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Rather than simply attempting to trace and isolate the specific contacts of an infected person, proponents of this approach suggest finding out first where the person was infected with COVID-19.
Taking this extra step, known as “crawling,” takes advantage of the virus’ weakness – the tendency to spread in groups, often in multiple mass events where the virus spreads rapidly.
KJ Seung, a doctor who helps ensure contact follow-up in Massachusetts, says that after reviewing material from Japanese scientists, he decided to adjust his method this summer. Since his team conducted a “trace,” they have discovered outbreaks at weddings, funerals, bars and other mass gatherings, and have provided new insights into how the disease is spreading.
“This can reveal more cases and much more effectively,” said KJ Seung, infectious disease specialist with Partners in Health, a Boston-based nonprofit group hired to help implement a statewide contact-tracking program. .
This approach is crucial for policy makers, who are once again introducing costly quarantines in many European countries and parts of the United States, after infection control strategies based on current evidence and contact tracing have failed in big measure.
Health officials like KJ Seung and proponents of the Japanese cluster search method are sending a clear message: don’t despair and get out of the way, there is room for improvement.
“The virus is under control,” said Maria Van Kerkhov, head of the Emerging Diseases Unit at the World Health Organization (WHO), who sees the formation of outbreaks as the hallmark of coronaviruses. “The trajectory depends only on us.”
The goal of tracing the source of the virus is not a new idea, it is standard practice for controlling sexually transmitted diseases like HIV and syphilis. But these diseases do not usually spread massively. And when it comes to respiratory infections, most European and American officials tend to see them through the prism of the flu, which is also common in outbreaks.
Discussions about the benefits of basic preventive measures, such as wearing masks and respecting physical distance, are also hampering efforts to fully understand the phenomenon of COVID outbreaks, said Zoë McLaren, professor of public health policy at the University of Maryland in Baltimore.
Many Western countries have not had enough experience with contact tracing this year and, by bringing their groups of COVID supporters together, they have focused primarily on surveillance for infections on the so-called “front line.”
There is logic in such a strategy. Because people can often spread the virus within a couple of days, even before symptoms occur, contact followers ask what they may have infected during this time, hoping to track other cases at an early stage. and prevent further spread of the infection.
The problem with COVID-19 is that a relatively small percentage of those infected will spread the virus, according to some studies. Therefore, contact followers spend a lot of time trying to identify people who may not have been infected.
In terms of ‘tracing’, officials dig into a person’s recent past, say, a two-week period, to find out when and where the infection occurred. If the virus has been transmitted in any group, especially in a closed space, talking or singing and with little ventilation, there is a high probability that other people who have been there will also be infected.
By focusing on those people, health officials can more easily trace infected people and then start investigating more contacts with those people.
“If 80 percent. Cases don’t transmit the virus, then an attempt to track those 80 percent.” William Hanage, an epidemiologist at the Harvard School of Public Health, said: “When you use traceability to find out where and when an infection occurred, the marginal benefit is greater. “
Some Western scientists have seen the trend of COVID clusters in the early stages of a pandemic. Franz Wiesbauer, a physician and epidemiologist who runs Medmastery, the medical personnel training service in Salzburg, Austria, observes: “
But even five months later, the West still doesn’t realize the main thing, he says. “It’s very sad about that,” Wiesbauer added.
In Asia, where countries have suffered from cluster-sensitive diseases such as tuberculosis and severe acute respiratory syndrome (SARS) in recent decades, the message has been better heard.
South Korea halted the massive spread in February-March, initiating massive tests and so-called “front contact tracking” particularly fast.
There have been no local infections in Taiwan for 200 days, thanks to border closures and strict travel regulations, as well as massive testing and very careful quarantine and contact tracing measures.
Japan is a particularly useful example for the West, as it did not rely on active COVID testing or massive collection of private information from people. However, the country established a task force in February whose main task was to identify hotspots and prevent large-scale infections rather than trying to track down each individual case. The country also had an extensive network of local health officials, who already had many years of experience in finding contacts, both “front” and “back”, in the fight against tuberculosis.
“Cluster formation is likely to be one of the most important epidemiological features of the coronavirus,” said Hitoshis Oshitanis, professor of virology at Tohoku University and a key author of the government strategy.
Japan has reported just over 100,000 COVID-19 cases since the start of the pandemic, less than a tenth of the cases recorded in France and Spain, which have smaller populations. The United States reports more than 9 million infections. The number of deaths in France on Tuesday rose to 854 cases, the majority since mid-April, to 38,289 cases. A total of fewer than 1,800 deaths from COVID-19 have been reported in Japan, according to data collected by Johns Hopkins University.
As the number of infections increases in both the United States and Europe, some fear that contact tracking will be abandoned entirely in societies.
Because several countries are struggling to fully implement key measures, from physical distance and large-scale use of masks to a coherent strategy that integrates testing, contact tracing, and isolating people.
White House Chief of Staff Mark Meadows said in October that the United States would not “control” the pandemic, but would instead focus on “vaccine development, treatment and other mitigation measures.”
Even in Germany, which was widely heard last spring for its contact-tracking program, records of coronavirus cases are being recorded, and the country has recently introduced month-long restrictions on public life.
One of the obstacles to “back testing” is that people don’t always remember the risky situations they found themselves in a week or two ago, Christian Drosten, director of the Charite Institute for Virology at Berlin University Hospital, recently said in your website. Since the beginning of August, he has been urging the Germans to keep a daily record of their contacts.
“We cannot afford to say, ‘Here we are just passive observers, the health authorities will find out and decide if I get sick'”, chap. Drostenas.
KJ Seung has been fighting infectious diseases for nearly two decades, since he joined Partners in Health in 2001, such as HIV in Lesotho and tuberculosis in Peru and North Korea. Since incorporating “traceability” into its COVID strategy, it has begun promoting its approach in other states in the US, offering a combination of targeted recommendations and emotional encouragement.
Contact trackers will need time to master this approach, but that’s another reason you need to get started, he said.
“The view that there is no need to continue contacts in the face of a sharp jump in cases is not really the correct approach,” he said.
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