US State Health
Officials Join With Johns Hopkins To Propose A Case Finding And
Contact Tracing Approach To Contain COVID-19
CDC Also Expected
To Propose A Similar Shoe-Leather Approach
Despite the US having
initially failed to effectively contain imported cases of COVID-19
using a case-based approach (a containment strategy), the Association
of State and Territorial Health Officials (ASTHO) has joined with the
Johns Hopkins University Center for Health Security to call for a
second try.
There has recently
been success with social distancing (a mitigation strategy) in some
locations, however, the impact on the economy means that strategy
cannot be the lynchpin the country relies on going forward. Instead,
the joint group is calling for “a robust and comprehensive system to
identify all COVID-19 cases and trace all close contacts of each
identified case.” Their proposal is entitled
A National Plan to Enable Comprehensive COVID-19 Case
Finding and Contact Tracing in the U.S.
Plan Elements
According
to the new plan, communities in the US will need to
1) test all symptomatic and suspect cases,
2) identify persons who have developed immunity,
3) trace all contacts of reported or identified cases,
4) safely isolate the sick, and
5) quarantine those exposed.
The task is considered
doable, however, it will require adding approximately 100,000
shoe-leather investigators and providing $3.6 billion in emergency
funding to state and territorial health departments.
The plan justifies its
approach based on what it calls “important lessons from overseas
responses that highlight just how vital teams of contact tracers and
disease investigators will be to our recovery, and the critical role
frontline public health workers have played to controlling COVID-19 in
China, South Korea, Singapore, New Zealand, and Iceland.”
CDC To Weigh In
In an interview with
National Public Radio, CDC Director Robert Redfield appeared to
support the ASTHO/Hopkins strategy by saying that a plan being
prepared by his agency will include not only increased testing but
very aggressive contact tracing of those who test positive and a major
increase in hiring of personnel to do the shoe-leather epidemiology
work.
Concerns
There are many
potential concerns about the feasibility of what ASTHO/Hopkins and in
all likelihood CDC are proposing. A first concern is whether or not
rapid diagnostic testing will be available widely enough and quickly
enough. It will not be possible to truly launch this strategy without
adequate testing resources.
Another concern is the
success some countries had with a more case-based approach which
included measures not acceptable in the US because of the importance
attached to privacy. According to NPR, Redfield sounded optimistic. He
noted the progress we have made with social distancing measures but
believes that the best hope until a vaccine is available is to fight
back potential new outbreaks with public health workers on the ground.
To read the ASTHO/Hopkins
proposed plan, visit:
https://bit.ly/3cuwCvk ■
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