Michael Reid, MD, on Contact Tracing: "Our Best Firewall" Against the Pandemic
Infectious Diseases Consultant Advisory Board Member Michael Reid, MD, discusses his work in helping establish a contact tracing and case investigation infrastructure in San Francisco, California, to help mitigate the COVID-19 pandemic.
Michael Reid: Great pleasure to be with you. My name is Mike Reid. I’m an infectious disease doctor and HIV specialist. I work at the University of California, San Francisco, and I was asked to kind of share my own personal experience and insight into the COVID-19 epidemic based on my evolving professional role.
So, before we get started, I was mostly involved with global HIV and TB work, building capacity to deliver high quality programs in Africa. Very quickly, that work is has evolved, but at the same time, there has been an increasing need for a robust public health response to COVID-19. And so, some of my skills have been quickly leveraged towards that. And so, I thought I’d just share with you how I'm spending 70% of my time directly. Thirty percent, I'm still clinical, and today I'm actually the attending on the COVID-19 service at one of our hospitals here in San Francisco, but the rest of the time I'm working on public health response.
… I think everybody is aware of how, in responding to any kind of pandemic, the traditional approaches have been to focus on containment, and then as an epidemic unfolds, pivot to mitigation. So, what I have been primarily involved with is containment, and we understand containment to be any kind of activity to minimize the expansion of the spread of an epidemic. And typically, this involves increasing testing, quarantining those that are exposed, contact tracing potentially exposed individuals, and developing algorithms based on dynamics of local spread, etc, to anticipate risk.
So just to back up … in China, one of the most effective interventions in Wuhan to control the spread of the epidemic was to rapidly scale up an army of people that could contact trace all contacts with cases. In fact, Wuhan had a population 54 million people. They recruited 18,000 people to do contact tracing and case investigation.
And so, in San Francisco, one of the things that we are ambitiously trying to pursue is a model that replicates the scale, but leverages some of the technology assets that we have in the Bay Area to do effective contact tracing. So, I am working with the Department of Public Health to implement a program for contact tracing in San Francisco, and our goal is … to put together a team between 100 and 150 people that can get on the phone and contact every single known contact of every known case. And fortunately, because of shelter in place and strategies that have already been put instituted to mitigate spread, we're not seeing such a huge number of cases on a daily basis that we can't do that contact tracing.
So, what are we doing? Well, we have an online platform where contact tracers are able to reach out to every single contact, record the details, and enumerate their risk, stratify their risk for developing COVID-19 based on a simple algorithm, and then advise each of those people, “You’re a contact of the case. You need to self-quarantine. Are you able to do that?” And, for a small population of individuals that aren't able to self-quarantine, then the city has some resources to support them to do that.
One of the main things that we're able to do is educate all of these people about the importance of being a contact and self-quarantine, the shared responsibility we all have to prevent spread, and these individuals stay indoors until that 14-day window is up, as an important part of the overall public health response.
So … super exciting to be involved with that arm. I think one of the cool things is that we're able to work with different city departments in San Francisco to make that happen. And in San Francisco, there are many, many elements of the city’s infrastructure that aren't able to work right now, and our hope is that we can mobilize some of those personnel to do this work, which isn't super technical, and be supported by … public health professionals that can oversee and manage the response.
So, I appreciate that that’s kind of a bit different from what other clinicians are involved with. I'm totally convinced that it's the pathway to minimizing the impact of the epidemic, and what we're seeing here in San Francisco is that implementing an effective case investigation and contact tracing infrastructure really is our best firewall against the epidemic–not just in the short term, not just until shelter-in-place is over, but really for the foreseeable future, and until there is a point at which a vaccine has arrived. So, it's not just about mobilizing that contact tracing workforce. Now, it's setting in place sustainable strategies that will allow us to continue to maintain a robust response in 12 months or 18 months time.
Thank you for listening, and it's been a pleasure to share some insights from my own work with you.
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- Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-2019): for healthcare professionals. https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html Page last reviewed on April 1, 2020. Accessed on April 7, 2020.
Michael Reid, MD, is an assistant professor in infectious disease in the Center for AIDS Research at the University of California, San Francisco.