Testing and Contact Tracing
By Alex Wyczalkowski, InSite Intelligence Director
Six months ago on March 11th, the US shut down travel to Europe in an effort to stem the spread of COVID-19 inside its borders. The NBA and NHL suspended their seasons. The world shut down to stop the spread and has struggled to keep infections low while also maintaining a semblance of daily life. Today, the US has over six million confirmed cases, with many more undetected infections across the country.
The story of testing in the US is a bit complicated. Six months ago we were struggling to perform several hundred per day. After those early hiccups, hundreds of thousands are now completed every day. The sheer volume exceeds any other country. And while some lament that high case counts make the US look bad, the fact remains that testing, along with contact tracing are two of our most powerful tools to limit the spread of COVID-19 and protect people from infection.
How testing helps limit the spread of COVID-19 is fairly simple. When a person tests positive, they isolate to prevent infecting others. Instead of infecting 2 or 3 people, each infected person may now only infect one person or none at all. In the aggregate, the amount of new infections decreases and may eventually stop altogether.
We’ve seen this method deployed effectively in high profile situations. Sports leagues like the NBA and MLB test athletes with great success. NBA players live and play in the “Disney Bubble” where they’ve gone months without a single infection. MLB players have been less isolated, and therefore saw a few instances where players were infected. For example, in late July, 17 Florida Marlins players tested positive. But thanks to testing, the team quickly halted play, and infections to other teams were limited. After a one week hiatus, the Marlins were back to playing again. Political figures have also been using testing to protect themselves and their staff from infections. When paired with mask-wearing, this has largely been successful.
New saliva tests will make it easier to test people more frequently, with near-immediate results. Among populations where everyone gets tested daily, with a result in fifteen minutes, life can largely resume back to normal. Saliva tests may help some college football teams back to playing quicker.
Short of delivering 330 million tests per day in the US, contact tracing allows for similar results by focusing testing. When active infection rates among a population are low, only those who’ve come into contact with a known COVID positive person need to be tested. Contact tracing can be as simple as calling everyone you know after you test positive, so they go and get tested themselves. Governments can assist contact tracing efforts by hiring workers to help track down more potential contacts of an infected person. Contact tracers will also identify where hot spots are occurring across a city or state, further focusing testing efforts to certain neighborhoods or communities.
Contact tracing can be very low-tech. In Germany, for example, several hundred call centers are set up to simply call people who’ve been in contact with an infected person. Germany now has one of the lower rates of infections and deaths in Europe.
How technology can help contact tracing
While low-tech contact tracing has been around for decades, technology can make contact tracing better and more efficient. Google and Apple have deployed a Bluetooth based tool to allow States to develop their own COVID tracing app. Many private companies have developed their own apps along with wearable technologies to improve their contact tracing abilities. Technology allows for more tracing with less human effort. Good technology tools do this while maintaining privacy as well.
Apple and Google developed a contact tracing protocol that allows any iPhone or Android to opt into a contact tracing app. The users are completely anonymous, in the same way that Google can aggregate traffic data without collecting any private data from smartphones. The apps themselves are created by each State’s department of health and people choose to opt-in. The following graphic describes how the app works:
1. Contact Tracing graphic courtesy nbcnews.com
The Apple – Google tool is set up with strict limits due to privacy concerns. No personal information is sent over the app. And because the data flow is one-directional, the match alert only exists on a persons’ phone. Health experts have even lamented the strict privacy of the tool, stating that its privacy control limits their ability to aggregate information about infections in the population.
Private companies have also been working on tools for contact tracing. For these companies, privacy may be less of a concern so contact tracing can gather more data when the users are employees. Location data, which is easily available on any smartphone can also be used to improve information about potential contacts. Beyond just using phones, wearable technology can give alerts that prevent unwanted behavior and further limit potential infections.
2. Wearable lanyard. Courtesy estimote.com
And beyond location services, technologies such as Bluetooth beacons can identify where interactions occurred with more precisely, for example within a room or area of a warehouse. If two people were in the same space, but at slightly different times, beacons can help identify those interactions as potential transmissions.
3. Bluetooth Beacon. Courtesy estimote.com
As fall and the typical start of flu season approaches, the potential infections to spike is very real. Outdoor dining and socializing are less attractive in the cold so people will spend more time indoors with poor ventilation. Dry air causes increased susceptibility to respiratory infections. Other viruses will cause symptoms similar to COVID-19. All of this means people need to be more vigilant at stopping the spread and protecting high-risk individuals.
Testing and contact tracing are two of the best tools we have to combat the spread. Testing has made huge advancements in just six months. More testing is always better. Contact tracing, unfortunately, lags in most states. In combination with proper behavior like mask-wearing and handwashing among the public, testing and tracing will help us get through the fall with fewer infections. 2021 can’t come soon enough.