CommonHealth CommonHealth

Support the news

Why Charlie Baker Thinks 'Contact Tracing' Cases May Help Mass. Slow — Or Stop — COVID-1904:36
Download

Play
Chief strategist and co-founder of Partners In Health, Dr. Paul Farmer, joins Massachusetts Gov. Charlie Baker to give an update to cases of coronavirus in the state. (Nicolaus Czarnecki/MediaNews Group/Boston Herald)
Chief strategist and co-founder of Partners In Health, Dr. Paul Farmer, joins Massachusetts Gov. Charlie Baker to give an update to cases of coronavirus in the state. (Nicolaus Czarnecki/MediaNews Group/Boston Herald)

If you’ve had contact with someone infected with the coronavirus — whether you know it or not — expect a phone call. Massachusetts is launching what Gov. Charlie Baker called the only U.S. effort to reach everyone who is at risk and get them tested, quarantined and into isolation, if needed.

The goal is to stop, not just slow, the spread of the virus that has killed at least 192 Massachusetts residents so far.

“We need to get out ahead of this and do everything we possibly can here in Massachusetts, through and in the aftermath of the surge,” Baker said during a briefing about the project on Friday.

The administration is partnering with the Boston-based health care nonprofit Partners in Health, which plans to hire and train roughly 1,000 people to do contact tracing, a strategy often used to determine the source of an infection and how it is spreading.

This team of callers will try to reach everyone who’s tested positive for the coronavirus. They'll then contact everyone with whom that person can recall being in close contact — meaning within six feet for more than a few minutes — within the past few days.

Many of the thousands of Massachusetts residents who will receive calls won’t know that they may have been exposed to the virus. Callers will keep the name of the infected person private, although organizers acknowledge it may not be difficult to determine the source.

In an ideal scenario, everyone who’s been in close contact with someone who is positive would be tested, even if they don’t have symptoms. But Massachusetts still doesn’t have the capacity to do that. Baker said the state conducted nearly 5,000 tests yesterday, up from 3,500 last week.

“Yesterday, we probably did not have the tools. Whether we’ll have the tools tomorrow remains to be seen.”

Public health experts say many more are needed to cover everyone who will be identified by this project. And waiting up to five days for results, as some people still do, is a problem.

“The delay in how long it takes to get the results remains too long to make contact tracing very effective,” said Dr. Sandro Galea, dean of the School of Public Health at Boston University.

But Galea noted that could change any time.

“Yesterday, we probably did not have the tools,” he said. “Whether we’ll have the tools tomorrow remains to be seen.”

And then there’s the question of how to keep people who test positive isolated so that they don’t transmit the coronavirus. Some people will have room to isolate at home. But others who share bathrooms, kitchens and bedrooms, or who live with someone at increased risk for a severe case of COVID-19, will be given some options.

The Baker administration is looking at setting up isolation units in dormitories and hotels. People in isolation will need food delivery, possibly child care and lots of additional help so that they don’t interact with others.

It’s going to be a huge job,” said Dr. Joia Mukherjee, the chief medical officer at Partners in Health. “I know we will succeed somewhat, and we will fail somewhat — we won’t be able to find every single person — but we will hopefully prevent a lot of deaths.”

Partners In Health Chief Medical Officer Joia Mukherjee. (Nicolaus Czarnecki/MediaNews Group/Boston Herald)
Partners In Health Chief Medical Officer Joia Mukherjee. (Nicolaus Czarnecki/MediaNews Group/Boston Herald)

Mukherjee, who has helped organize similar projects to fight Ebola in West Africa and cholera in Haiti, calls this "going on the offensive" against the coronavirus. She argues a defensive strategy alone isn’t good enough.

“Let’s just spell out what the defensive is. The defensive is, we’re going to get creamed, and let’s just make sure our hospitals are staffed,” she said. “What we’re saying is, 'Lets use tools that can reach into that silent epidemic and start to cut that off.' ”

Some public health leaders and infectious disease doctors are questioning the timing of this launch. Galea said contact tracing is usually more effective at the beginning of an epidemic, before a disease like the coronavirus has spread.

“I don’t know that it’s too late, it’s certainly late,” he says. “Had we had the tests and were we organized enough to do contact tracing right up front, it would have potentially taken us down a very different path in this epidemic.”

But there are likely still millions of Massachusetts residents who’ve not been exposed to the coronavirus. Baker said contract tracing is a “powerful tool” the state must try to prevent more infections.

“Had we had the tests and were we organized enough to do contact tracing right up front, it would have potentially taken us down a very different path in this epidemic.”

Massachusetts will be the only state in the country conducting widespread contract tracing, according to Baker. It's getting much less attention than other strategies for combatting the pandemic even though contract tracing, along with widespread testing, appears to have helped South Korea contain the coronavirus.

Partners in Health will work in collaboration with the Baker administration’s COVID-19 Response Command Center, the state Department of Public Health and the Massachusetts Health Connector to ramp up operations. On Friday, a sort of advance guard of 230 public health students began assisting public health officers in 22 cities and towns across Massachusetts. They’re helping with social media and other public messages as well as translation. Eleven colleges and universities put out the call for volunteers about a week ago. More than 1,400 students and alums have responded.

Public health student volunteers who've been meeting daily for a little more than a week to connect hundreds of students with local public health officers.
Public health student volunteers who've been meeting daily for a little more than a week to connect hundreds of students with local public health officers.

“We had an amazing outpouring of interest,” said Stacey King, director of practice at Harvard University’s T.H. Chan School of Public Health, and one of three co-leaders of the volunteer project.

Some of the students may be hired for the Partners in Health call network. King said making these calls, with questions about symptoms, contacts, recent activities and the health of family members, will be challenging, “especially when people are under so much stress right now."

"I think it will be one of the hardest things that we experience,” she said.

In the event you get a call and are asked to trace your contacts, it might help to start keeping notes: who have you spent more than a few minutes with — and been within six feet of — recently?

The Partners in Health project is set to continue through October and ramp down in January. The organization referred questions about project costs to the Baker administration, which has not responded with information about the budget or the source of funding.

This article was originally published on April 03, 2020.

This segment aired on April 3, 2020.

Related:

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.

More…

Support the news