Saving the economy with a ‘think national, act local’ approach

Published: Wednesday, September 23rd, 2020

There's growing evidence that COVID-19 contact tracing is more effective when it is conducted at the community level. It turns out that community members tend to know each other and that helps to support the intuition that is an essential part of any sort of detective work.

It is also clear from the evidence that COVID-19 is with us for the foreseeable future, and so the need for contact tracing is too. But as countries around the world recover from their initial peaks in infection, clusters appear and, if they are not brought under control, they quickly become outbreaks and the need for lockdowns and curfews soon follows.

We are seeing this in the UK at present, where several cities in the north of the country are now facing reimposed restrictions as outbreaks in their communities grow. These are opportunities for applying a localised approach to contact tracing to speed up bringing the outbreaks under control.

But just because an infection cluster is localised doesn’t mean all the close contacts of the positive case are limited to that community. In a recent case in the Australian country town of Colac, where community-based contact tracing had proven very effective, the infection resurfaced due to a community member who visited a hospital in Melbourne, 150km (94 miles) away, setting off the need for contact tracing in multiple communities.

As the infections ebb and flow in communities, so too will the need to quickly re-establish localised contact tracing. But these efforts need to be coordinated, as the Colac example shows. It’s little use if each of these localised responses manages its data independently without the ability to cross-reference close contacts across multiple communities. At the very least, there needs to be a common data repository that enables the detective work of finding all close contacts to happen quickly across multiple communities, and to do so means being able to use technology to analyse the data. A centralised contact database is essential for that to work.

It is also clear by now that contact tracing is a tough job. The calls can be long and difficult and can take many twists and turns. Contact tracers learn ‘tricks of the trade’ for having successful calls with cases and contacts. In the contact tracing that Panviva has been involved in multiple states in the USA we have seen the contact tracing processes and procedures change as more is learned about how to do it well. Tracers learn from each other if best practice is captured and can be shared. Best practice only works if it becomes common practice and the thing about a localised approach to contact tracing is that few, if any, communities will have time to practice at all. When an outbreak occurs whoever can be assigned to the task of contact tracing will need to be effective immediately, using the data management system efficiently and compliantly, and following the best practice as it has evolved based on the efforts of other communities that have refined it in responding to their own outbreaks. There’ll be no time for training and no time for learning on the job.

We have seen this need for speed in the COVID-19 contact tracing implementations that Panviva has been part of. Tracers who have access to best practice guidance on contact tracing processes and procedures and on the proper use of the data management system become effective infection detectives more quickly and are able to contribute positively to ‘flattening the curve’.

So, a localised approach to contact tracing makes a lot of sense, but without a national approach to data and knowledge management it is likely to be less effective than we all need it to be.