Testing and Contact Tracing - What Do We Need?

[gwraigty]

On the subject of testing and contact tracing, I just read an article in my local news specific to my county. The county health department defines a probable case as someone who they order into quarantine (after being identified as a known contact) who later develops symptoms of coronavirus. Yet, someone who develops symptoms without having been identified as a known contact, won't be defined as a probable case. In both cases, neither person gets a COVID-19 test, both people probably have it, but only the known contact case is reported to the state and added to the daily case numbers. (The health department doesn't know the second case exists and you can't self-report.) Proof positive that they know there are higher numbers of people who should be counted as cases and counted among the recovered.

 

[audreyh1]

Oh there are definitely way more cases than are reported due to both limitations on testing, and a high percentage of asymptomatic carriers. The only way a community can get a handle on likely % population exposed is to do a random sampling with both PCR and antibody tests, and they’d have to take into account likely false positives with the PCR test.

 

[Leo1277]

I am always wondering a bit when I read about the testing status in the WH:

- Apparently the pres is tested daily, but other WH staff weekly. Do we want to protect the other staff in case the pres is infected, and hence test him more often? It should be the other way around. But that takes way more tests...

- The test they are using was reported to have many false negatives, and for presumably small numbers of positives like in the WH, up to 70% of positive cases could be missed. If it's a staff person (s)he could walk around spreading virus for three weeks.

- If the WH does this frequent testing, isn't this an indication that there is some merit to it? If so, then why don't we test other folks with high close contact to others daily - doctors, nurses, flight attendants, teachers, servers in restaurants, supermarket cashiers...

 

[audreyh1]

I strongly believe that the only way to manage workplaces to be relatively safe is with very frequent testing* in addition to distancing (not having people on top of each other, wearing masks in busy rooms with people moving around, etc.). Yes, the testing done at the White House is the indication that lots of testing is how you have to contain spread in the workplace and get early warnings of a problem. And guess what - they recently found a couple of close aides positive! Just shows again that someone might feel just fine and look just fine, but they are infected and can infect others at work.

Places of employment with frequent testing would also give public health contact tracers a framework from which to work as they try to trace spread within the community.

*unfortunately still with fairly high false negatives - that has got to improve!

 

[brewer12345]

I strongly believe that the only way to manage workplaces to be relatively safe is with very frequent testing* in addition to distancing (not having people on top of each other, wearing masks in busy rooms with people moving around, etc.). Yes, the testing done at the White House is the indication that lots of testing is how you have to contain spread in the workplace and get early warnings of a problem. And guess what - they recently found a couple of close aides positive! Just shows again that someone might feel just fine and look just fine, but they are infected and can infect others at work.

Places of employment with frequent testing would also give public health contact tracers a framework from which to work as they try to trace spread within the community.

*unfortunately still with fairly high false negatives - that has got to improve!

I never much cared for my employer being up in my business too much. This sort of thing strikes me as awfully invasive.

 

[audreyh1]

Dealing with a pandemic is going to be invasive because you can infect others at work unless you can work isolated.

 

[brewer12345]

Dealing with a pandemic is invasive because you can infect others at work unless you can work isolated.

Privacy and HIPAA is so old fashioned.

 

[audreyh1]

Privacy and HIPAA is so old fashioned.

Personnel Department can still work within that framework.

Many of us have been lucky enough to work in jobs where testing such as drug testing was not required. But lots of jobs require it. And lots of companies subject potential hires to lie detector tests. And extensive background checks are required for certain jobs, and for security clearances.

 

[Aerides]

Privacy and HIPAA is so old fashioned.

Well it's interesting, but HIPAA doesn't really address employer/employee. It's more doctor/insurance/medical provider stuff. So, from a legal standpoint, it might be that employers now ask their employees to "opt in" for testing and disclosure in order to re-enter the workplace, as a condition of future employment.

I agree I'm not sure I'd want my boss to know I had a potentially debilitating illness, but at the same time, I'd want to be excused and not go back to the shop floor, or office, to get others sick. So on a personal level I'd want to know asap and go home, but on a professional level, yeah... I can see concerns about privacy.

And I'm sure in some cases there might be legal challenges. But usually these things come down on the side of public health and greater good stuff iirc. Will be interesting to watch how this plays out in the courts, as there will be challenges.

