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Contact tracing in the canton of Zurich is at its limit. Canton doctor Christiane Meier admits that not all contact persons can be reached anymore. Help is asked of infected people.
Employees of the JDMT company work shifts in the Zurich Oberland.
On September 21, Zurich’s health director Natalie Rickli was still optimistic: “I think we are on the right track,” she said when the canton council discussed contact tracing. Beatrix Frey (ndp.) And the co-signers presented an urgent question with the title: “Trace or virus – who is ahead?” In it he wanted figures from the canton, which his councilman Rickli also provided. 88 percent of people who tested positive would be located by contact tracing on the same day. Of the people who had contact with the infected person, 85 percent can be contacted the next day. There will certainly be errors in individual cases, Rickli said, but compared to other cantons, Zurich is doing well.
On September 21, the canton reported 41 new infections, the trend at that time was down again after an increase in the number of cases. But the situation has now fundamentally changed. The number of infections has risen sharply since the beginning of October. As of last Saturday, the canton reported a record 271 new infections; even last April, such high figures were never reached. By Monday there were 171 positive tests. Even if one has to assume that the number of unreported cases was higher in spring due to testing that was even less widespread at the time, the current development is shaking up.
The canton announced that it would expand contact tracing. Instead of 50 people, 60 people will be deployed per shift. But is that enough?
Tracking is reorganizing
Over the weekend, voices were raised that the tracers could no longer keep up with their work. The “Sonntags-Zeitung” reported on several people who had been in contact with those who tested positive, but were never called by the Zurich contact follow-up team. The NZZ has similar accounts of those affected. It is difficult to say whether these are isolated cases or just the tip of the iceberg. The health department appeased that night in a press release with the headline: “Contact tracing in the canton of Zurich works.” Christian Althaus, an epidemiologist at the University of Bern, has already seen clear signs “that contact tracing at ZH can no longer be done professionally,” as he announced on Twitter. It came to this harsh trial because the health department had announced that it had those who tested positive to actively inform their contact persons.
Another number also makes people sit up and realize: Three-quarters of those who tested positive can’t tell the tracers where they got infected. In September it was only half. This makes it increasingly difficult to trace contacts to find sources of infection.
In this uncertain situation, the canton tried to generate transparency on Monday afternoon. For a short time, the health department invited a tour of the facilities of the JDMT company, which operates from a commercial property on the western edge of Pfäffikon in the Zurich Oberland. The company has been in charge of locating contacts in the canton of Zurich since September and has had to adapt processes in recent weeks, as was made clear at the event.
The image of the detective in the crown tracking down every contact person for a person who tested positive and sending them to quarantine is now out of date. This “super ideal tracking”, which was planned in the summer, is no longer possible in view of the growing numbers, said canton doctor Christiane Meier. Because according to governing council guidelines, the focus was on around 100 infections per day, a threshold that has now been far exceeded. According to Meier, it is therefore no longer possible to call all the contact persons; Tracking during quarantine is also not an option.
Dr. Andreas Juchli, co-founder of JDMT and operational head of contact tracing, explained how the processes are currently running. According to him, a person who tested positive now receives a text message half an hour after a laboratory sent the message. In it, you are not only asked to isolate yourself, but you are also asked for an email address. You then receive brochures from the Federal Office of Public Health and a description of who the contact person is. You must inform the people close to her directly and send the cell phone numbers and addresses of other contacts.
As soon as the information reaches the contact tracker, nearby people receive an SMS asking them to provide the email address so that more information can be sent to the quarantine. But many phone calls were still being made, Juchli said. First of all, through the hotline, which can be used by contact persons to inform. Second, each index case, that is, an infected person, is called within 24 hours of a positive test. Personal conversation is important because many are in a difficult situation, Juchli said.
In the face of complex processes, contact tracers break up work, as the tour of the center demonstrated. 20 employees sit at tables arranged in rows of five along one wall. SMS and emails are sent to the contact persons at the front, and inquiries received via the hotline or by email are answered at the rear. The tracers are medical students or other people suitable for the tasks, as the head of the company, Juchli, said.
At the second location of the Zurich Corona detectives, at the airport, mainly members of the airport police and medical specialists work. From there calls are also made to people who tested positive. The plotting team will soon be comprised of a total of 260 people, each of whom will work in shifts of 60 people.
More personal responsibility than a solution?
When asked about breakdowns, Juchli referred to the complexity of the processes, into which a large number of individual parts would have to fit, from the lab report to the contact details of people in the vicinity of a index case. The processes are basically resilient, Juchli said. But with as many infections as Zurich is currently experiencing, it could be that a certain percentage of contacts will not be reached, which does not have a major impact on the course of the pandemic. The JDMT chief also asked people to contact the tracking team via the hotline “if you have the feeling that something is not going optimally.”
Josef Widler also knows of cases where the infection tracking did not go well. The CVP Cantonal Council and director of the Zürcher Ärztegesellschaft heard from their circle of friends about a positive test in which individuals reported their surroundings much faster than contact trackers. Widler would focus more on personal responsibility. But the authorities don’t trust the people, it’s a shame. “People do it well,” he says.
Widler had already offered the Zurich Health Directorate the services of the doctor’s phone in April, and then again in July. Back then, a case of super-spreaders at a Zurich club brought contact markers to the ground for the first time. The Zurich Health Directorate then decided to outsource infection monitoring to individuals. However, Widler’s offer was rejected.
The chairman of Zürcher Ärztegesellschaft would proceed more selectively with contact tracing and focus contact tracker energy on potential hotspots such as nursing homes, clubs, major events and regions with high caseloads, not as widely as currently drives. That would probably be more efficient, he says.
FDP cantonal councilor Beatrix Frey believes that those who have tested positive can be expected to inform their own contact persons. But he also believes that the canton must increase its commitment to contact tracing. “It is definitely the wrong place to save.” After all, breaking the chains of infection is one of the most important strategies in the fight against the corona epidemic. A new blockade or other serious measures should be avoided by all means.
