In an email, officials wrote that Denver is assessing how best to reinstate contact tracing since it became less effective as community spread of the disease took hold. They wrote that once there are fewer cases, “and we can better identify where individuals may have contracted COVID-19, and with whom they had been in contact with after, it may become effective to return to contact tracing and use of quarantine to ensure we do not see another rise in case counts.”
The email noted that, “Because of the huge hit COVID-19 has taken on our economy, we don’t plan on hiring new employees [to conduct contact tracing], but hope to pull in volunteers, like graduate students and retirees to help.” In emails obtained by CPR, city officials revealed that they are beginning the development of a recovery plan.
Albanese, with Tri-County, said there’s planning at the state and local level, “and coordination between the two,” for what to do when people get sick in this next phase of COVID-19 response. That includes testing, to “rapidly find out if they’re infected,” along with “trying to come up with innovative ways” to identify and communicate with people who’ve come into contact with the novel coronavirus.
“It’s a huge process underway, a huge effort,” Albanese said.
Once restrictions are lifted, she’s nervous people will return to normal social behavior too soon. The state expects another bump in cases and hopes that new technology will help make contact tracing more timely and less manual. “We want the decision to ease [stay-at-home] restrictions to be made carefully,” she said. “We want more availability for lab testing in the Metro area and around the state. That needs to be in place.”
Local public health departments need more resources to be able to respond to cases quickly, like “strike teams,” Albanese said. “To be able to say, ‘We have a new case, let’s draw an investigation around that.”
Technology Can Assist Contact Tracing, But At What Cost?
If Colorado has a role model for the next phase of its coronavirus response, it’s likely Taiwan.
Polis has repeatedly praised the island nation’s response, which stopped the spread of the virus without the autocratic surveillance and lockdown measures now in place in China. Businesses remain opened. Kids are in classrooms. The country’s response has been so effective, it has a surplus of protective medical equipment like facemasks, some of which it recently donated to Colorado, according to a tweet from Polis.
Stanford Health Policy researcher Jason Wang wrote an article for the Journal of the American Medical Association that examined the country’s success. While early interventions prevented anything like the outbreaks now crippling the U.S., he said Taiwan still contains a critical lesson for states like Colorado: You can’t completely protect both public health and privacy.
“It’s a trade-off,” Wang said. “You want to do the minimally invasive procedure to protect public health.”
Chiang Ying-ying/AP
For example, Wang pointed to data sharing across huge pieces of Taiwan's government. In the early stages of the outbreak, the country integrated travel history information into its national health care system. The move allowed doctors to know if a patient had been to a virus hotspot and needed special care or testing.
Wang added Taiwan’s contact tracing program can be an example for other democracies. When the government declared an emergency, it assumed powers to track cell phone data for public health reasons and enforce quarantines. He stressed those additional controls are set to expire next year.
With its new authority, the country has built a system of carrots and sticks to ensure citizens obey 14-day quarantine orders. Government workers provide food and symptoms checks three times a day. Anyone forced to stay home receives payments from the government, which can turn into a fine if that person hops on a bus or visits a grocery store. While cell location tracking assists those efforts, Wang said the government is transparent about what’s happening and why it’s necessary.
“If you do contact tracing, you have to explain to people why you’re using the information, how you’re going to be using it, exactly where you got it from and who’s going to have access,” he said.
As Colorado reopens, Wang thinks the state shouldn’t choose between traditional contact tracing interviews and cell phone tracking. Instead, he said, “do both.”
He suggests epidemiologists should work in concert with new surveillance programs, like the recently proposed plan from Apple and Google. The project would use Bluetooth to record when two people, or at least their phones, come into close contact. Public health officials could then tap into a database to help figure out who needs to be tested or placed under self-quarantine.
What Comes After The Leveling Off
Colorado hit a significant milestone in its coronavirus odyssey on April 15: a leveling off of hospitalized COVID patients.
“As of yesterday [April 15], there were 1,215 Coloradans hospitalized with COVID-19 or with COVID-19 symptoms,” the Colorado Hospital Association said in a statement. “That number had grown steadily since mid-March when hospitals began reporting this data to the state, but it has leveled off in the past week.”
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