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State and local governments across the country are loosening stay-at-home and safer-at- home restrictions, allowing businesses of all kinds to reopen so the economy, ground to a near halt by coronavirus protections, can kick back into gear.

As activities of everyday life resume, public health experts at all levels of government remain concerned about the potential for COVID-19 flare ups and the possibility of a second wave of outbreaks. To prevent this from happening, public health departments are relying on contact tracing to help reduce community spread of the coronavirus.

“Contact tracing is key to being able to, first of all, identify who has been exposed and then use that information to identify people that that person might have come in contact with so you can isolate those people so they don’t spread the disease further,” Rachel Vasconez, MBA, MPH, ORAU project manager for health communication and marketing, said.

People who know they have been exposed or may have been exposed to an infectious disease are asked to self-quarantine. In the case of COVID-19, self-quarantine lasts 14 days.

Contact tracing is a process that has been used for decades to combat the spread of illnesses like Ebola and SARS. ORAU takes a whole system approach to helping our customers implement public health interventions like contact tracing programs.

Because COVID-19 is so easily spread, as many as 100,000 contact tracers may be needed to help monitor for case spikes and outbreaks, according to a report by the Johns Hopkins Bloomberg School of Public Health Center for Health Security.

“That just demonstrates the level of effort that is needed in order for public health to get its arms around who’s been potentially exposed, how you remove them and put them in quarantine, so to speak, until we make sure they are not infectious and not going to be exposing other people. It’s really a big, big challenge,” Freddy Gray, MPH, MCHES, ORAU director of heath preparedness and response and health communications programs, said.

ORAU works with public health agencies to hire contact tracers and train them to do the work, and they need to possess an innate emotional intelligence and empathy, Jennifer Burnette, MPH ORAU project manager in STEM workforce development, said.

“Even in smaller outbreaks in communities, for instance a meningitis outbreak at a college, there are so many complexities with contact tracing,” she said, including understanding cultural sensitivities, underlying medical issues, and other issues that may arise in response. Contact tracers need to be mindful of how they would want to be approached if they were the person on the other end of the phone.

“If you’re telling someone they may have been exposed to a disease, sensitivity is required,” Vasconez said.

The data collected by contact tracers is analyzed and evaluated to determine the rate of community spread, where hotspots and flare-ups exist, and where additional public health response, including the possibility of reinstating social distancing guidelines may be necessary. How long a contact tracing program lasts depends on the prevalence of disease in a community.

“Evaluation and assessment occurs throughout the cycle of public health activities,” Julie Crumly, Ph.D., MCHES, ORAU research and evaluation specialist and senior scientist, said. She added that steps in the cycle might include needs assessment, where plans and capabilities are assessed; process evaluation, which looks at how well activities like contact tracing are being implemented; outcome evaluation, or how well the community is responding; and then quality improvement, where improvements are made all along the way.

“We want to know what’s working well and what needs adjusting, then make those adjustments so we can do everything possible to reduce the spread of disease,” Crumly said.

Contact tracing is a labor-intensive, hands-on process. Media coverage of contact tracing has often included discussions about the use of smartphone apps. Burnette said such apps may be helpful in some respects, but may not give the full picture of disease spread.

“There is so much more to contact tracing. A more holistic approach is required. Just asking someone to hit some buttons on a smartphone isn’t enough to turn the tide,” she said.

ORAU has previously worked on text messaging protocols for other types of public health emergencies, which focused on medical countermeasures follow up and making sure people got the medical countermeasures they needed, like an additional dose of a vaccine.

Using smartphone technology “is not necessarily a new concept, but we are in a place where technology can support mechanisms that help public health do what they need to do,” Burnett said.

This is Not a Simulation

One of the important ways public health officials prepare their response to crises like disasters and pandemics is by running simulations, either as a theoretical tabletop event or by staging an event where volunteers pose as patients who have been exposed to an illness or injury. These simulations are vital to ensuring rapid and effective response, and ORAU has decades of experience helping government agencies and communities with preparedness measures.

Obviously, this is not a simulation.

“What we’re dealing with today is an actual real response with real consequences that are immediate,” Gray said. “That’s what makes things so different in a response like this, where you can’t see it, there’s not any vaccination, there are no real medical countermeasures, and there’s a high rate of exposure and infection.”

Because public health agencies run simulations to keep themselves prepared, they have time to make necessary changes, strategize how they can improve, identify obstacles and gaps, and develop innovative solutions.

“Here, you’ve got to do all of that on the fly in some senses, if plans are not in place. That’s what makes this such a big challenging event,” Gray said. “So we’re grateful to public health because they’re really doing a phenomenal job.”

Contact tracing will to be an important part of public health’s role in tracking the spread of the coronavirus, should outbreaks occur as the nation reopens for business.

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Our Experts

Rachel Vasconez

Rachel Vasconez, M.B.A., M.P.H.

Expertise: Public health preparedness, private sector partnerships, medical countermeasures and project management

Vasconez has more than 17 years of experience in public health preparedness, program management and program development, including expertise in developing and managing public and private sector partnerships, health communications, and program evaluation initiatives.

Freddy Gray

Freddy Gray, M.P.H.

Expertise: Public health and healthcare preparedness, medical countermeasures, team dynamics, strategic planning

Gray has more than 25 years of experience managing and supervising public health and healthcare system preparedness and response programs involving medical countermeasures to help mitigate the surge of patients due to a public health emergency.

Certification: Master Certified Health Education Specialist

Julie Crumly, Ph.D.

Julie Crumly, Ph.D.

Expertise: Health and education program evaluation, research methods and data analysis, multicultural and social psychology, evaluation of health interventions and programs, and outcome evaluations for continuing medical education

Co-author: “Non-pharmaceutical interventions for pandemic influenza: An assessment of communication, training, and guidance needs of state, tribal, local, and territorial public health officials,” 2018

Certification: Master Certified Health Education Specialist