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What are 2 biggest impediments to effective test-trace response in US (including backwards & forwards tracing)?
-Easy rapid free testing
-Trust/cooperation
Test-trace could help reverse surge & minimize business closures so badly needed.
Short thread w/ urgently needed solutions
-Easy rapid free testing
-Trust/cooperation
Test-trace could help reverse surge & minimize business closures so badly needed.
Short thread w/ urgently needed solutions
As everyone knows, testing has been Achilles heel of US response to COVID. If you can't easily get free test & get results fast, you might go to work/party w/ mild symptoms. If you wait until symptoms are severe (often 5-8d later) it's too late; you're mostly done transmitting.
Testing capacity & turn around times in US have improved in US, but are still not sufficient. One recent improvement in CA is a contract that provides more testing capacity w/ $$ linked to turn around time. https://www.gov.ca.gov/2020/08/26/governor-newsom-announces-major-plan-to-more-than-double-states-testing-capacity-reduce-turnaround-time/
We still need to do much better (need turn around time of <24 hr, not 48hr; <1 hr even better - follow @michaelmina_lab to see how rapid tests could be hugely impactful), but it's an improvement.
Unfortunately we are doing even worse on 2nd key issue: trust/cooperation.
Getting folks to get tested asap when symptomatic & after risky contacts requires people to trust & cooperate w/ public health system.
Getting folks to get tested asap when symptomatic & after risky contacts requires people to trust & cooperate w/ public health system.
Similarly, case investigation & contact tracing requires cases to tell public health folks how they got infected & who they might have infected. Doing so requires trust & cooperation. Unfortunately, both are greatly lacking at present & result is very low public participation.
Challenge #1: Great thread from @JuliaLMarcus on how COVID stigma hurts public health efforts:
https://twitter.com/JuliaLMarcus/status/1327305367253037061
This makes people less likely to provide info/contacts.
Challenge #2: Worries about loss of job/pay/deportation for undocumented dis-incentivize getting tested
https://twitter.com/JuliaLMarcus/status/1327305367253037061
This makes people less likely to provide info/contacts.
Challenge #2: Worries about loss of job/pay/deportation for undocumented dis-incentivize getting tested
I am working w/ local health dept to add backwards contact tracing to toolkit.
#1 challenge? Getting cases to provide info to backwards trace b/c of trust.
#2 challenge? Getting source case to provide contacts b/c of trust.
#3 challenge: rapid easy testing
#1 challenge? Getting cases to provide info to backwards trace b/c of trust.
#2 challenge? Getting source case to provide contacts b/c of trust.
#3 challenge: rapid easy testing
How can we address these issues?
1) Must provide full support (safe space, pay, job security etc.) for those getting tested. Some programs exist ( https://www.dol.gov/agencies/whd/pandemic/ffcra-employee-paid-leave) but aren't sufficient for problem: undoc workers fear gov & getting fired; also delays in receiving sick pay
1) Must provide full support (safe space, pay, job security etc.) for those getting tested. Some programs exist ( https://www.dol.gov/agencies/whd/pandemic/ffcra-employee-paid-leave) but aren't sufficient for problem: undoc workers fear gov & getting fired; also delays in receiving sick pay
2) Must increase trust & incentivize cooperation. People need to see real benefit of providing info on how they became infected & who they might have infected. Part of this is removing stigma; part is providing support & part is clear communication: we are all in this together!
Politics & especially GOP over past year have greatly hurt public's trust in government in general & public health in particular, & false tradeoff b/w economy vs public health is especially damaging. We need reboot & launch of collective efforts now! We can't wait until Jan.
