Preparing for the Next Steps: Case Finding and Contact Tracing

Many people are asking me “When do you think that life will go back to normal?” They are getting tired of social distancing and not being able to do most of the things they enjoy. We must still be vigilant, wash our hands, and keep a safe distance from others, but it appears that the steps taken to control the coronavirus (COVID-19) have had a positive effect and the peak of the outbreak may not be as bad as was once thought. If this is the case, since our economy is suffering from these restrictions, the pressure will be on the Governor to let people go back to work.

However, lessening the restrictions is potentially dangerous unless we are prepared for the next steps. A few months ago, when COVID-19 first came to the United States, 100% of the population was susceptible to contracting the disease. Now, some have had the disease and survived and carry antibodies against the virus and are immune. Others have not been exposed and are still susceptible.

Since we have not had enough test kits available to test directly for the virus or to do blood testing for its antibodies, we really don’t know what percentage of the population is still susceptible. Since there still is no treatment or vaccine, lifting the restrictions could allow the virus to spread rapidly once again. We must be able to find each new case, quarantine the patient, and then identify his or her contacts and quarantine them as well.

This case finding and contact tracing is already done for other diseases by our local health departments. If a patient is identified as having syphilis, for example, they are reported to the health department, which then interviews the patient, identifies anyone who the patient may have transmitted the disease to, and contacts them as well. The contacts are tested and treated if they come back positive. This process will be more difficult with COVID-19 because it is very contagious and can be transmitted to a larger number of people.

Experts at the Johns Hopkins Bloomberg School of Public Health released a paper entitled “A National Plan To Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the U.S.” You may want to read this paper. It identifies the steps needed to create a system of case finding and contact tracing for the country and it gives an estimate of the costs associated with building such a system.

Over the next few weeks, the conversation will turn from the medical care of COVID-19 patients and the work of hospitals, to the next phase: the work of a revitalized public health system. Stay tuned.