Contact tracing 'best strategy' against virus, but some won't cooperate
People worry they’ll be blamed for spreading the virus to their friends or family or that they’ll be criticized for their lifestyle choices during the pandemic.
By Kaitlin Durbin / The Blade
Tue, 11 Aug 2020 22:22:39 GMT
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More often than not, when a person tests positive for coronavirus they answer a series of questions from contact tracers about their symptoms, pre-existing conditions and every place and person they were around when contagious.
But apparently, some people are starting to refuse questioning or even refusing to quarantine while infected, and experts are worried it could create a major health issue.
“Those are the type of people who are helping to keep this problem going,” Joseph Dake, a professor in the University of Toledo’s school of public health, said.
Perhaps surprisingly, questions in conflict are not related to an individual’s personal information or medical history — age, health conditions, whether they’ve been hospitalized related to their coronavirus systems, etc. — but rather the names of those who they were around.
People “fear disapproval by others,” professor Dake said. They worry they’ll be blamed for spreading the virus to their friends or family; that they’ll be criticized for their lifestyle choices during the pandemic; or that they simply want to avoid any stigma associated with having the virus.
The problem is, those contacts are “the crux of contact tracing,” he said, and by not sharing them an individual could actually be spreading the disease and putting others at risk.
Because the tedious task of calling every person who was potentially exposed to determine if they need to self-quarantine or be tested “is our best strategy to try to slow the spread down from a prevention perspective,” Mr. Dake said.
It’s simple math; if those who are sick are not out in the community infecting others, then case numbers go down.
Prevention is especially important as infection and death rates remain high in the state.
Total state figures on Tuesday showed caseloads continue to fall below the 21-day average of 1,217 new cases a day, but that doesn’t mean the threat has retreated. The state reported 1,095 new coronavirus infections since Monday and 35 deaths.
Numbers remain particularly concerning in Lucas County. Gov. Mike DeWine on Tuesday recognized Lucas County as having the fourth-highest virus occurrence rate, per population, in the state, behind Mercer, Champaign, and Darke counties.
The Toledo-Lucas County Health Department reported 78 new cases Tuesday, bringing the total number of confirmed and probable cases to 5,300, with 313 confirmed and probable deaths. Wood County reported 11 new cases, for a total of 1,071.
Since Lucas County went red on the state’s public health alert system, Toledo-Lucas County Health Commissioner Eric Zgodzinski says compliance has increased, but he still estimates at least 1 percent of residents contacted refuse to cooperate with contact tracing, and even one person can have a major impact on the area’s overall health.
For every positive test, contact tracers have been contacting anywhere from three to 50 people to assess their level of exposure and determine the next steps that should be taken. So one person left unchecked could not only spread the virus to up to 50 people, but then those 50 people could unknowingly spread it to another 50 people and continue to drive infection in the community.
They also put at risk any of their contacts who have pre-existing conditions or family members who may be vulnerable to the disease, experts say.
“We have some people who, they basically believe that people are going to get sick and this just has to work its way through society,” professor Dake said. “[They think], they have it so why stay home and ruin their fun? In my opinion that’s a selfish view.”
Apparently, it’s a national trend.
Health experts in one county in New York issued subpoenas to at least eight people who refused to respond to questions about whether they’d attended a birthday party, who else was there, and where they went afterward.
Answer the questions or face a fine of up to $2,000 a day, the subpoena warned. The people talked.
It’s not the ideal way for a health agency to operate, but if necessary, it is legal, said Shelley Cavalieri, a professor of law at UT specializing in property, human rights, and public health law.
In an opinion piece published July 31 in the Hill, Ms. Cavalieri and two colleagues defended that “courts have repeatedly found that the government can limit our liberty to protect the health of people in our community.”
They were especially talking about the state’s ability to mandate residents to wear masks in public, but she said the state’s police powers also support other decisions needed to protect the public’s health, safety, and general welfare.
It’s the same justification used to mandate people be vaccinated for smallpox in 1905. It’s why restaurant kitchens are subject to inspection by health departments or why smoking is banned in public places. It’s also the legal basis for rules governing workplace safety, land use regulations, public health regimes, traffic ordinances, and the operation of the police force, the opinion piece said.
None of those regulations is controversial, she said, because when public health is done right, it’s invisible.
“Nobody counts the people who didn’t get waterborne diseases in the United States because we have safe and clean drinking water that is chlorinated, that runs in clean pipes, that comes from good sources,” she said. “Well-done public health work means everybody just continues on their merry way.”
So for the greater good of public health, local health departments can also compel individuals to answer questions needed for proper contact tracing.
She doesn’t see that happening in Ohio anytime soon, and health commissioner Zgodzinski agreed, saying the community has been “pretty responsive.” But if things were to continue to decline, “we could,” he warned.
The department has already issued orders in close to a dozen cases where residents who were sick refused to quarantine, he said.
“We have virus in this community at a rate that is concerning, but it’s not insurmountable,” Mr. Zgodzinski said. “Everybody needs to understand that this disease, it’s really up to us to control it.”
Most importantly, he stressed, contact tracing is proven to be successful.
Recently, the county was notified about coaches and players on a sports team testing positive for the virus. They were able to isolate and quarantine those members while tracking back potential exposures, which saved the rest of the team from getting sick, he said.
“Take that microcosm and apply it to a bigger level,” Mr. Zgodzinski said. “So it does work.”