Contact Tracing is a Huge Success So Why Won't The US Use It?

Mish

Singapore and Australia are among the countries successfully using contract tracing. The US is reluctant.

Contract Tracing South Korea 

Bloomberg reports These Elite Contact Tracers Show the World How to Beat Covid-19

In May, when a coronavirus outbreak hit nightclubs in the South Korean capital of Seoul, health officials quickly unleashed their version of the Navy Seals -- elite teams of epidemiologists, database specialists and laboratory technicians.

An old-school, shoe-leather investigation showed the virus had jumped from a night-club visitor, to a student, to a taxi driver and then alarmingly to a warehouse employee who worked with 4,000 others.

Thousands of the employee’s co-workers, their family members and contacts were approached and 9,000 people were eventually tested. Two weeks later, the warehouse flareup was mostly extinguished and infections curtailed at 152.

The work of such so-called Immediate Response Teams offers a look at how South Korea -- once the second worst hit by the coronavirus -- has succeeded in largely quelling its spread without the lockdowns that have derailed lives worldwide. 

South Korea’s strategy is also a contrast with the harsh shutdowns instituted in parts of China or the tourism blockade implemented by New Zealand in an attempt to completely stamp out the virus. The Asian nation meticulously targets dangerous hotspots and then simply allows most people to lead lives and run businesses unimpeded.

Contract Tracing Singapore

Singapore started Nationwide Contact Tracing in September

Singapore will begin issuing COVID-19 contact tracing wearables to all residents and introduce additional safety measures as it looks to resume more public activities in the coming weeks. These new measures will include the mandatory use of the TraceTogether Tokens or contact tracing app TraceTogether to facilitate digital check-in procedures at some locations where "higher-risk activities" are held.

To date, its TraceTogether app has topped 2.4 million downloads, accounting for about 40% of the local population.

An initial batch of 10,000 Bluetooth-enabled TraceTogether Tokens were distributed to the elderly in June, days after the country's plans to introduce the wearables sparked public outcry amongst individuals concerned about their privacy. It prompted the government to reveal that the contact tracing devices did not contain a GPS chip and would not have internet or cellular connectivity, so the data collected could only be extracted when the devices were physically handed over to a health official.

Contact Tracing Australia

The COVIDSafe app is part of our work to slow the spread of COVID-19. COVIDSafe supports the current manual process of finding people who have been in close contact with someone with COVID-19.

The COVIDSafe app is completely voluntary. Downloading the app is something you can do to protect you, your family and friends and save the lives of other Australians. The more Australians connect to the COVIDSafe app, the quicker we can find the virus and prevent the spread.

In many cases, people won't know the names and contact details of everyone they’ve been in close contact with (for example, on public transport). COVIDSafe uses technology to make this process faster and more accurate.

State and territory health officials can only access app information if someone tests positive and agrees to the information in their phone being uploaded. The health officials can only use the app information to help alert those who may need to quarantine or get tested.

COVIDSafe stores contacts on the phone for 21 days. This allows for the 14-day incubation period of the coronavirus, plus the time taken to confirm a positive test result. The rolling 21-day window allows COVIDSafe to continuously note only those contacts that occur during the coronavirus incubation window. It automatically deletes contacts older than 21 days.

Nobody can access the encrypted information on your phone, including you.

Downloading and using COVIDSafe is voluntary. The app has a range of privacy and security safeguards built in. It uses secure encryption and does not collect data on your location.

New Cases Per Million 

New Covid Cases Per Million - 2020-11-04A

Tests Per Confirmed Case

Covid Tests Per Confirmed Case - 2020-11-04A

It's a lot easier to know who to test in a timely manner with contract tracing. 

Singapore and Australia have done a massive amount of testing per case: 4,062 and 3,848 respectively.

In contrast the US has done 13.5 tests per case. Spain, Italy, and the UK are even worse than the US.

Guess which countries have problems and which don't.

Contact Tracing Is Badly Underused by the U.S.

Scientific  American reports Contact Tracing, a Key Way to Slow COVID-19, Is Badly Underused by the U.S.

