Seattle, Washington. March 1919. The mood in North America is euphoric. The Great War has just come to an end and the Spanish Flu seems like ancient history. In sports, the Montreal Canadiens are on the brink of defeat to the Seattle Metropolitans, who only need one more win for the Stanley Cup.
But Montreal’s star enforcer Joe Hall leaves Game Six early. And what was once a fight to avoid championship elimination suddenly becomes a fight for actual survival as Hall, his teammates and members of the Metropolitans reach the cytokine storm phase of the same flu everyone assumed was gone.1
The NHL never crowned a Stanley Cup winner that year. The Canadiens couldn’t field even one line of players by the next game. Many of them fell sick, mirroring the millions more who were about to succumb to the flu’s resurgence across the globe.
More than 100 years later, in the US and around the world, we’re winding down from the first wave of COVID-19. Many consider it a warmup for either a resurgence of the virus or for another future pandemic.
Here’s why we can be optimistic, but not complacent.
There’s much to learn from the Joe Hall story, but today we have technological advances to reduce pandemics in a way not possible a century ago. Science and governments are scrambling as never before to develop, test and manufacture a viable vaccination. Only when manufacturing is at a critical mass, however, will we be technically out of the woods with COVID-19. Whatever entity has efficacy and approval, it will wield immense influence on the global stage.
According to a recent article in The Guardian, “As soon as a vaccine is approved, it’s going to be needed in vast quantities. In a best-case scenario, mass manufacture probably won’t arrive before 2021 – and many of the organisations in the Covid-19 vaccine race simply don’t have the necessary production capacity.”2
The Four T’s
So, where does that leave us? Some nations have been largely successful at tamping down the contagion using a variety of tools—most notably, the Four Ts: (1) Timing, (2) Tactics, (3) Testing and (4) Tracing.
- Timing. Of the Four Ts, The timing of actions is the most critical early on, keeping overall national and personal losses to a minimum. Prime Minister Jacinda Ardern’s quick decision to lock down New Zealand has been cited as the primary reason for her country’s low virus-related case numbers and deaths.
- Tactics. Tactics include informing affected individuals, quarantining, and issuing guidelines. Nations like South Korea and Germany, for example, have mobilized to swarm affected individuals and the individuals they likely had risk-of-infection encounters with.
- Testing. Testing in the US has been far from perfect, but is becoming more accurate. As of June 25, more than 31 million tests have been completed in the United States alone. Given the nature of this Coronavirus, these first three Ts are interdependent in successfully and speedily arresting the community spread of the pandemic.
- Tracing. The fourth T, contact tracing, is a foundational element in preventative medicine, and in this stage of the COVID-19 pandemic, it’s fast becoming the most critical tool for every public health organization charged with combating the exponential spread of the virus. Unfortunately, it’s also one of the more difficult tools to administer.
So What Makes Tracing So Cumbersome?
First, contacting COVID-19-positive individuals to try to piece together their whereabouts since first possibly becoming infectious is laborious. Add to that the task of contacting all those who spent significant time with an infected individual from the probable date of exposure to provide advice on how to self-isolate, symptoms to watch for, where to get tested, systems of social support, and length of time before an individual is presumed clear. The CDC’s PUI form for contact tracing is a small-font two-pager that has to be a real-time bandit for a COVID-19 tracer filling out each manually by pen or keyboard strokes.
Also, many state and local health systems recently showed what happens when their legacy systems are hit with a deluge of unemployment claims. Contact tracing may rely on the same legacy systems for data and communications, so a contact tracing platform should be able to communicate with legacy systems without breaking them.
Finally, time is of the essence. As an infectious virus like COVID-19 spreads exponentially, the tracing piece of the containment equation grows hyper-exponentially. So here we are in June 2020 in the USA with over 2.3 million cases and 123,000 casualties,3 and some combination of state, county and local health boards are obligated to develop their own tracing and case management systems.
This makes real-time reporting on case management crucial to a successful tracing program.
Making It Easier on States’ Boards of Health
Several steps to making tracing more effective are identifying and digitally connecting with all data providers, scripting initial contact tracing calls, providing tools like apps or automated phone call follow-ups, text-messaging, and automating as much of the case management as possible. Even contact tracing to susceptible populations can be greatly helped by automating casework.
The Pennsylvania National Electronic Disease Surveillance System, for example, has received an $18.7 million federal grant of which a part of is earmarked for contact tracing.4 While individuals are critical to an empathetic outreach, making investments in automating public health workflow makes them more accurate, less repetitive, and most likely, less-stressed employees. As I wrote earlier, investing in building systems rather than proportionally hiring more temporary contact tracers makes a state health agency more prepared for the next COVID-19 resurgence or global pandemic.
The Rest of the Story
March 2020 marked the 101st anniversary of Joe Hall’s death 3,000 miles from his Montreal home. A critical component that could have saved Joe and millions like him would have been any effort to enact an organized contact tracing effort that isolated the infected as soon as possible. It would have been far more manual and cumbersome than with the technology we have today, but with so much at stake, we as a nation and global community must get this right.