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Contact tracing is something we are hearing a lot about lately, as one of the tools in the battle against COVID-19, the illness caused by the new coronavirus. I’ll make a confession, in four years of medical school, and my first half of residency training, I only had a basic understanding of what the term meant.
In order to come up to speed, I contacted Nirav Shah, asking if he would be willing to help a second-year medical resident understand contact tracing and the role it plays in fighting the COVID-19 pandemic. Shah, in his role as director of the Maine Center for Disease Control and Prevention, has become the leader in the state’s efforts to get the pandemic under control.
Here’s what Shah had to say.
“Contact tracing varies greatly based on the type of disease and the type of outbreak you are contending with.” In a particularly memorable example, Shah continues to explain, “I first learned how to do this in 2001 when I was working in Southeast Asia, in connection with a type of particularly virulent dengue hemorrhagic fever outbreak in Northern Cambodia, when we had to go about contact tracing in that fashion to try and find the pool of mosquitoes that carried it were breeding in.”
My response is a single word was “wow,” which he appropriately used as an opportunity to shift the conversation back to the coronavirus.
“In this current situation, the purpose of the contact tracing is twofold. The first is upstream, which has to try to get a sense of where the person who’s infected with COVID-19 may have acquired it from … The other reason we do contact in this situation is downstream, which is to say who do they live with or who do they interact with who they might transmit the virus to … We generate a list of all of those close contacts, and inform them they have been in close contact with someone who is now positive, and they need to watch out for symptoms for 14 days.”
I asked if those diagnosed with coronavirus should ever attempt to do the work of the “contact tracers” independently, and Shah explained “because the advice can vary so much … the advice is really what is critical with contact tracing … and so that should be done by epidemiologists.” He adds that after being diagnosed as positive, however, it may not be a bad idea “to generate a list of close contacts” in preparation for speaking with one.
Aware that the potential success of the Maine CDC’s contact tracing efforts will depend on public participation and trust, I next asked Shah about confidentiality and privacy concerns. “We don’t reveal information about the person who contacts us,” he said. “If we call someone, all we say is you have been identified as a close contact … We understand the privacy concern, and we do a lot to protect that, which is why we don’t identify who the close contact is.”
Asked finally about how Mainers can help support his office’s efforts, Shah kept it simple. “If you get a phone call from someone who says they are from the Maine CDC, and they want to chat with you, and give you advice to help you stay healthy, that’s a phone call you want to return.”
Reliable, timely, trustworthy health information has and will continue to save lives in Maine, and I have a daily appreciation and respect for the expertise of Shah.
As a doctor training in Maine, I have been proud of the state’s efforts to “flatten the curve” behind his and Gov. Janet Mills’ leadership. I hope others continue to trust this administration to lead us carefully and thoughtfully through this, with as much patience as required, to save as many lives as possible, and to show one of our state’s values, that even in tremendously difficult and challenging times, we care for each other as much as we care for ourselves.
Matthew Wetherell of Portland is a second-year resident in family medicine.