Hi HLS members and alum!
It’s been a weird, long first month as an alum. In the vacuum left by classes, group projects, HLS happy hours, and your wonderful, beautiful, intelligent faces, I’ve opted to spend a few hours a week volunteering as a COVID contact tracer working on behalf of the Michigan Department of Health and Human Services (MiDHHS). I wrote a bit about this on my LinkedIn page, but in the intimacy of our newsletter, I thought I might share a bit more; I hope this discussion about tensions in standing up novel health programming can stimulate you to consider similar trade-offs and challenges in your internships and careers.
As a state trained volunteer, I call individuals who have been identified as contacts of patients who have tested positive for COVID. Most experts agree this kind of contact tracing is critical for measuring and slowing the spread of COVID (UT Health).
Broadly, our calls serve three purposes; firstly, to inform people they must quarantine away from other members of their household for a 14 day period to protect the other household members from possible transmission. This is how contact tracing can impact community transmission rates. Secondly, our calls support people with wellness checks during the quarantine period, to provide information about where to get tested, and to motivate patients to seek care if symptoms intensify; this is how tracing reduces mortality rates. And thirdly, our calls collect information for a record of transmission we can use to understand the epidemiology of the disease; of the ten contacts the patient interacted with, how many became sick? How many required hospitalization? How many recovered?
But as is common with novel programming, implementation runs into real-world tensions. Here are just a few I’ve noticed:
• Conflict of “User Value Prop” – before I call someone, they’re living their #bestquarantinelife; after I speak with them, they’re supposed to isolate away from friends and family, coordinate someone else to get their groceries, figure out who will watch after their kids, etc. While some people see the value in this pro-active action, many people without symptoms feel little to no motivation to heed our instructions. This is especially true if the person isn’t convinced that they were exposed in the first place. As a result, it’s not uncommon for people to screen our calls and avoid wellness checks. This dynamic, in turn, undermines the completeness of that epidemiology record we’re trying to develop through outreach.
• Contact Overload – because MiDHHS took a long time to get its tracing program off the ground (controversy around the vendor selected and patient data security), some counties, care facilities, and hospitals have stood up their own tracing programs. Now that MiDHHS’s program is up and running, this means a person may be getting tracing calls from two or three programs at once. Because many of these programs got spun up in a hurry, record keeping processes can be faulty or inconsistent, resulting in multiple calls to the same household to track family members or roommates who were identified as contacts. Imagine a family of four possible contacts all exposed by a mutual friend being traced by two programs, each attempting daily wellness checks; in a worst-case scenario, this could mean as many as eight tracing calls executed in a day. No, thank you. Luckily, this issue will improve as processes are streamlined and county-run programs phase out and onboard with MiDHHS.
• Data Accuracy vs. Patient Privacy – imagine I call someone on their mobile phone for a wellness check; they say they are fully isolating, but I can hear voices and sounds in the background that sound suspiciously like a grocery store. Maybe it’s a TV show; probably it isn’t. During frustrating moments like this, it’s tempting to advocate for some sort of app-based, GPS-enabled tracing program that provides accurate information about how well people are actually adhering to isolation requests. But tracing involves physical location and health status information, topics where privacy is heavily valued. The UK recently commissioned a third-party assessment of such tracing app options, and the resulting report suggested that “based on the current evidence in this review, the significant technical limitations, and deep social risks, of digital contact tracing outweigh the value offered to the crisis response.” For more information on governments’ assessments of digital tracing, I recommend this 5-minute short read.
As a graduate of the School of Public Health, I see these tensions as topics to discuss to make tracing more effective, not reasons to stop tracing programs wholesale. And as a graduate of Ross, I know our role as students and alum is to estimate (or when possible, actually quantify) the impact of these trade-offs and then make the calls that most benefit those we serve.
From that perspective, it is absolutely worth it to call 50 people, leave 30 voicemails, get 10 disconnected numbers, get hung-up on 5 times, speak with 3 people who can’t or won’t to comply with isolation, and support 2 people who believe isolating will protect the people they love. That’s two more households protected. And maybe many more.
Wishing you the best!
Resources for more reading:
CDC’s page on Contact Tracing, including a general list of needs for tracing management: https://www.cdc.gov/coronavirus/2019-ncov/php/principles-contact-tracing.html