The Register Citizen (Torrington, CT)
‘You need an army’ for virus contact tracing
A Connecticut doctor reflects on lessons he learned during the Ebola outbreak
It was autumn when Dr. Majid Sadigh arrived in Liberia.
The peak of the 2014 West African Ebola outbreak that killed more than 11,000 people had recently subsided. And health officials in Liberia, Guinea and Sierra Leone were still working frantically to combat the deadly hemorrhagic fever that would wreak havoc on the region for two years.
For seven weeks, Sadigh was on the front lines, running a medical facility in Buchanan, the country’s third-largest city, and treating cases coming predominantly from remote villages near Liberia’s border with Guinea. With a team of medical professionals from around the globe, Sadigh traveled the country’s mud-bedraggled roads — Liberia is among the world’s leaders in annual rainfall — to treat and contain those afflicted with the disease.
“What I learned immediately for the confinement of the epidemic, you need to be very, very sensitive to cultural, historical background. And community engagement is crucial,” Sadigh said Friday in an interview with Hearst Connecticut Media.
During his time that fall, Sadigh saw first hand the movement of the virus, its devastating effect on individuals and efforts to control its spread — including contact tracing, an important practice in limiting the transmission of pathogens that spread disease.
Sadigh now finds himself on the front lines again, but, at his post as director of Global Health at Nuvance Health out of Danbury Hospital, in a vastly different context.
COVID challenges
The novel coronavirus that has left nearly 3,000 dead statewide and infected more than 30,000, is less fatal but much harder to contain than Ebola, which in two years infected roughly 28,000. In America, especially in densely populated areas like Connecticut, COVID-19 presents its own set of challenges.
One is tracking the spread of a respiratory illness that can pass via tiny particles released when a person, who may show no symptoms, speaks, breaths or coughs, while Ebola is spread through direct contact with bodily fluids.
And while the exact scope of exposure remains unclear — more widespread serological testing is needed — the number of tests being conducted and people infected, even just in Connecticut, remains so high as to prohibit contact tracing.
“I think that will be the major challenge — the major difference between COVID and Ebola in West Africa,” Sadigh said. “The dimension, the scope, was much, much smaller.”
Still, Gov. Ned Lamont plans to begin contact tracing as soon as this week in the hopes that the number of new cases will have dropped to the point that public health officials and volunteers would be able to identify and communicate with anyone who may have had meaningful contact with an infected individual.
Contact tracing is by no means a new technique. But it’s one that functions differently depending on the disease.
“Though many folks are hearing this term for the first time during the current pandemic, it’s not new,” said Jacqueline Vernarelli, assistant professor of health science and leadership at Sacred Heart University. “Public health professionals have employed contact tracing for many types of infectious disease — including HIV — for decades. What makes contact tracing harder for COVID-19 is that we are now needed to trace exposure of a respiratory virus that can be spread through airborne particles.”
That precedent extends to Ebola, as well. Part of Sadigh’s work in Liberia was to isolate whomever came in contact with an infected patient.
Because of the nature of the disease, treatment was limited. Doctors and nurses would give patients fluids to keep them hydrated. But the crucial step was isolating those infected, and anyone they came in contact with, in medical tents, where there was little risk of them spreading the disease through bodily fluids to others.
Contact tracing in Connecticut
Similar efforts would be difficult to replicate in Connecticut, Sadigh said. But, given that the majority of cases are transferred within households, according to Sadigh, it’s worthwhile to make efforts whenever possible.
The West African Ebola outbreak had a high mortality rate — the World Health Organization lists it around 50 percent, with certain outbreaks killing up to 90 percent of those affected — but the disease infected relatively few people.
Sadigh said the disease was contained partly because of successful efforts to isolate those affected, and primarily, because infection often occurred in remote villages with few inhabitants.
“In Connecticut, already the number of cases we have is beyond the scope of Ebola, because Ebola was in very remote countries, remote villages,” Sadigh said. “There were not many travelers coming from Liberia, Sierra Leone or Guinea to the United States. So Ebola didn’t become really more than a local epidemic.”
In addition, Ebola, unlike coronaviruses, is transmitted through direct contact with bodily fluids of the
“I think contact tracing is going to be very hard. You need an army of public health experts putting boots on the ground and going to talk to each of these contacts.”
Dr. Majid Sadigh
infected individual. When a person fell sick, the family members or close friends who cared for the person were at risk, but likely not others in the community.
For Ebola, “close contacts,” described as face-toface interaction between two people for longer than 15 minutes, according to the Centers for Disease Control and Prevention, were relatively infrequent.
Close contact between COVID patients and family, friends and acquaintances — particularly in highdensity areas — are far more common. Sadigh estimated that for every person diagnosed with the virus, 20 to 30 others might meet the criteria for contact tracing. That number could rise as stay-at-home orders are lifted.
Still, the number of those infected in Connecticut is on the decline. And Lamont has expressed hope that the trend will continue to a more manageable point for tracing. The state has already begun assembling a team of tracers.
“We estimate there are 300 existing staff members and then plan to recruit 400 to 500 students,” said Kristen Soto, surveillance coordinator for the state Department of Public Health. “We feel this will be sufficient, but if we find out current staffing levels are not sufficient, we’ll work on expanding at that time.”
Local health departments are also reallocating workers and recruiting volunteers in an effort to scale up their contact tracing capabilities.
But whether there will be enough manpower depends on several factors, Sadigh said.
“I think contact tracing is going to be very hard,” Sadigh said. “You need an army of public health experts putting boots on the ground and going to talk to each of these contacts.”
The percentage of positive tests per those administered will need to be reduced, particularly as the state attempts to greatly increase the number of weekly administered tests. On Friday, Sadigh said roughly 16 percent of all tests administered returned a positive result, down from about 30 percent near the beginning of the outbreak. That percentage will need to shrink into the single digits to make comprehensive tracing efforts feasible, Sadigh said.
Also crucial is the continued adherence to the governor’s social distancing mandate, even as businesses begin to reopen. A return too soon to business-asusual could cause cases to spike, overwhelm the system and preclude meaningful tracing efforts.
The continued observance of these practices is personal for Sadigh.
Sadigh is in his 70s and lives with his wife, who is in her 60s, and his motherin-law, who is in her 80s. All three of his children are in the medical field, including a son who is working with COVID patients at Stony Brook University Hospital.
For the health of his family, and for other doctors and nurses working on the front lines, Sadigh hopes people will stay vigilant.
“They (doctors and nurses) are tired, they are exhausted,” Sadigh said. “So please, my plea to everyone is please, just follow whatever the governor instructs.”