(flashbacks remembering that time in the 7th grade where we had mandatory lice testing and I got sent home... I was mortified and so embarrassed....)

 

[audreyh1]

Well it's interesting, but HIPAA doesn't really address employer/employee. It's more doctor/insurance/medical provider stuff. So, from a legal standpoint, it might be that employers now ask their employees to "opt in" for testing and disclosure in order to re-enter the workplace, as a condition of future employment.

I agree I'm not sure I'd want my boss to know I had a potentially debilitating illness, but at the same time, I'd want to be excused and not go back to the shop floor, or office, to get others sick. So on a personal level I'd want to know asap and go home, but on a professional level, yeah... I can see concerns about privacy.

Yes, basically. Part of condition to work with a group of people would be agreeing to be tested. Other types of testing are routinely done for certain jobs.

I believe that it ultimately would give employees more confidence about their workplace.

A lot of places are trying to manage now with taking temps, but that’s a very poor, almost useless substitute for specifically testing for the virus.

 

[Turbo29]

In most states food service employees are required to report certain illnesses to their employer because there is a valid public health reason.





"The PERMIT HOLDER shall require FOOD EMPLOYEES and CONDITIONAL EMPLOYEES to report to the PERSON IN CHARGE information about their health and activities as they relate to diseases that are transmissible through FOOD. A FOOD EMPLOYEE or CONDITIONAL EMPLOYEE shall report the information in a manner that allows the PERSON IN CHARGE to reduce the RISK of foodborne disease transmission, including providing necessary additional information, such as the date of onset of symptoms and an illness, or of a diagnosis without symptoms"


https://www.fda.gov/media/110822/download



Testing for covid-19 in workplaces would also have a valid public health reason and so would probably pass legal muster.

 

[Leo1277]

The first part of this post if from something I just posted on the "Shutdown Exit Strategy" thread, and I am copying it here in an attempt to perhaps re-start this thread which I consider very useful. I then add some more thoughts specifically for this thread.

I am worried that perhaps the key message that we are being given is the idea of "bending the curve", and that that is our goal and measure of success. In the earlier phase of the coronavirus discussion, this was primarily interpreted as a first test whether the distancing measures have sufficient effect or not; but it now has morphed into the ultimate goal in much of the messaging we are receiving.

I personally think this is a mistake: we should not only try to bend the curve, but rather try as hard as we can to squash it down to zero and thus eradicate the virus, through very aggressive distancing early on, and then very aggressive testing and contact tracing later. It's a bit like with cancer: you try to get all of it, as early as possible, and throw all means you have at it (surgery, chemo, radiation...) instead of cutting off part of the tumor today, and come back to it every few months to cut off some more. South Korea, Taiwan, Hong Kong, Singapore (at least until recently) and China have shown that this can be done.

Of course such an effort requires an "army" of contact tracers. But we currently have a large group of unemployed restaurant employees and other service workers, and hiring them as contact tracers would not result in much more cost than the unemployment compensation they are receiving. Training is likely rather quick, and it gives them something to do instead of sitting at home. And since this task is rather important to society in our effort to beat the virus, many may also view it as work that is meaningful and has purpose.

 

[harllee]

Personally I think it is too late to try to eradicate the virus in the U.S. through testing and tracing--it has already spread too far. Plus we have a large segment of the population that will not cooperate with tracing and testing. What I would like testing and tracing (and staying at home) to do is to continue to slow things down for at least another 6 months. The COVID-19 experts at UNC where I live are feeling very confident that they are going to have an effective antiviral pill by Fall. They say it will be a "game changer." So I hope that many of us can avoid getting infected until the Fall when an antiviral pill might be available. Testing and tracing could help with that.

 

[Leo1277]

Personally I think it is too late to try to eradicate the virus in the U.S. through testing and tracing--it has already spread too far. Plus we have a large segment of the population that will not cooperate with tracing and testing. What I would like testing and tracing (and staying at home) to do is to continue to slow things down for at least another 6 months. The COVID-19 experts at UNC where I live are feeling very confident that they are going to have an effective antiviral pill by Fall. They say it will be a "game changer." So I hope that many of us can avoid getting infected until the Fall when an antiviral pill might be available. Testing and tracing could help with that.