The tracing approach is built on a simple idea: When someone tests positive for the new coronavirus or becomes sick with COVID-19, you find all the people the infected person came into contact with, because they, too, may be infected.

Contact tracing is a tried-and-true method that epidemiologists have been using for decades to tackle everything from foodborne illnesses to sexually transmitted diseases, as well as recent outbreaks of SARS and Ebola. “It’s a great tool for bringing an epidemic into the suppression or containment phase,” says special pathogens expert Syra Madad of NYC Health + Hospitals, which leads New York City’s Test & Trace Corps contact-tracing program.

Large-scale contact-tracing programs in places such as South Korea and Germany have been instrumental in suppressing the novel coronavirus, SARS-CoV-2. Within days of detecting its first case on January 20, South Korea created an emergency response committee that quickly developed wide-scale virus testing, followed by an extensive scaling up of the nation’s network of contact tracers. Germany similarly committed resources to mobilizing a tracing workforce. In both countries, cases have dropped dramatically.

A look at some individual states makes it clear that the workforce has not reached the scale required in several places. For instance, Arkansas recently announced plans to hire 350 new contact tracers, which would bring its total to about 900. But based on the number of current cases, the state actually needs 3,722 tracers, according to a contact-tracing-workforce estimator developed by the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University. In Florida, where the pandemic is surging terribly, the same estimator calculates that 291 tracers per 100,000 residents are needed. Yet as of early July, the state had only seven per 100,000. And cases of COVID-19 surged in Texas, even as contact tracers working for the Texas Department of State Health Services were taken off the job.

Though numerous phone apps now aid in identifying potential contacts, “technology can’t solve the problem of convincing someone they should pick up the phone when a contact tracer calls,” says Mary Gray, a social scientist at Microsoft Research, who also has affiliations with Harvard University and Indiana University Bloomington. “It is the reason we are failing—because we keep searching for something else we can buy or put into place. We have not conceded how deeply human this process is.”

One of the biggest challenges is misinformation being disseminated on social media. BuzzFeed News reports that “Facebook posts and YouTube videos spreading hoaxes and lies about contact tracers have received hundreds of thousands of views.” Some of these posts compare tracers to Nazi secret police and falsely say they take people to internment camps. Others suggest they should be greeted with guns. Contact tracers report they have faced death threats.

The next action that comes after a tracer has identified a potential infected person—getting that individual to adhere to quarantine—has proved exceptionally difficult in the U.S. For stopping the spread of a virus, however, isolation is absolutely key. “You can do the contact tracing all you want. But if you’re not also providing these support services people need to isolate, it won’t work,” Madad says. No one is going to quarantine for 14 days if that means losing a job and income or abandoning caregiving.

Personal Anecdote

A friend of mine back in Illinois just informed me that she went in for Covid testing. The test facility said results would take 3 to 7 days.

Is this totally nuts or what?

She went to a second place that told her it would be expensive to do the test unless her plan covered it. Most plans don't but her plan did. She was positive and two days later started vomiting. 

How many people who are asymptomatic or have very minor symptoms will bother to quarantine for 7 days waiting for a damn test?

Is it any wonder this is spreading like mad?

Addendum

Another comment from a friend I trust 100% .

My daughter who lives in Ludington [Michigan], is on the board for the Jaycees. They always have a Halloween party, and she wanted to find a way to do it this year. She offered to have it at her house, did everything outside. Several of the board members did not come because they thought she was being too crazy about being careful. There were 10 people there. 

The next day one of their friends started to feel bad. On Sunday he got tested for Covid. He did not get his results until the following Friday. And, yes, he was positive. His wife was not, but their son was also positive.

Right now we have a country where about half the people think wearing a mask in public places is an infringement of their personal liberty. 

Understanding the Problem

The main problem is not insufficient contract tracing, it is piss poor policy on the need for testing and terrible delays in getting results from tests. 

I provided two examples from people I trust 100% on these delays. 

If it takes 2-3 days to get results from a test, and people are reluctant to get a test, and individuals have to take it upon themselves to follow up on contacts, guess what? Contact tracing is useless.

