Contact tracing falls flat in Western states

Key element to rein in virus stifled by lack of trust, underfunding

LONDON — As the coronavirus stampeded across Europe and the United States in the spring, governments made their depleted citizens a tantalizing promise: Soon, legions of disease detectives would hunt down anyone exposed to the virus, confining them to their homes and letting everyone else get on with their lives.

Nearly eight months on, as a web of new infections spreads across Europe and the U.S., that promise has nearly evaporated.

Despite repeated vows by Western nations to develop “world-beating” testing and tracing operations, those systems have been undone by a failure of governments to support citizens through onerous quarantines or to draw out intimate details of their whereabouts. That has shattered the hope of pinpoint measures replacing lockdowns and undermined flagging confidence in governments.

Beholden to privacy rules, Western officials largely trusted people to hand over names to contact tracers. But that trust was not repaid, in large part because governments neglected services that were crucial to winning people’s cooperation: a fast and accurate testing system and guarantees that people would be housed, fed and paid while they isolated.

“Public health leaders fell in love with the idea of contact tracing as an important tactic — and it is — but that’d be like if you’re going into war and were just talking about the tanks,” said Brian Castrucci, president of the de Beaumont Foundation, a public health charity in Maryland.

Just as important, officials overlooked the impact of raging mistrust in government and a thicket of conspiracy theories about the virus’s spread. Fearful of plunging themselves or their friends into a painful period off work, infected patients have handed over a paltry number of contacts and often flouted self-isolation rules. Contact tracers are struggling to reach people who test positive and being rebuffed once they do.

In theory, countries were to build mass testing programs that would provide quick diagnoses. Then a group of tracers would find others who had crossed paths with the infected person and tell them to stay home.

Elected officials presented the system as a critical bridge between lockdown and a vaccine, allowing them to contain small outbreaks without shutting down large parts of society. But construction of that bridge has been rocky, at best.

The West’s public health systems have not matched the success in parts of East Asia where the fear of epidemics became more ingrained after outbreaks of severe acute respiratory syndrome, also known as SARS, and Middle East respiratory syndrome, or MERS.

Following those outbreaks, places like Taiwan and South Korea built robust tracing systems and legal frameworks for limiting civil liberties during an epidemic. Some contact tracers have used cellphone and credit card data to identify people who were potentially exposed.

In Taiwan, an infected person names more than 15 contacts on average, and tracers often interview patients in person, trying to extract details about secret jobs or marital affairs. But the picture in Europe is far different, and the low level of cooperation has startled public health experts.

In Spain, where hospitals are struggling with a new rush of cases, contact tracers identify on average only three contacts for each known case. In France, the figure has fallen below three.

Yet those numbers are higher than in the U.S. In New York City, each infected person hands over an average of 1.1 names.

Crucially, many Western governments have failed to cushion the financial and psychological blow of self-isolation by guaranteeing people tests or giving them enough money to weather two weeks without work.