Thanks for helping to keep the thread alive It may possibly be too late and there may not be enough compliance, and if so it's really unfortunate. Other than that, go UNC! However, many others are much less optimistic about treatment or vaccination. After all these decades, we have not really succeeded to find means against the four coronavirus that causes the cold, other than chicken soup...

 

[Gumby]

However, many others are much less optimistic about treatment or vaccination. After all these decades, we have not really succeeded to find means against the four coronavirus that causes the cold, other than chicken soup...

It could be the case that the common cold is simply not dangerous enough to make it economically worthwhile to develop a vaccine. But perhaps you have other information.

 

[RAE]

Personally I think it is too late to try to eradicate the virus in the U.S. through testing and tracing--it has already spread too far. Plus we have a large segment of the population that will not cooperate with tracing and testing.

Yes, I agree with harllee on this. The time to do aggressive testing and contact tracing would have been back around February or early March, when the virus had not spread all that much yet. Missing that window of time to do the testing/tracing was a very serious mistake, IMHO. At this point, with the virus already all across the country, I think we're going to have to deal with it until an effective vaccine is developed and widely distributed (ideally), or until the virus spreads on its own until 60% of the population has been exposed, when herd immunity starts to kick in. The latter scenario would have serious consequences (in terms of both human health and our economic health), in terms of additional deaths and probably a much longer period of social distancing restrictions that would likely be imposed.

 

[Leo1277]

It could be the case that the common cold is simply not dangerous enough to make it economically worthwhile to develop a vaccine. But perhaps you have other information.

It's a good point, apparently the cold is much less deadly, and I don't have much information on attempts at finding cures either. But the economic impact is also not something to sneeze at (excuse the pun) if per citizen we spend say a week on average per year with a cold, year after year. I for one would spring for $50 or $100 to be done with it each time it happens, so the economy for a treatment may still be favorable. Anyway, let's see what our clever colleagues in the medical profession come up with regarding CV vaccines and treatments, let's just not think it's going to be trivial or quick.

 

[gwraigty]

I am worried that perhaps the key message that we are being given is the idea of "bending the curve", and that that is our goal and measure of success. In the earlier phase of the coronavirus discussion, this was primarily interpreted as a first test whether the distancing measures have sufficient effect or not; but it now has morphed into the ultimate goal in much of the messaging we are receiving.

I personally think this is a mistake: we should not only try to bend the curve, but rather try as hard as we can to squash it down to zero and thus eradicate the virus, through very aggressive distancing early on, and then very aggressive testing and contact tracing later. It's a bit like with cancer: you try to get all of it, as early as possible, and throw all means you have at it (surgery, chemo, radiation...) instead of cutting off part of the tumor today, and come back to it every few months to cut off some more. South Korea, Taiwan, Hong Kong, Singapore (at least until recently) and China have shown that this can be done.

Of course such an effort requires an "army" of contact tracers. But we currently have a large group of unemployed restaurant employees and other service workers, and hiring them as contact tracers would not result in much more cost than the unemployment compensation they are receiving. Training is likely rather quick, and it gives them something to do instead of sitting at home. And since this task is rather important to society in our effort to beat the virus, many may also view it as work that is meaningful and has purpose.

We're way past early on, which would have been in January. Distancing for the last 2 months has resulted in 36.5 million unemployed people so far. Many of them still haven't seen a penny of unemployment in the last 2 months, or a stimulus check. Many of them don't want to distance any more when it starts interfering with their ability to feed themselves and their kids.

No, it's not one bit like cancer. My mother battled cancer for 11 years before finally succumbing to it in 1991. Cancer is not a communicable disease and it doesn't force millions of total strangers to the patient to become unemployed overnight.

Thankfully for our economy, many of those unemployed restaurant workers and service workers are going back to work, some immediately, some in weeks to come. We also still have some freedoms left and people can't be pressed into service to be contact tracers. Most would probably rather go back to doing their former jobs, or something similar to them.

 

[harllee]

We're way past early on, which would have been in January. Distancing for the last 2 months has resulted in 36.5 million unemployed people so far. Many of them still haven't seen a penny of unemployment in the last 2 months, or a stimulus check. Many of them don't want to distance any more when it starts interfering with their ability to feed themselves and their kids.

No, it's not one bit like cancer. My mother battled cancer for 11 years before finally succumbing to it in 1991. Cancer is not a communicable disease and it doesn't force millions of total strangers to the patient to become unemployed overnight.

