As economic pressures mount, the desire to get the economy up and running is only growing stronger. If businesses are allowed to reopen before the virus is properly contained, experts warn of a resurgence in COVID-19 cases that risks thousands of more lives. As new cases flatten out and begin to descend, tracing how the disease moves through society is essential to getting the spread under control.
“The process of containment is the way we get back to work,” says Dr. Robert Haley, Chief of Epidemiology at UT Southwestern. “Supervisors and CEOs need to realize this is the way we get back to work and stay at work. They need to exhibit leadership in their company, give directions to their personnel and provide sick leave if their employees get sick.”
While authorities are more hopeful now than they were a few weeks ago about North Texas’ ability to handle the influx of coronavirus patients, there was a period where things could have spun out of control. Dallas County Judge Clay Jenkins put the shelter in place after COVID-19 cases tripled each week. That was just in time, according to Haley. “If we had waited another week, we would have looked like a little New York, with patients dying in halls untreated,” he says.
But now that new case numbers appear to be leveling off and trending downward, county health officials and epidemiologists are working to make sure the virus doesn’t rebound by tracing the contacts of those who were infected.
The task won’t be easy. It involves interviewing positive COVID-19 patients or their loved ones if they are unable to speak, finding out with whom they were in contact, notifying those individuals, and making sure that those contacts continue to isolate. It may sound like a straightforward process, but there are several complicating factors.
But there is precedent, even at low cost. In Vietnam, quick action, testing, and making sure potential COVID-19 patients quarantine was paramount, and as a result the country of 95 million has only had 268 confirmed cases and no deaths as of April 17. But the United States is hampered by several factors, says Dr. Jeremy Gabrysch, CEO of Remedy, a telehealth and concierge healthcare company running testing sites in Fort Worth.
Testing kits with quick turn-arounds are in short supply, he says. His company has the machines to do quick turnaround testing, but are waiting on the kits. Remedy is also looking to do antibody testing, but is waiting on the FDA to give clear guidance on what is legal and available. “We have the machine to run the tests, but haven’t been able to get the test kits,” he says. “That has been the case with a lot of companies with swabs in limited supply.”
Infected individuals may be on a ventilator or may have died, making identifying their contacts more difficult. In addition, the individuals need to isolate themselves for at least two weeks, which is no easy ask in a home or apartment with other family members and responsibilities at work and at home.
If contacts can be identified, they have to be reached. With the number of cases in Dallas, this means thousands of phone calls and attempted contacts, and UT Southwestern students have stepped up to make some of these calls to trace contacts and let them know they may have been exposed. Contacts are told to stay home and watch closely to see if they begin to have symptoms, which include fever and a loss of taste and smell.
An added difficulty is the high number of people who are contagious but show no symptoms themselves, who might be likely to continue working or going to the grocery store and infecting others. This makes the tracing of contacts that much more important.
Because of the numbers of people involved, it will be difficult for the county to enforce this sort of isolation, though there is precedent dating back to the forced isolation of tuberculosis patients in the past. Haley says that while it may be painful now, residents need to follow isolation instructions, or the impact could be extended for months. “It depends on people’s good judgment and their civic spirit to contribute to the effort by quarantining,” he says.
As patients recover, antibody testing will become more important to donate plasma and contribute to others’ treatment, but that provides its own challenges. Health officials aren’t sure how long immunity will last for recovered COVID-19, as some viruses cause immunity for one’s entire life, while others just last a few months, Gabrysch says. The market has been flooded with antibody tests, and some are providing false positives. Patients may think they have immunity if they receive a false positive, which could put put patients at risk.
Solid antibody testing can provide reassurance to patients, but Gabrysch says the technology isn’t quite there yet. “It would be nice to have that, but it isn’t the current state,” he says. “We could get to that point, but we aren’t there yet.”
Haley and others have been working with county health officials to trace contacts and compile a database, but he says there are still significant needs. If there are retired law enforcement who would like to travel to homes to deliver enforcement orders to infected individuals, they can be put to work. He also said that IT personnel who can help build a digital database to help track contacts is needed as well.
Haley says it may take a couple years before COVID-19 cases are completely eradicated, but if people comply with the process, it can be done with minimum pain. “If we are successful we can drive this down to almost nothing, and people can go back to work.”