I do not support forced contact tracing. I do support voluntary contact tracing and I am sure it would help, but only if we had more testing and faster results.

Addendum II

I cannot vouch for these comments but they ring true given what I do know.

Mish

Comments (119)
No. 1-37
PecuniaNonOlet
PecuniaNonOlet

The main reason for that will be gone in January. Sanity returns. We are finally turning the corner....lol.

JJ Johnson
JJ Johnson

North Dakota told it's citizens to do their own contact tracing about 3 weeks ago. That sure worked out well.

My brother-in-law died of it. At the funeral on Oct 24th 4 of 38 people in attendance wore a mask.

Can't fix stupid, but COVID just may.

FromBrussels
FromBrussels

In Belgium we have had contract tracing for months before the present lockdown, we are disciplined folks wearing masks and keeping distances...and enjoy state of the art medical care on top of that......Look where we are !

njbr
njbr

Why no tracing?

Federal top-down incompetence and denigration of the seriousness of the pandemic.

After all, we're going down the herd-immunity path for the next few months (thanks, Scott Atlas, radiologist). You're going to get it, just accept it and hope for the best. Who gives a damn where you got it.

When's the last time you heard the WH talk about the vaccine?

Talk about dropping the issue after the election.

nzyank
nzyank

Many Americans' deep seated distrust of government makes contract tracing apps politically challenging. Until society becomes more community minded and less individualistic, this will be an ongoing issue. Libertarianism focuses too much on individual freedom, and doesn't suffiiently convey that individual freedom is enhanced by strong and diverse community.

RreadyKilowatt
RreadyKilowatt

How about because these countries trust their governments to not abuse the data they collect? A database of contacts (even when somewhat anonymized) on every American is just too tempting for law enforcement to not grab. San Diego installed "smart street lights" that have cameras installed. The local PD immediately pounced on the camera feeds, even though the system was sold to the public to be used "for urban planning." The PD used the system 400 times since 2018. And there's the whole Ring doorbell network, where local PDs can use your doorbell to spy on your neighbors. We know that it is fairly routine for law enforcement at all levels get access to cellular metadata to do some data drag-netting. And even if there's specific legislation passed to try to prevent this from happening there will be language tacked on (probably in reconciliation) that grants exceptions.

Eddie_T
Eddie_T

Social media.......we live in a world chock-full of dangerous misinformation...brought to us by all kinds of nut cases, with all kinds of axes to grind.

Same reason people are afraid to get vaccinated....with something as incredibly safe and efficacious as the measles vaccine.

People love to mistrust authority these days......even when it’s in their own best interest....and people are not that well educated in this country.....

And...we have a President who thought it would be a good idea to have fifty different state programs competing with each other for resources, instead of a coherent national approach...and his motivation for that was he thought it would help him win an election......and it allowed him to punch his political opponents in certain blue states.

Those are all reasons we don’t have contact tracing.

Realist
Realist

Fortunately, Biden will begin assembling his pandemic response team this week. They will prepare their plan and get ready to hit the ground running as soon as they can. Sadly, Trump will be around for another 2 months, blocking an effective response as the virus spreads out of control in America.

Here are the daily case:death numbers for the last week.

Nov 1 S 71,321:399

Nov 2 M 88,905:522

Nov 3 T 94,463:1199

Nov 4 W 108,352:1200

Nov 5 T 118,204:1125

Nov 6 F 132,540:1248

Nov 7 S 115,240:1002 (so far today)

Why is it that Republican Presidents always hand over a crisis to their Democratic successors?

Sechel
Sechel

Contact tracing works but the virus level has to be low. In many parts of the country it's too high.

Contract tracing potentially involves privacy issues, those need to be overcome. In Israel they are using some of the same surveillance tools they use to track terrorists onto their own citizens. It's also a management issue. Deblasio has totally failed at running a good program.

Biggest reason its not being done in the U.S. across the country is because the Federal government isn't championing it. I agree where it is being employed countries are far more effective at keeping the virus in check. But in a country where the Federal government won't get behind basic social distancing and mask wearing contact tracing seems like a pipe dream. Maybe we'll revisit these issues after January.

