Contact tracing, key to reining in the virus, falls flat in the west
By Benjamin Mueller
As the coronavirus stampeded across Europe and the United States this spring, governments made their depleted citizens a tantalizing promise: Soon, legions of disease detectives would hunt down anyone exposed to the virus, confining them to their homes and letting everyone else get on with their lives.
Nearly eight months on, as a web of new infections spreads across Europe and the United States, that promise has nearly evaporated.
Despite repeated vows by Western nations to develop “world-beating” testing and tracing operations, those systems have been undone by a failure of governments to support citizens through onerous quarantines or to draw out intimate details of their whereabouts. That has shattered the hope of pinpoint measures replacing lockdowns and undermined flagging confidence in governments.
Beholden to privacy rules, Western officials largely trusted people to hand over names to contact tracers. But that trust was not repaid, in large part because governments neglected services that were crucial to winning people’s cooperation: a fast and accurate testing system and guarantees that people would be housed, fed and paid while they isolated.
“Public health leaders fell in love with the idea of contact tracing as an important tactic — and it is — but that’d be like if you’re going into war and were just talking about the tanks,” said Brian Castrucci, president of the de Beaumont Foundation, a public health charity in Maryland.
Just as important, officials overlooked the impact of raging mistrust in government and a thicket of conspiracy theories about the virus’s spread. Fearful of plunging themselves or their friends into a painful period off work, infected patients have handed over a paltry number of contacts and often flouted self-isolation rules. Contact tracers are struggling to reach people who test positive and being rebuffed once they do.
In theory, countries were to build mass testing programs that would provide quick diagnoses. Then a group of tracers would find others who had crossed paths with the infected person and tell them to stay home.
Elected officials presented the system as a critical bridge between lockdown and a vaccine, allowing them to contain small outbreaks without shutting down large parts of society. But construction of that bridge has been rocky, at best.
The West’s public health systems have not matched the success in parts of East Asia where the fear of epidemics became more ingrained after outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
Following those outbreaks, places like Taiwan and South Korea built robust tracing systems and legal frameworks for limiting civil liberties during an epidemic. Some contact tracers have used cellphone and credit card data to identify people who were potentially exposed.
But in Europe and the United States, which have largely relied on the public to provide information and follow quarantine rules voluntarily, the response has been spotty.
The West also ran up against the blunt fact that contact tracing, while useful in containing limited cases, has become overwhelmed by a new explosion of infections. In the past week, Europe has averaged about 60,000 new daily cases, while the United States is registering more than 40,000.
“The track and trace system is unrealistic and useless,” said Mahmoud Salamon, 27, a recent business school graduate on a visit to Brighton, on England’s south coast, where a testing center at a stadium was recently closed for the start of soccer season. He said he distrusted restaurants or stores with his personal information.
In Taiwan, an infected person names more than 15 contacts on average, and tracers often interview patients in person, trying to extract details about secret jobs or marital affairs. But the picture in Europe is far different, and the low level of cooperation has startled public health experts.
In Spain, where hospitals are struggling with a new rush of cases, contact tracers identify, on average, only three contacts for each known case. In France, the figure has fallen below three.
Yet even those numbers are higher than in the United States. In New York City, each infected person hands over an average of 1.1 other names.
In England, people are neither handing over many contacts — about five, on average — nor following the rules. In a survey of about 32,000 Britons, less than 1 in 5 who reported coronavirus symptoms said they had stayed home. Of those alerted that they had been close to an infected person, only 1 in 10 said they had complied with orders to self-isolate.
“It suggests there is some degree of skepticism in the population to engagement,” said professor Christophe Fraser of the University of Oxford, an adviser to the government’s tracing program, referring to the proportion of known cases — a fifth — who handed over no other names.
Crucially, many Western governments have failed to cushion the financial and psychological blow of self-isolation by guaranteeing people tests or giving them enough money to weather two weeks without work.
With tests results lagging in many countries, contact tracers cannot get ahead of the virus. In Paris, people wait up to a week to get testing appointments and results. England recently recorded a backlog of nearly 200,000 untested lab samples, making it impossible to track the virus through newly reopened schools.
Some elected leaders have blamed recalcitrant citizens for undermining contact tracing. Prime Minister Boris Johnson recently said the problem was that Britain was “a freedom-loving country.”
But the evidence for such claims is thin. Some countries have successfully tracked the virus despite people’s resistance, in large part by investing in chronically underfunded health departments, epidemiologists said.
In Germany, people said they would refuse to hand over names to contact tracers at double the rate of Britons, according to a poll by Imperial College London. Even so, the country has largely kept a small uptick in new infections under control.
Beyond Germany’s strong testing program, said Ralf Reintjes, a professor of epidemiology at Hamburg University of Applied Sciences, the country also responded to the pandemic by pouring money into its roughly 400 local public health offices, which had long conducted contact tracing for communicable diseases.
England, by contrast, awarded a 108 million British pound ($138 million) contract to an outsourcing company, putting the fate of contact tracing in the hands of ill-trained call center workers.