Manoj Jain and Bill Frist, Guest Columnists
The Tennessean Published 5:00 p.m. CT April 22, 2020
South Korea proved it could contain COVID-19 without a lockdown through aggressive contact tracing. That is what the U.S. must do to be successful too.
After implementing social distancing through a lockdown, but before deploying a vaccine, the single best tool we have to contain the COVID-19 pandemic is contact tracing.
Countries that have been successful outliers in halting the virus’s spread, like South Korea, have deployed contact tracing early and extensively.
If we want to wisely reopen our state (and our nation), as quickly and safely as possible, we must aggressively implement this approach. And for it to be successful, we must involve a public-private partnership, compensating private healthcare providers for sharing the work of public health delivery.
Before we detail how let’s step back and understand contact tracing.
Contact tracing has three standardized steps.
First, a COVID-19 positive patient provides a list of all persons they may have been close to (within 6 feet for over 10 minutes) from the present to two days prior to onset of symptoms.
Next, a health official notifies the persons on the contact list that they were exposed to a COVID-19 patient and need to self-isolate.
Finally, each of those contacts is monitored and tested as appropriate.
Generally, a public health official from the health department would be responsible for interviewing patients, gathering the contact list, notifying everyone on the list, and following up over time.
But as our state and our nation transitions our priority from social distancing through a lockdown to contact tracing, the Centers for Disease Control and Prevention (CDC) and health departments are not equipped to handle contact tracing in each of the 3,000 U.S. counties.
In Tennessee alone, we have nearly 200 new cases each day that would benefit from the arduous task of contact tracing.
This poses an overwhelming challenge to the nation’s and the state’s public health system. The CDC estimates we may need as many as 30,000 public health workers nationally. Now we have 1,600.
How can we bridge this gap in days and not weeks or months as we being reopening the state?
We can learn from the recent rapid scaling-up the country undertook for COVID-19 testing. In early March, when the CDC was unable to provide sufficient testing kits, it shared the testing protocol with private labs. Now a month later, with unleashing and partnering with the private labs we are doing thousands upon thousands of tests each day.
What the CDC would never have been able to do alone, we are accomplishing through a public-private partnership.
Likewise, a public-private partnership between public health officials and private healthcare providers can bridge the urgent gap for contact tracing. By engaging doctors, clinics, and hospitals in the race to identify contacts who have been exposed, we can make dramatic improvements in our infection rates.
What would this public-private partnership for contact tracing look like?
When a patient first goes for a COVID-19 test, the healthcare provider would explain contact tracing and ask the patient to begin compiling a list of contacts, and advise them to self-isolate until the test results are ready.
If the test is positive (which occurs in around 10% of cases), the healthcare provider can submit the already-developed contact list — including contacts and types of exposure into a software already used by the health department.
Drawing from the software, the health department would trace each contact and stay connected to monitor exposures, while the healthcare system continues to care for the original patient and any others identified who fall ill.
This partnership of public health efforts with private healthcare providers enlists doctors to take on an additional — and important — role: educating patients on contact tracing, facilitating list creation, and following up with both the original patient and new patients identified in the process.
Currently, healthcare providers are not reimbursed for any conversations or workaround contact tracing. Their priority — and the only work they are paid for — is the sick patient in front of them, not potential patients in the community.
We can rectify that by creating a new, specific ICD-10 payment code for health insurance reimbursement after successful monitoring of a case, identification of contacts, and logging the information into the software.
The providers would be trained, regulated and held to strict quality standards by the local and state health departments and the CDC.
Privacy concerns, as well, are addressed by keeping contact tracing within the care team, which already follows HIPPA regulations. Likewise, the patient would be comforted and have confidence in the process given his or her doctor’s close collaboration with the health department.
We know from the successful South Korean experience that COVID-19 can be contained without a lockdown, largely due to the successful implementation of contact tracing. We can do the same in America and Tennessee. A trusted public-private partnership can make it happen.
Dr. Manoj Jain, M.D., M.P.H., is an infectious disease and health policy expert, and Dr. Bill Frist, M.D., is a former U.S. Senator and heart-lung transplant surgeon. This is part of series of article to help us understand and adjust to the new normal of COVID-19.
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