How to quickly scale up contact tracing across the US
-
0:02 - 0:04Chris Anderson: Joia,
both you and Partners In Health -
0:04 - 0:08have spent decades
in various battlegrounds, -
0:08 - 0:10battling epidemics.
-
0:10 - 0:14Perhaps, for context, you could give us
a couple examples of that work. -
0:16 - 0:18Joia Mukherjee: Yeah,
so Partners In Health -
0:18 - 0:22is a global nonprofit
that is more than 30 years old. -
0:22 - 0:26We started famously in Haiti
in a squatter settlement, -
0:26 - 0:28people who were displaced.
-
0:28 - 0:29And when we talked to them,
-
0:29 - 0:31they wanted health care and education,
-
0:31 - 0:33houses, jobs.
-
0:33 - 0:35And that has informed our work,
-
0:35 - 0:39that proximity to people
who are suffering. -
0:39 - 0:42When you think about
health care and the poor, -
0:42 - 0:45there is always disproportionate suffering
-
0:45 - 0:48for people who have been
historically marginalized, -
0:48 - 0:51like our communities
that we serve in Haiti. -
0:51 - 0:54And so we've always tried
to provide health care -
0:54 - 0:57for the poorest people on earth.
-
0:57 - 1:01And we were launched
into an international dialogue -
1:01 - 1:03about whether that was possible
-
1:03 - 1:07for drug-resistant tuberculosis, for HIV.
-
1:07 - 1:10Indeed, for surgery, for cancer,
-
1:10 - 1:12for mental health,
-
1:12 - 1:14for noncommunicable diseases.
-
1:14 - 1:17And we believe it's possible,
-
1:17 - 1:21and it is part of the basic
human right to care. -
1:21 - 1:25So when COVID started,
we saw this immediately as a threat -
1:25 - 1:28to the health of people
who were the poorest. -
1:28 - 1:30And Partners In Health
now works in 11 countries, -
1:30 - 1:32five on the African continent,
-
1:32 - 1:34Latin America and the Caribbean,
-
1:34 - 1:37as well as the former Soviet Union.
-
1:37 - 1:40And we immediately prepared
to scale up testing, -
1:40 - 1:44contact tracing, treatment, care,
-
1:44 - 1:48and then saw that it wasn't being done
in the United States in that way. -
1:48 - 1:52And in fact, we were just sitting,
passively waiting for people to get sick -
1:52 - 1:54and treat them in hospital.
-
1:54 - 1:58And that message got
to the governor of Massachusetts, -
1:58 - 2:03and we started supporting the state
to do contact tracing for COVID, -
2:03 - 2:08with the very idea that this would help us
identify and resource -
2:08 - 2:11the communities that were most vulnerable.
-
2:13 - 2:18CA: So it's really quite ironic
that these decades of experience -
2:18 - 2:20in the developing world and elsewhere,
-
2:20 - 2:25that that has now really been seen
as a crucial need to bring to the US. -
2:25 - 2:28And especially to bring your expertise
around contact tracing. -
2:28 - 2:31So, talk a bit about contact tracing,
-
2:31 - 2:33why does it matter so much,
-
2:33 - 2:35and what would, I don't know,
-
2:35 - 2:38a perfect contact tracing setup look like?
-
2:40 - 2:43JM: Well, first I want to say
that you want to, always, -
2:43 - 2:45in any type of illness,
-
2:45 - 2:48you want to do prevention,
-
2:48 - 2:51and diagnosis and treatment and care.
-
2:51 - 2:55That is what comprehensive
approaches look like, -
2:55 - 2:57and that "care" piece, to us,
-
2:57 - 3:02is about the provision of social support
and material support -
3:02 - 3:04to allow people to get the care they need.
-
3:04 - 3:07So that might be transportation,
it might be food. -
3:07 - 3:10So when you look
at that comprehensive approach, -
3:10 - 3:12for an infectious disease,
-
3:12 - 3:17part of prevention is knowing
where the disease is spreading -
3:17 - 3:20and how it's spreading
and in whom it's spreading, -
3:20 - 3:23so that resources can be
disproportionately put -
3:23 - 3:25to the highest-risk areas.
-
3:25 - 3:29So contact tracing
is a staple of public health -
3:29 - 3:32and what it means is that every time
a new person is diagnosed -
3:32 - 3:36with COVID or any infectious disease,
-
3:36 - 3:42then you investigate and innumerate
the people they've been in contacts with, -
3:42 - 3:46and call those contacts
and say, "You've been exposed," -
3:46 - 3:49or talk to them, "You've been exposed,
-
3:49 - 3:51these are the things you need to know.
-
3:51 - 3:53First of all, how are you?
-
3:53 - 3:54Do you need care yourself?"
-
3:54 - 3:56And facilitating that.
-
3:56 - 4:01"Second of all, these are the information
you need to know to keep yourself safe. -
4:01 - 4:03About quarantine, about prevention."
-
4:03 - 4:06And again, this would be
with any infectious disease, -
4:06 - 4:13from Ebola, to cholera, to a sexually
transmitted disease like HIV. -
4:13 - 4:15And then we say,
-
4:15 - 4:17"OK, knowing what you know,
-
4:17 - 4:20do you have the means
to protect yourself?" -
4:21 - 4:23Because often the most vulnerable
-
4:23 - 4:26do not have the means
to protect themselves. -
4:26 - 4:30So that is also where this resource
component comes in -
4:30 - 4:34and where equity is so critical
-
4:34 - 4:38to making this disease stop
-
4:38 - 4:41and also getting the information
and the resources -
4:41 - 4:44to people who need them the most.
