Contact tracing continues to be regarded as a key element of any successful COVID-19 response plan, but a new survey from Pew Research Center finds that Americans have a variety of views that could complicate the ongoing efforts of public health authorities battling the outbreak.
Contact tracing—identifying individuals who may have come into contact with an infected person and then collecting data on these contacts—has helped stop previous deadly outbreaks, but the current COVID-19 virus presents a far greater challenge given that there’s been millions of confirmed cases in the U.S. already.
For the research, Pew surveyed more than 10,000 U.S. adults in July 2020. Everyone who took part is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses.
According to Pew, on the one hand, majorities of Americans say they would be at least somewhat comfortable or likely to engage with some parts of contact tracing programs. For example, this survey revealed that 58 percent of U.S. adults said they would be very or somewhat likely to speak with a public health official who contacted them by phone or text message to speak with them about the coronavirus outbreak.
Further, roughly three-quarters (77 percent) reported they would be at least somewhat comfortable sharing information with a public health official about the places they have recently visited. A smaller number, 49 percent, said they would be similarly comfortable sharing location data from their cellphone. And fully 93 percent of adults said they definitely or probably would quarantine themselves for at least 14 days if they were told they should do so by a public health official because they had the coronavirus.
At the same time, the Pew research also shows that portions of Americans could be hard to reach and relatively uncomfortable engaging with public health officials as part of the contact tracing process related to the outbreak. For instance, 41 percent of those who were asked about their views on speaking with a public health official who might contact them about the coronavirus outbreak via phone or text said they would be not at all or not too likely to do so. A similar share (40 percent) of those who were asked about speaking with a public official who showed up at their residence to talk about COVID-19 said the same thing.
As Pew noted, there are several factors that influence Americans’ participation in contact tracing and quarantine programs. The survey asked U.S. adult respondents how they might behave in three major aspects of contact tracing in the context of the coronavirus outbreak: the likelihood that someone would speak with a public health official (i.e., a contact tracer) who contacted them about the coronavirus; the degree of comfort that someone would have in sharing information like the names of people with whom they have been in physical contact and the places they have recently visited, or data from their cellphone that tracked their locations; and their willingness to quarantine for 14 days if they were advised to do so by a public health official. Pew refers to these three steps as “speak,” “share” and “quarantine” throughout the report.
Overall, taking account of the public’s wariness with some parts of the contact tracing process, the survey shows that 48 percent of U.S. adults say they would be comfortable or likely to engage with all three key steps – speaking, sharing and quarantining. And if public health officials could break through people’s wariness of speaking with a public health official by phone, the results further show that another 21 percent might be willing. These are the individuals who said they would be very or somewhat comfortable sharing information and definitely or probably would quarantine, but also who said that they would be less likely to speak with a public health official by phone or text message in the first place.
A consistent struggle, nationwide
Contact tracing is the last two-thirds of public health leaders’ “test-trace-isolate” strategy, but in the U.S. so far, the results have not been there. A Reuters survey of 121 local agencies, published in August, concluded that the U.S. “badly lags other wealthy countries in contact tracing, including South Korea and Germany, which ramped up their programs months ago. Contributing to the faltering U.S. response is the government’s failure to provide accurate and timely diagnostic testing, something other countries were able to roll out much faster and more broadly.”
Common challenges and barriers mentioned in the Reuters report included: efforts to simply reach people who tested positive, let alone interview them; a lack of sufficient staff and funds; and technical problems and poor coordination. Per the report, one local health director in Wisconsin said responses her team got when calling positive patients ranged from “yelling and hanging up, to those telling us that they have already contacted all of their friends and will not give us those names.” The Pew research reinforced this anecdote in its survey, as just 19 percent of Americans said they generally answer their cellphones when an unknown phone number calls. Some 67 percent said they don’t answer but would check a voicemail if one is left. And 14 percent said they generally don’t answer and would ignore a voicemail.
Some U.S. states—such as Massachusetts—initially tried to get out in front of the issue. The Massachusetts Community Tracing Collaborative, a program focused on reaching out to the contacts of confirmed positive COVID-19 patients to help others who have been potentially exposed to the virus, had originally employed nearly 2,000 contact tracers—some nurses, some community health center staff, and some from the collaborative itself. But in July, the Boston Globe reported that the state's multimillion-dollar joint contact tracing effort with the Boston-based Partners in Health—which was the first of its ilk in the country—dropped its number of staffers to approximately 700. The state’s governor, Charlie Baker, had committed significant resources to build a central COVID-19 contact tracing force, but said in July that the effort simply had more staff than needed because the pandemic has been easing in Massachusetts. Just last week however, with COVID-19 cases in Massachusetts again rising, the group running the state’s contract tracing program began hiring new workers.
More recently, though, industry observers have pointed to San Francisco as a place where contact tracing has been successful. Currently in San Francisco, more than 83 percent of COVID-19 cases and contacts are reached on a regular basis, according to an ABC News report. In September, more than 1,600 COVID cases resulted in tracing more than 1,700 contacts. Close to 60 percent of those contacts then got tested, representing a significant jump from four months ago, the report noted. The San Francisco Department of Public Health employs 250 contact tracers and case investigators, and after a positive test result, the vast majority of people will receive a call within 24 hours.
The U.S. has more than 50,000 contact tracers for the first time since the coronavirus pandemic hit, according to a recent survey of states conducted by the Johns Hopkins Center for Health Security in collaboration with NPR. Public health experts have previously called for 100,000 contact tracers nationwide, a number that’s also been mentioned by presidential candidate Joe Biden.
Meanwhile, although contact tracers recommend that infected people self-isolate, but they have no authority to enforce isolation. The Pew research specifically asked how difficult it would be for people to isolate themselves for 14 days because they had COVID-19—regardless of whether or not they would actually do so. About three-in-ten Americans (32 percent} said it would be very or somewhat difficult to quarantine. Among those who would find it at least somewhat difficult, 40 percent said that having too many other obligations is a major reason for this difficulty, and about the same share (39 percent) said being unable to miss work would be a major reason.
Another contact tracing concern that has continuously been brought up is around user security. The Pew survey looked at people’s views about what happens to their personal information once it is in the hands of others. Half of Americans reported they are not at all or not too confident that the federal government will keep their personal records safe from hackers or unauthorized users. For some, those concerns also apply to public health organizations. About four-in-ten Americans (41 percent) said they are not at all or not too confident that public health organizations will keep their personal records safe.
To this end, earlier this year mobile app security company Guardsquare conducted a comprehensive review of 17 contact tracing apps, each from a different country, and ultimately found that the vast majority of contact tracing apps built and deployed by governments are not sufficiently secured. In the U.S. specifically, the report found that 100 percent of apps include some level of name obfuscation and string encryption, but none include asset/resource encryption or class encryption, and none have root detection or emulator detection.
