i have sort of joked in the past...but there are ways to build up voluntary and paid people to learn how to track and trace ......... South Korea had it right on this. We MUST develop forces to do this... And as we keep learning from more and more research, there are just o many asymptomatic people out there. There is no way to truly capture this without
Much smaller country but you might find the contact tracing operation in Ireland interesting, where all close contacts of confirmed cases are contacted and told to isolate. Public health staff, army cadets and civil servants from departments that are currently less busy have been drafted in to do this work...
Coronavirus: The inside story of Ireland’s contact tracing operation
Public servants are making 2,000 calls a day to monitor and tackle the spread of Covid-19
Dr Greg Martin uses a resonant phrase when describing the contact tracing programme the HSE has mounted in Ireland to respond to the Covid-19 pandemic. “We are sort of building a plane while we are trying to fly it,” he says as he tries to explain the speed, and scope, and sheer breadth of the operation that has been put in place.
Ireland had its first case of confirmed Covid-19 on February 29th. And at time of writing, more than 6,000 cases have been confirmed in the country.
Every one of those 6,000-plus people’s contacts has been contacted. In the beginning, that involved tracing another 40 people or even more. Now, with social distancing, it has become somewhat easier, an average of three per person.
Last Monday and Tuesday, 2,000 phone calls a day were made from the nine contact tracing centres around the country. By next week, it will be geared up to place 5,000 calls a day.
The team responsible for all of this has been scaled up from a few dozen people to a few hundred. It can become a few thousand if the outbreak continues to escalate at pace.
Martin, a public health specialist, refers to the UK where the contact tracing programme was quickly jettisoned on the basis it would be impossible to accomplish.
“Most countries have not even attempted this. Most countries didn’t think of this as something you could do. Ireland has done something that is, in my opinion, quite remarkable, especially given the timeframe within which it’s being done.”
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So far, there are 200 people working on the programme but in total 1,700 have received training in how to make the calls. From nine centres around the country, mostly on university campuses but also in the Curragh Defence Forces base in Co Kildare and the offices of the Revenue Commissioners, they place 1,000-2,000 calls a day, depending on how many new cases have been identified.
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Killian McGrane is the HSE lead on the programme and oversees the design and implementation of the scheme. One of his first realisations was that the system was never going to be without flaws, but that acting quickly was vital.
“The line of Dr Mike Ryan from the WHO that you don’t let perfection get in the way of good has been very much our mantra.”
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It has resulted in more than 60,000 personal contacts and a complex mapping of the State that identifies clusters, demographic information, and lifestyle and travel patterns.
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The process is broken down into three phone calls. Everyone who is diagnosed is required to supply a mobile number, which is contacted. In nursing homes and hospital settings, the information gathering is done in conjunction with specialist public health staff, or designated contacts, in situ.
Doyle explains what each call entails: “Call one is done by people who have a clinical background. They tell the person the result is positive, ask them about symptoms and give medical advice.” These people are in a position to make medical decisions if the person is symptomatic.
Call two is made about an hour later. It’s from a contact tracer in one of the centres. They go through a long list of questions and get details of all their contacts, and all of those details are entered into the information system. The person is asked to trawl back through all close contacts for the past fortnight, before they became symptomatic. Close contact is defined as closer than two metres for more than five minutes.
Call three is to all the contacts listed by the person who has a diagnosis. The person is not named and the contacts are asked if they have any symptoms. If they do, they are advised to contact their GP. They are all told to self-isolate for 14 days, irrespective of having symptoms or not. There are always medical personnel on hand in the centres to deal with health issues that might arise.
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As time moved on, the number of cases escalated. However, social distancing quickly led to a reduction of contacts, from an average of 20 down to three (in most cases within the same household).
“When we started on March 10th, our mandate was to to deal with 500 new cases a day,” says McGrane, who says the longer term plan was to scale up to 4,000 a day.
There has been some good news. “We haven’t needed anything like that but that’s the scale of the operation.” Some 1,700 people have been trained, about 200-300 of whom are currently deployed.
But long delays, of up to 14 days, in results for Covid-19 testing has made the situation more challenging. “Contact tracing is less effective in that timeframe,” says Martin. “It’s still important as you are still providing contacts with information. [But] the shorter you can make that time, the better.”
Last week, the National Public Health Emergency Team addressed that big delay by allowing contact tracing for presumptive, as opposed to confirmed, cases.
McGrane says it will lead to a big scaling up of numbers, putting them in a position to deal with 1,000 new cases each day. That’s 5,000 calls or more (1,000 from call one, 1,000 from call two, and an average of 3,000 from call three).
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Doyle and Martin have a message for the “unsung heroes” making those thousands of calls. “What they’re doing is saving lives by contributing to a process that is going to reduce the number of people who get sick in Ireland,” says Martin.
“Whatever this outbreak turns out to be, is going to be less than it would have been without the operation . . . The people whose lives they save will never even know that their lives were saved.”
Coronavirus: The inside story of Ireland’s contact tracing operation
