Is it too late for the US to execute a pandemic plan?
October 31, 2020
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by admin

A woman in a face mask holds up a phone.
Enlarge / A woman in France displays a contact tracing app.

There’s a standard set of best practices for disease outbreaks that includes a process called contact tracing. Each time you identify someone infected, you figure out who they’ve been in proximity to during the time they were infectious. You then get the person infected to self-isolate, and also convince their contacts to do so, at least until they can be tested and found to be uninfected. Doing this successfully can bring the rate of infection down below the point where the outbreak is self-sustaining—even if not everybody’s picked up through contact tracing, there won’t be many who aren’t, and anyone they infect eventually will be.

For the COVID-19 pandemic, infection rates in many countries were initially so high that contact tracing was impractical. But a suite of social interventions—social distance,  mask wearing, limiting time out of the home, washing hands, etc.—were used to bring rates back down to where contact tracing could be effective again.

This didn’t happen in the US. There was no national effort to contact trace, each state set its own policy regarding social restrictions, and many states lifted their social interventions too soon, all of which have allowed several surges in infections.

Should a national plan materialize at this point, it’s difficult to tell whether it could possibly be effective. Many state governments would undoubtedly oppose any national effort for political reasons. Basic public health measures have become so politicized that it seems likely that many in the US would risk their health and that of everyone around them in order to promote their ideological affiliation. In light of that, it’s no surprise to hear that a new poll indicates that only about half of the US would be willing to participate in contact tracing. But the underlying data indicates that only part of the opposition is ideological; most issues stem from privacy concerns.

It’s a process, not an action

The survey is a product of the Pew Research Center, which maintains a panel of over 10,000 US adults for surveys of the country’s attitudes. In this case, the Pew asked them about contact tracing, but did so indirectly. Rather than simply letting people check a box for will/won’t participate in contact tracing, they broke down the process into its component parts. Those involve contacting public health officials, sharing personal information with them, and then self-isolating if conditions call for it.

This is significant because a lot of people may not understand the full process of contact tracing. They may agree with it in principle as a way of fighting the pandemic but balk when it comes to some of the specific details. The poll gets at precisely this difference.

For contact tracing to work, people have to agree to talk with public health figures, share some of their health information with them, share their recent activities with them, and then agree to self-isolate for an extended period of time. These are each very different hurdles that someone has to agree to clear for contact tracing to work.

The good news  is that almost everyone would take the most difficult step: self-quarantining if asked to do so by a health official. On average, 73 percent said they definitely would, and another 20 percent that they probably would. Lumping these together, and nearly every demographic sub-group saw 90 percent or more agreement to isolate; gender, ethnic background, and education only made marginal differences. At worst, those who identified as Republican came in at 88 percent. The unfortunate thing is that, among the small fraction that said they might not self-isolate, about 80 percent simply said that they didn’t believe it was necessary—a number that was higher than any concerns like work or childcare.

Is anybody there?

The biggest problem for contact tracing may be, unexpectedly, the bombardment of the US population with spam phone calls. Only about 20 percent of US adults would pick up the phone if an unidentified number is calling them, and 15 percent wouldn’t even listen to a voicemail left by one of these callers. So, public health officials might have to work hard just to get in touch with anyone who has been identified by contact tracing. (Again, things like income and gender didn’t make much difference.)

Another fear is that, in the age of online and phone scams, people are justifiably leery of giving out their personal information. About 90 percent of people surveyed were aware of this potential, and about two-thirds said they feel less secure about their personal information than they did five years ago.

The end result of this is that only about 40 percent of the public said they’d be likely to speak to a public health official either by phone or in person. The probability that someone was willing to speak went up with age, education, and income (all of which are correlated, so don’t read causation into this). And here, Republicans were far less likely (by about 50 percent to 30 percent) to agree to talk to a public health official, suggesting the politicization of the pandemic may be a factor here as well.

People were also very uneasy with sharing personal information that’s needed for contact tracing. The Pew asked about collecting names, the locations visited, and cell phone location data. About a quarter of the survey population were uncomfortable with sharing the names of people or places they’ve spent time near, and half wouldn’t want to share their phone’s location data. Again, willingness to do so increased age, education, and income. Also again there was a substantial partisan gap, with Republicans about 20 points more likely to be uncomfortable with sharing these details.

There is some hope that further education about contact tracing will help the situation. People who said they had a higher understanding of the contact tracing process were significantly more likely to fall in the group that agreed to all the steps needed for the process to work. And while only half of the survey population would agree to the three key steps—talk to officials, share information, and isolate—a lot of people were close. If we include everyone who was comfortable with at least two of the three key steps, then the fraction of people who are close to being willing goes up to over 80 percent.

So while there are some signs of problems due to politicization, we’ve not reached the point where it would prevent an effective pandemic plan should there be a change in political leadership. And the survey points out where we’d need to do some public health messaging to boost participation: by helping people to understand how to differentiate public health officials from spammers and scammers.

Correction:  fixed a reversal of the likelihood that people would talk to public health officials, and clarified some wording.

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