics creates the future of where we want to be in terms of understanding and managing the spread of the virus. For now, it takes collaboration among all parties – and the combination of people, knowledge and technology – to mitigate the impacts of COVID-19.