Carl_R
Carl_R

Blame it in part on the insane comment that "more testing means that you find more cases". The point that you WANT to find more cases if you want to slow the spread. Every case that you don't find is someone who can spread the virus to others.

Webej
Webej

In Japan they have been smarter about track & trace. Instead of wasting a lot of time trying to map out all contacts (many of which are asymptomatic and not contagious), they have been trying to track backwards to the origin of the infection. We already know that most people to not spread the disease, and that 8% of the infected are responsible for 60% of the spread. Tracing back to the origin and quarantining the super-spreaders makes a lot more sense than attempting to track and quarantine scores of asymptomatic or non-contagious individuals, focusing your resources on the vectors that matter.
Of course any strategy that has a built in latency of 3-4 days between test and result is pretty much doomed to going through the motions, pretending you're doing something about it.

Greggg
Greggg

As for us, we have dropped out of the covid freak-out program, on the advice of our doctors.

FeMaiden
FeMaiden

Why no contact tracing? Simple. Like it or not, it's no one's business with whom I do and do not associate. I own a business and have had a significant number of employees test positive. Not a single instance of peer to peer transmission (they all have contracted it socializing on the weekend) and no one... absolutely no one... has gotten seriously ill.

njbr
njbr

Can't resist this one....

Trump tweeted about a big news conference at the Four Seasons in Philly today.

And then Trump modified the venue to Four Seasons Total Landscaping in an industrial area of Philadelphia

The new conference was held in the parking lot of the landscaping business, which is located by a sex store and a crematorium. The landscaping business was closed on Saturday. There was a sale on at the sex store. No word on the happenings at the crematorium.

Rudy Guiliani spoke of voter fraud and impending major lawsuits.

The pictures of the event are hilarious. Rudy looks rediculous. The current Yelp reviews on the landscaping company are funny. ( Example review--Avoid like the plague, terrible people. Said they were going to build a wall four years ago and that my neighbor would pay for it. Never came through, just a bunch of lies and for whatever reason they spend way too much time on Twitter. Seriously just strange people.)

I know people fall fast, but this is bizarre. Who has a press conference on serious national issues in the parking lot of a random small business?

Unless Rudy is trying to out-Borat Borat.

Tengen
Tengen

I remember the heady days at the beginning of the year on ZH where they were laughing about Covid, saying only Asian people could get it. There was also no small amount of schadenfreude sparked by this conclusion. They're definitely not laughing now, but that may be because they're busy declaring that Trump will still win the election.

East and southeast Asia seem to be the only real success stories. A few factors may be causing this, including that they're being careful, they're willing to cooperate with each other, and they're not corpulent pigs like a lot of people are in the West.

Mish
Mish

Editor

BoneIdle
BoneIdle

Sorry Mish, but you should have done more research into the Australian Covid app.

It only found 14 instances in all the months of operation.

nigelss
nigelss

In Australia, the CovidSafe app was largely a fallback for the existing contact tracing (using the phone, and contact lists required by all businesses such as restaurants, hairdressers and gyms). In NSW, we had daily announcements on the TV and Radio of all locations that had cases. People are encouraged to come forward for testing, even with little or no symptoms. The testing is free and available to anyone, although the criteria changes a bit from week to week. We had pop-up testing centres set up in particular areas where hotspots emerged. If the testing drops below certain thresholds, people are encouraged to come forward by the government.

This culture of diving on any residual cases has made it safe for the rest of the population to return to some sort of normality until 100% of cases are eliminated or a vaccine can be distributed (likely in 2021). In some states of Australia, the virus has been completely eliminated, which means that life has largely returned to normal, with people going to the office instead of working-from-home.

Jojo
Jojo

Contract tracing doesn't work well here because there are too many people in the USA who are free to move about as they wish. Then there is the problem as to how you coordinate tracing from one locale to another, especially as you cross city/county/state borders. Someone is paying for the contract tracing work and are they going to pay to run through people in other locales. I'd bet no.