Thankfully for our economy, many of those unemployed restaurant workers and service workers are going back to work, some immediately, some in weeks to come. We also still have some freedoms left and people can't be pressed into service to be contact tracers. Most would probably rather go back to doing their former jobs, or something similar to them.

I think many people are going to find out that their former jobs are gone. I think many restaurants, bars, nightclubs, fitness centers, spas, etc will have to close. People will need to find other types of jobs. In my opinion Covid 19 will change our economy dramatically.

 

[Leo1277]

No, it's not one bit like cancer. My mother battled cancer for 11 years before finally succumbing to it in 1991. Cancer is not a communicable disease and it doesn't force millions of total strangers to the patient to become unemployed overnight.

Sorry to hear about your mother; mine had a very similar situation and outcome. Actually what I mean is not about cancer for an individual, but it's like a cancer where the whole country is the patient, perhaps I wasn't quite clear about that. The analogy was that the virus spreads in the population similar to the way cancer cells spread in the individual.

 

[audreyh1]

Yes, I agree with harllee on this. The time to do aggressive testing and contact tracing would have been back around February or early March, when the virus had not spread all that much yet. Missing that window of time to do the testing/tracing was a very serious mistake, IMHO. At this point, with the virus already all across the country, I think we're going to have to deal with it until an effective vaccine is developed and widely distributed (ideally), or until the virus spreads on its own until 60% of the population has been exposed, when herd immunity starts to kick in. The latter scenario would have serious consequences (in terms of both human health and our economic health), in terms of additional deaths and probably a much longer period of social distancing restrictions that would likely be imposed.

I disagree that we are past contact tracing. We missed the possibility of complete containment early on - which honestly would have required a complete international travel ban early on, not just China. But localized outbreaks can still be managed and reduced through testing and contact tracing. Monitoring first responders, hospital staff, nursing homes, even places of employment and tracing from there. If we have to live with this virus for many months, contact tracing still plays a role, which is why state health departments haven’t given up on it. Widespread frequent testing and contact tracing is really the only tool we have to avoid more blanket shutdowns.

 

[donheff]

I disagree that we are past contact tracing. We missed the possibility of complete containment early on - which honestly would have required a complete international travel ban early on, not just China. But localized outbreaks can still be managed and reduced through testing and contact tracing. Monitoring first responders, hospital staff, nursing homes, even places of employment and tracing from there. If we have to live with this virus for many months, contact tracing still plays a role, which is why state health departments haven’t given up on it. Widespread frequent testing and contact tracing is really the only tool we have to avoid more blanket shutdowns.

+1. It is early on in many places and, if places that had larger breakouts beat them back with a shutdown, they return to “early on.”

 

[audreyh1]

+1. It is early on in many places and, if places that had larger breakouts beat them back with a shutdown, they return to “early on.”

Yes, good description. There are lots of areas in the US with low cases, but it won’t stay that way without some vigilance. Fortunately several states seem to be serious about hiring a lot of contact tracers. Now if we can just get that testing ramped up to way more, simpler, faster, much more accurate. Asking a lot - but you gotta do what you gotta do.

Without this, people are going to feel much less confident and stay pulled back.

 

[harllee]

I wish we did have adequate testing and tracing. But I am pessimistic about it. I think in our country (unlike many other countries) we have a significant portion of people who will not cooperate with the testing and tracing. We can't even get people to wear masks in crowded places.

 

[Gumby]

Yes, good description. There are lots of areas in the US with low cases, but it won’t stay that way without some vigilance. Fortunately several states seem to be serious about hiring a lot of contact tracers. Now if we can just get that testing ramped up to way more, simpler, faster, much more accurate. Asking a lot - but you gotta do what you gotta do.

Without this, people are going to feel much less confident and stay pulled back.

Here in CT, the state has already done 170k tests, which is nearly 5% of the population (Maybe. There could have been multiple tests on some people). Currently, they are testing at a rate of almost 7k per day and the plan is to ramp up to about 15k per day by month's end. They have also started up a contact tracing program and hired a bunch of people for that. Given our relative success in beating the infection rate down over the past two months (there are currently only 937 people hospitalized, which is less than half of the peak reached on April 22), there is a chance that the tracing will be able to keep things under control as some of the restrictions are lifted.