Con­tact trac­ing falls at in U.S., Europe

Hous­ton Chron­i­cle Sun­day, United States of Amer­ica, 4 Oc­to­ber 2020, https://www.pressreade­­ti­cle/2820848692­59115

COVID-19 News - - News -

LONDON — As the coro­n­avirus stam­peded across Europe and the United States this 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 seven months on, as a web of new in­fec­tions spreads across Europe and the United States, 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 trust­was 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’ 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 self­iso­la­tion rules. Con­tact trac­ers are strug­gling to reach peo­ple who test pos­i­tive and be­ing re­buffed once they do.

Suc­cess in East Asia

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 SARS and MERS.

Fol­low­ing those out­breaks, places such as 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.

But in Europe and the United States, which have largely re­lied on the pub­lic to pro­vide in­for­ma­tion and fol­low quar­an­tine rules vol­un­tar­ily, the re­sponse has been spotty.

The West also ran up against the blunt fact that con­tact trac­ing, while use­ful in con­tain­ing lim­ited cases, has be­come over­whelmed by a new ex­plo­sion of in­fec­tions. In the past week, Europe has av­er­aged about 60,000 new daily cases, while the United States is reg­is­ter­ing more than 40,000.

“The track and trace sys­tem is un­re­al­is­tic and use­less,” said Mah­moud Sala­mon, 27, a re­cent business school grad­u­ate on a visit to Brighton, on Eng­land’s south coast, where a test­ing cen­ter at a sta­dium was re­cently closed for the start of soc­cer sea­son. He said he dis­trusted restau­rants or stores with his per­sonal in­for­ma­tion.

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.

‘De­gree of skep­ti­cism’

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

In Eng­land, peo­ple are nei­ther hand­ing over many con­tacts — about five, on av­er­age — nor fol­low­ing the rules. In a sur­vey of about 32,000 Bri­tons, less than 1 in 5 who re­ported coro­n­avirus symp­toms said they had stayed home. Of those alerted that they had been close to an in­fected per­son, only 1 in 10 said they had com­plied with or­ders to self-iso­late.

“It sug­gests there is some de­gree of skep­ti­cism in the pop­u­la­tion to en­gage­ment,” said pro­fes­sor Christophe Fraser of the Univer­sity of Ox­ford, an ad­viser to the gov­ern­ment’s trac­ing pro­gram, re­fer­ring to the pro­por­tion of known cases — a fifth — who handed over no other 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.

With tests re­sults lag­ging in many coun­tries, con­tact trac­ers can­not get ahead of the virus. In Paris, peo­ple­wait up to aweek to get test­ing ap­point­ments and re­sults. Eng­land re­cently recorded a back­log of nearly 200,000 untested lab sam­ples, mak­ing it im­pos­si­ble to track the virus through newly re­opened schools.

Some elected lead­ers have blamed re­cal­ci­trant cit­i­zens for un­der­min­ing con­tact trac­ing. Prime Min­is­ter Boris John­son re­cently said the prob­lem was that Bri­tain was “a free­dom-lov­ing coun­try.”

But the ev­i­dence for such claims is thin. Some coun­tries have suc­cess­fully tracked the virus de­spite peo­ple’s re­sis­tance, in large part by in­vest­ing in chron­i­cally un­der­funded health de­part­ments, epi­demi­ol­o­gists said.

In Ger­many, peo­ple said they would refuse to hand over names to con­tact trac­ers at dou­ble the rate of Bri­tons, ac­cord­ing to a poll by Im­pe­rial Col­lege London. Even so, the coun­try has largely kept a small uptick in new in­fec­tions un­der con­trol.

Be­yond Ger­many’s strong test­ing pro­gram, said Ralf Rein­t­jes, a pro­fes­sor of epi­demi­ol­ogy at Ham­burg Univer­sity of Ap­plied Sciences, the coun­try also re­sponded to the pan­demic by pour­ing money into its roughly 400 lo­cal pub­lic health of­fices,

which had long con­ducted con­tact trac­ing for com­mu­ni­ca­ble dis­eases.

Eng­land, by con­trast, awarded a 108 mil­lion Bri­tish pound ($138 mil­lion) con­tract to an out­sourc­ing com­pany, putting the fate of con­tact trac­ing in the hands of ill-trained call cen­ter work­ers.

Dmitry Kostyukov / New York Times

Con­tact trac­ing is seen as a vi­tal tool to avoid lock­downs and open economies, but that re­quires a ro­bust sys­tem, wide­spread rapid test­ing and pub­lic trust. All are lack­ing in thewest.

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