Contact Tracing, Key to Reining in the Virus, Falls Flat in the West

LONDON — As the coronavirus stampeded across Europe and the United States this spring, governments made their depleted citizens a tantalizing promise: Soon, legions of disease detectives would hunt down anyone exposed to the virus, confining them to their homes and letting everyone else get on with their lives.

Nearly eight months on, as a web of new infections spreads across Europe and the United States, that promise has nearly evaporated.

Despite repeated vows by Western nations to develop “world-beating” testing and tracing operations, those systems have been undone by a failure of governments to support citizens through onerous quarantines or to draw out intimate details of their whereabouts. That has shattered the hope of pinpoint measures replacing lockdowns and undermined flagging confidence in governments.

Beholden to privacy rules, Western officials largely trusted people to hand over names to contact tracers. But that trust was not repaid, in large part because governments neglected services that were crucial to winning people’s cooperation: a fast and accurate testing system, and guarantees that people would be housed, fed and paid while they isolated.

“Public health leaders fell in love with the idea of contact tracing as an important tactic — and it is — but that’d be like if you’re going into war and were just talking about the tanks,” said Brian Castrucci, president of the de Beaumont Foundation, a public health charity in Maryland.

Just as important, officials overlooked the impact of raging mistrust in government and a thicket of conspiracy theories about the virus’s spread. Fearful of plunging themselves or their friends into a painful period off work, infected patients have handed over a paltry number of contacts and often flouted self-isolation rules. Contact tracers are struggling to reach people who test positive, and being rebuffed once they do.

In theory, countries were to build mass testing programs that would provide quick diagnoses. Then a group of tracers would find others who had crossed paths with the infected person and tell them to stay home.

Elected officials presented the system as a critical bridge between lockdown and a vaccine, allowing them to contain small outbreaks without shutting down large parts of society. But construction of that bridge has been rocky, at best.

The West’s public health systems have not matched the success in parts of East Asia where the fear of epidemics became more ingrained after SARS and MERS.

Following those outbreaks, places like Taiwan and South Korea built robust tracing systems and legal frameworks for limiting civil liberties during an epidemic. Some contact tracers have used cellphone and credit card data to identify people who were potentially exposed.

But in Europe and the United States, which have largely relied on the public to provide information and follow quarantine rules voluntarily. The response has been spotty.

The West also ran up against the blunt fact that contact tracing, while useful in containing limited cases, has become overwhelmed by a new explosion of infections. In the past week, Europe has averaged about 60,000 new daily cases, while the United States is registering more than 40,000.

“The track and trace system is unrealistic and useless,” said Mahmoud Salamon, 27, a recent business school graduate on a visit to Brighton, on England’s south coast, where a testing center at a stadium was recently closed for the start of soccer season. He said he distrusted restaurants or stores with his personal information.

In Taiwan, an infected person names more than 15 contacts on average, and tracers often interview patients in person, trying to extract details about secret jobs or marital affairs. But the picture in Europe is far different, and the low level of cooperation has startled public health experts.

In Spain, where hospitals are struggling with a new rush of cases, contact tracers identify, on average, only three contacts for each known case. In France, the figure has fallen below three.

Yet even those numbers are higher than in the United States. In New York City, each infected person hands over an average of 1.1 other names.

In England, people are neither handing over many contacts — about five, on average — nor following the rules. In a survey of about 32,000 Britons, less than one in five who reported coronavirus symptoms said they had stayed home. Of those alerted that they had been close to an infected person, only one in 10 said they had complied with orders to self-isolate.

“It suggests there is some degree of skepticism in the population to engagement,” said Professor Christophe Fraser of the University of Oxford, an adviser to the government’s tracing program, referring to the proportion of known cases — a fifth — who handed over no other names.

Crucially, many Western governments have failed to cushion the financial and psychological blow of self-isolation by guaranteeing people tests or giving them enough money to weather two weeks without work.

People self-isolating and unable to work in England were eligible for just 13 pounds, or $16.70, per day, until the government increased the payments this past week.

“You need to have the trust of people for this to work, and trust comes by whether you’re going to take care of me,” said Dr. Jason Wang, a Stanford University professor of health policy who has studied Taiwan’s coronavirus response. “If I’m sick, are you going to help me, or just quarantine me? Are you going to get me tested on time?”

With tests results lagging in many countries, contact tracers cannot get ahead of the virus. In Paris, people wait up to a week to get testing appointments and results. England recently recorded a backlog of nearly 200,000 untested lab samples, making it impossible to track the virus through newly reopened schools.

Danielle Lennon, who lives in hard-hit northeastern England, sat in a mile-long line of idling cars for almost an hour to get her 7-year-old daughter tested, only for someone to announce that the testing center was closed.

“The government has kind of lost the general public on this, through incompetence,” she said.

Some elected leaders have blamed recalcitrant citizens for undermining contact tracing. Prime Minister Boris Johnson recently said the problem was that Britain was “a freedom-loving country.”

But the evidence for such claims is thin. Some countries have successfully tracked the virus, despite people’s resistance, in large part by investing in chronically underfunded health departments, epidemiologists said.

In Germany, people said they would refuse to hand over names to contact tracers at double the rate of Britons, according to a poll by Imperial College London. Even so, the country has largely kept a small uptick in new infections under control.

Beyond Germany’s strong testing program, said Ralf Reintjes, a professor of epidemiology at Hamburg University of Applied Sciences, the country also responded to the pandemic by pouring money into its roughly 400 local public health offices, which had long conducted contact tracing for communicable diseases.

England, by contrast, awarded a £108 million ($138 million) contract to an outsourcing company, putting the fate of contact tracing in the hands of ill-trained call center workers.

Gerry, a former nurse who asked not to be fully identified because she was barred from speaking publicly, said she had quit her job as a more senior contact tracer in England because so few people either picked up the phone or helped her track cases.

Western countries have been slow to introduce mobile contact tracing apps like those used in parts of Asia, which notify users who have spent time near an infected person. Even if only 15 percent of people download them, they can reduce infections by 8 percent and deaths by 6 percent, according to research by Prof. Fraser, the Oxford professor.

But the dissonance of countries asking people to take personal and professional risks in handing over contacts’ names, while at the same time scarcely supporting those who do, makes tracking the virus a difficult order.

“We say we’d like you to quarantine for the good of your neighbors, but in doing so potentially your kids starve and you lose your home,” Mr. Castrucci said. “That’s bad math.”

Anna Schaverien and Megan Specia contributed reporting.


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