Contact tracing: What it is, why it’s done, and is it private?

Due to the respiratory droplet spread of Sars-Cov-2, people in close contact with someone who has COVID-19 are at risk of harboring the virus.

Contact tracers try to identify and alert people with a transmissible disease, such as COVID-19, and trace who the person recently interacted with. The idea is to stop future spread of the virus by the infected individuals or the others who may acquire the virus due to their interaction with a Sars-Cov -2 positive patient.

Contact tracing is a tool to aid in protecting oneself and others from disease. It helped halt further outbreaks of SARS and Ebola during their spread.

The method prevents future spread of cases by encouraging isolation or quarantine of individuals at risk of harboring the virus Sars-Cov-2. This practice dates back centuries, but wasn’t utilized initially in this pandemic secondary to the initial large surge of COVID-19 cases. Social isolation and shutdown were required to halt COVID-19 spread as quickly as possible.

Unfortunately, misinformation, the current socioeconomic issues, and acts of violence have eroded trust in public health organizations. To be successful, a contact tracing program must establish trust within all communities. This is even more important for communities at increased risk for poor outcomes due to COVID-19 spread. These at-risk populations are seen within communities of color or other marginalized communities.

As of early May in the United States there were 30,000 contact tracers; we may need up to 100,000 tracers ultimately. Here in Minnesota there are 800 interviewers for contacts or cases. All do not work on any given day.

They are composed of Minnesota Department of Health (MDH) staff and staff from local medical insurance companies. In addition, medical students from the University of Minnesota work in this role, as do on-site foreign language interpreters who have been trained to conduct interviews independently. 

The health data acquired by any of these interviewers is deemed as private. MDH follows Minnesota Data Practices law, and a Tennessen warning is given with each interview conducted. This warning describes why they are collecting information, who the information may be shared with, and that your participation is voluntary.

Information is shared initially only with people who are working directly on medical investigations at MDH or local public health. Information may be shared with the individual’s healthcare provider if they need immediate medical care.

On the MDH website they state that health data may be disclosed to the extent necessary to assist the MDH health commissioner in locating or identifying a case, carrier, or potential case.   An executive order was created on April 10, 2020 by Governor Walz, known as EO 20-34. The intent was specifically to protect first responders from COVID-19 exposure.

First responder is defined as emergency medical services personnel, ambulance transport staff, law enforcement personnel, fire responders, fire inspectors, and probation officers as well as parole agents. Law enforcement may include state, local and federal law enforcement.

At the start of each day, MDH runs a report containing the addresses for individuals who:

1. Have a laboratory-confirmed positive COVID-19 test result;
2. Are under current recommendation for self-isolation in their own residence;
3. Provided an address after receiving the Tennessen warning.
4. Addresses are not provided for hospitalized patients, the homeless, inmates, or those individuals who did not provide an address.

EO 20-34 only mandates that addresses (deemed private data as it relates to health status) of those with potential COVID-19 risk are shared with the department of public safety. This allows 911 dispatch to inform first responders to use appropriate infection precautions.

EO 20-34’s intent is to protect first responders and law enforcement, but every call to emergency dispatch first goes through a screening question protocol searching for COVID-19 symptoms. Sharing your personal address information is only encouraged, not mandatory.

Other privacy protocols are in place, and one can view the actual policies as well as frequently asked questions regarding these policies in the links below. 

There are obvious concerns regarding medical information privacy, even when limited information is shared with law enforcement. This is why most states, including Minnesota, have protocols that protect this information and only allow its use for public health information. A potentially infected individual’s identity does not need to be released in the search for finding others who may have symptoms. 

If you are presumed to be infected, a public health official will simply inquire what other people you have come into contact with, advise if isolation or quarantine are recommended, and if testing should be performed.

Since people can be contagious before showing symptoms or being tested, two paths are recommended: Isolation, when individuals are told to stay in home isolation for at least 10 days since symptoms started, ending when symptom-free for at least three fever-free days and improving respiratory symptoms; and Quarantine, which is advocated for 14 days from time of exposure to a potentially COVID-19 individual. 

If you do have to self-isolate or quarantine, clearly you may need assistance during this time.  This could be help with groceries, medications, household supplies, or even the care of another family member. Sometimes hotels or college dorms can be offered to allow people to quarantine or self-isolate from other family members. In any event, the MDH may assist in providing resources or direction towards aid in any of the above.

For contact tracing to be successful, it is crucial that as a community we participate in this process. An added benefit is the relaxation of stay-at-home and social distancing orders if we are successful. The process is only successful if it provides better outcomes for all.

To view the actual privacy policies as well as frequently asked questions regarding these policies, go to https://dps.mn.gov/divisions/ecn/Documents/mdh-dps-eo-20-34-protocol.pdf.

For additional information, visit “How long to stay home if sick” at the MDH COVID-19 website: www.health.state.mn.us/diseases/coronavirus/basics.html.

Sean J. Ennevor, M.D. graduated with a B.A.S. in biology and economics from Stanford University, and as a Dean’s Scholar from UCLA School of Medicine where he received his MD. He completed his medical residency and fellowship in anesthesiology at Yale University, where he was chief resident and on staff. He practiced medicine in the Twin Cities for over 14 years, and presently serves as an advisor and investor for medical technology companies throughout the country.