And of course, you have all the privacy issues. I certainly would not run a Covid app on my phone nor reply to any queries as to who I have been in contact with. And I don't believe that anyone can make me do so.

caradoc-again
caradoc-again

I have no bias one way or another but as Mish has a libertarian bent I'm surprised he even asks the question.

mrutkaus
mrutkaus

We are too cantankerous for contact tracing.

hfom
hfom

It also seems like a great beta test for any future authoritarian states need to track it citizens..

FromBrussels
FromBrussels

With all those 'blue' celebrations going on, very often without masks and definitely without social distancing, C cases will surge dramatically in coming weeks..... Election celebration, hahaha....This can only happen in gullibly entoosed America! Here in Europe, the plebs NEVER celebrate elections, unlike you we are very much aware that some political jerks will be substituted with other jerks, and that's about it , nothing fundamental will ever change, business as usual.... or even worse, the way things have been developing in recent years....

Six000mileyear
Six000mileyear

I'm another person who doesn't trust the government. When in public I'll wear a mask out of respect for others. When I see someone without a mask (a week ago at the hardware store) I won't confront the individual.

Scooot
Scooot

Enter people that use the app into a free prize draw.

Zardoz
Zardoz

A common conceit of Americans is that their lives are interesting enough that someone would want to spy on them.

caradoc-again
caradoc-again

Until you have full voter identification there should be no talk of track & trace.

ToInfinityandBeyond
ToInfinityandBeyond

We can continue to ignore COVID with the belief that it will magically go away one day but that will come at a cost of over 2,000 deaths a day come January. Some of the less empathic will shrug and say it is mainly the elderly and those predisposed with preexisting conditions. Or we can try to drive the numbers down to a manageable level where contact tracing might actually be viable. It is a sad indictment of our country that the worst pandemic in 100 years became a highly politicized event. I strongly believe Trump might actually have won this past election if he had stepped up and shown some real leadership instead of trying to wish it away.

Sechel
Sechel

Joe Biden is making Covid-19 his first priority. I'm sure he will follow the science and listen to the virologists and pandemic experts. Hopefully Fauci stays on.

2flit
2flit

I am a US citizen in New Zealand since last November. I went thru the hard lock-down and watched contract tracing at work here in a country that has contained and controlled transmission. After having been thru it here.... I would say that America is past the point where contract tracing can be effectively used in the way that it has been in Taiwan or Australia. A few weeks ago; NZ had a single worker at a managed Covid isolation facility become infected. That single case resulted in thousands and thousands of close and near contract traces. Once the virus is in the general population and running rampant (as in the USA)... the only means at the countries disposal would be a VERY HARD and complete lockdown. All schools must close, almost all business need to shutter, you stay at home, and so on. America would be incapable of doing this. Heck, Americans can't even agree on wearing a mask!... and a huge percentage believes the Covid-19 virus is nothing or little to be concerned about.
I feel very lucky to be 'stuck' in New Zealand during Covid.

Mish
Mish

Editor

Another comment from a friend I trust 100%

My daughter who lives in Ludington, is on the board for the Jaycees. They always have a Halloween party, and she wanted to find a way to do it this year. She offered to have it at her house, did everything outside. Several of the board members did not come because they thought she was being too crazy about being careful. There were 10 people there.

The next day one of their friends started to feel bad. On Sunday he got tested for Covid. He did not get his results until the following Friday. And, yes, he was positive. His wife was not, but their son was also positive.

Dodge Demon
Dodge Demon

Mish, I congratulate you on another leading edge idea. It should also be mandatory for cases of tracing VD and where the “Single Moms” were passed around. After all, it’s all for the public good and we’re all in this together!

danisssy
danisssy

As an Aussie, I would remove the COVIDSafe app section as if you actually looking into what it has achieved (rather than copy/paste some government marketing) it doesn't support your argument. It is widely recognised as a complete joke and hasn't helped Australia at all. The NSW government was/is quite good at contract tracing, the Victorian government was awful at it and only got the virus back under control via a brutal 14 week lockdown. Other states never really had very serious outbreaks.

It's actually kind of funny to see someone thinking Australia's contract tracing app is a success story.


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