HEALTH
COVID-19 Contact Tracing Comes to Chicago The city plans to add contact tracing to its arsenal in August BY ELORA APANTAKU
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n June 26, Chicago moved into Phase Four of reopening after initiating a shelter-in-place shutdown three months earlier to limit the spread of COVID-19. At its peak in late April, there were 1,400 new confirmed cases every day, but daily new cases now number around 200. Yet reopening to phase four, during which businesses are allowed to open—albeit with a number of regulations in place to reduce COVID-19 transmission— raises concerns that the city’s number of COVID-19 cases will again rapidly increase. To limit that possibility, Chicago announced in late May that it plans to begin widespread contact tracing in August. Contact tracing is the process of identifying and isolating people who have been exposed to a disease to minimize their likelihood of spreading it. According to Dr. Allison Arwady, the Commissioner of the Chicago Department of Public Health (CDPH), contact tracing has thus far been limited to patients who have been in congregational settings such as correctional facilities, nursing facilities, group homes, and homeless shelters. (Some hospitals and clinics, such as Howard Brown Health Center, have been doing independent contact tracing for their patients.) An additional 100 contact tracers will begin work in August to help track cases, and the hope is to have 600 contact tracers and resource coordinators employed within the next three months. The goal for CDPH is to have contact tracers capable of reaching 4,500 new exposed contacts every day. This has worked well in other countries and there is hope it will work in Chicago.
Contact tracing, also known as contact investigation, is the root of epidemiology, the process of monitoring and preventing diseases as they affect populations. The earliest record of it dates back to the 1500s after syphilis arrived in Europe, likely brought there from the Americas by Christopher Columbus’s crew members. Its use during the last century to contain diseases such as tuberculosis, STIs, measles— and more recently Ebola and Zika—was similar to the contact tracing used to combat COVID-19. In all these diseases, patients who test positive are interviewed to ascertain if any one of their contacts may be at risk of infection. Then those contacts will be called and interviewed to determine if they need to be treated or quarantined to avoid further spread. These diseases all have different modes of transmission and the recommended protocols for case investigations is different for each, but the goal is the same: to prevent people who are at increased risk of having a disease from spreading it uncontrollably. In countries that have successfully reduced their COVID-19 case numbers, contact tracing played a critical role. In New Zealand, authorities began contact tracing almost immediately. Their approach was thorough: any contacts a person who tested positive had made in the fourteen days before their test were also isolated. Additionally, New Zealand—whose population is twice the size of Chicago and is spread across an area 450 times as large— also restricted travel early on during their outbreak and achieved stricter lockdowns for non-essential businesses. As of July
20, New Zealand has had 1,200 cases and twenty-two deaths compared to Chicago’s 57,000 cases and 2,727 deaths. South Korea implemented a digital contact-tracing system it originally developed in response to the MERS outbreak of 2015 that uses a combination of smartphone GPS, credit card history, travel data, and medical records to inform citizens whether they need to self-quarantine. Amazingly, in a country of 50 million people that is roughly the size of Indiana, South Korea has only had 296 deaths. The United States is unlikely to use digital tracing for its COVID-19 outbreak, given concerns regarding individual privacy and our lack of a centralized medical system. Several COVID-19 apps have been developed to help people keep track of their contacts, but without widespread adoption, they will have little effect. Both the U.S. Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials (NACCHO) have recommended contact tracing to slow the spread of COVID-19. But whether and how to implement contact tracing is left up to the states. Illinois has received $326 million through the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and the Paycheck Protection Program and Health Care Enhancement Act to address COVID-19related issues. On June 11, the mayor’s office announced that it would be allocating $56 million from the CDC and the Illinois
Department of Public Health to create 600 new public health jobs, including 480 contact tracing positions, for the next two years beginning in August. As implemented, Chicago would rely on a group of contact investigators comprised of public health officials and volunteers at the CDPH to call individuals who test positive for COVID-19 and identify anyone they had been within six feet of for at least fifteen minutes within forty-eight hours of developing symptoms (or within ten days of a positive test result for asymptomatic patients). Investigators share a list of potential contacts with other tracers who work on contacting and informing them that they were at risk, requesting they quarantine for fourteen days after the contact occurred, and telling them where to get tested if they have or develop symptoms. Coordinating the effort to get widespread contact tracing completed throughout Cook County is the Chicago Cook Workforce Partnership (CCWP). On June 30, the City tasked the CCWP with hiring contact tracers through community organizations based in high economic hardship areas. When Lori Lightfoot first announced the contact tracing initiative on May 26, she said that she’s excited to “expand health equity” in the city. “If we train up a legion of people from these same communities where there are health disparities, by virtue of the fact that they are involved in health care, their neighbors will know that they do this work,” Lightfoot said. “We hope that one of the residual benefits is … people understand they can be engaged with the health care JULY 22, 2020 ¬ SOUTH SIDE WEEKLY 13