-
4:45 - 4:49CA: And in a pandemic,
the people who need them the most, -
4:49 - 4:51the most vulnerable, as you say,
-
4:51 - 4:53are probably also --
-
4:53 - 4:55That's where the disease
is spreading a lot. -
4:55 - 4:57It's in everyone's interest to do this.
-
4:57 - 5:00You're not just making this sort of,
wonderful, equity moral point -
5:00 - 5:02that we've got to help these people.
-
5:02 - 5:04It's actually in all
of our interest, right? -
5:04 - 5:05JM: Yes.
-
5:05 - 5:08Yes, we are one humanity,
-
5:08 - 5:12and any disease, any infectious
disease that is spreading -
5:12 - 5:15is a threat to all of us.
-
5:15 - 5:20And that is one of the pieces,
there's the moral imperative, -
5:20 - 5:22there is the epidemiologic imperative,
-
5:22 - 5:26that if you can't control
these diseases everywhere, -
5:26 - 5:27that it's a threat anywhere.
-
5:27 - 5:32And so as we look to the kind
of society we want to live in, -
5:32 - 5:38good health is something that gives us all
so much return on our investment. -
5:39 - 5:43CA: Now, some countries were able
to use contact tracing -
5:43 - 5:48almost to shut down the pandemic
before it took off in that country. -
5:48 - 5:50The US was unable to do that,
-
5:50 - 5:52and some people have taken the view
-
5:52 - 5:54that therefore, contact tracing
became irrelevant, -
5:54 - 5:59that the strategy was mitigation,
shut everything down. -
5:59 - 6:00You've argued against that,
-
6:00 - 6:03that even in a process of lockdown
-
6:03 - 6:07that actually contact tracing
plays a key role. -
6:07 - 6:09Help us understand the scale,
-
6:09 - 6:11when there's a lot of cases,
-
6:11 - 6:13the scale of tracing, both cases
-
6:13 - 6:15and everyone they may
have been in contact with -
6:15 - 6:17and their contacts.
-
6:17 - 6:19It quickly gets to a huge problem.
-
6:19 - 6:20JM: It's massive.
-
6:20 - 6:23CA: What sort of workforce do you need
to make a difference -
6:23 - 6:26at this moment, where the US is at?
-
6:28 - 6:29JM: It's massive.
-
6:29 - 6:30I mean, the scale is massive,
-
6:30 - 6:33and we should not take that lightly.
-
6:33 - 6:35And we don't, at Partners In Health.
-
6:35 - 6:38I mean, we are willing
to try to figure this out, -
6:38 - 6:42and I always feel
that if we could stop Ebola -
6:42 - 6:44in some of the poorest
countries in the world, -
6:44 - 6:46of course we ought to do it here,
-
6:46 - 6:52and was it too late when there were
28,000 deaths in Ebola? -
6:52 - 6:54Sure, it's always too late.
-
6:55 - 6:56We should have started earlier,
-
6:56 - 6:58but it's not too late to have an impact.
-
6:58 - 7:02And so there's three aspects
of timing and scale. -
7:03 - 7:05First is, the earlier you start,
-
7:05 - 7:06the better, right?
-
7:06 - 7:08And that's what we saw in Rwanda.
-
7:08 - 7:12They went from early testing
and contact tracing, -
7:12 - 7:17the first two cases entered
into the country on March 15, -
7:17 - 7:18and in one month,
-
7:18 - 7:22because of contact tracing,
isolation and plenty of testing, -
7:22 - 7:27they had held that case rate
to 134 people. -
7:27 - 7:29It's remarkable, it's remarkable.
-
7:29 - 7:33In the state of Georgia,
where is home to the CDC, -
7:33 - 7:36similar population size, about 12 million,
-
7:36 - 7:39from the first two cases
in the first month, -
7:39 - 7:42those cases became 4,400 cases.
-
7:42 - 7:44And in the country of Belgium,
-
7:44 - 7:45a similar population,
-
7:45 - 7:48those two cases became 7,400.
-
7:49 - 7:52So you do have to make scale to stop this.
-
7:52 - 7:54But the earlier you do it,
-
7:54 - 7:57the more benefits there are
to your society -
7:57 - 8:01and also to the other people
who need medical services -- -
8:01 - 8:02women who are pregnant,
-
8:02 - 8:05people who need their fracture repaired,
-
8:05 - 8:08because services themselves
in the United States -
8:08 - 8:12have been, you know, really hampered
by this huge amount of COVID. -
8:12 - 8:15So the first point is,
-
8:15 - 8:19it's always late, but it's never too late.
-
8:19 - 8:20Why?
-
8:20 - 8:24Because vulnerable populations
are sitting ducks, -
8:24 - 8:29and so imagine if one of your contacts
was a nursing assistant -
8:29 - 8:31who worked in a nursing home.
-
8:31 - 8:37We know that one nursing assistant
can spread it throughout a nursing home. -
8:37 - 8:40And is it important to identify
that person as a contact -
8:40 - 8:44and assure that he or she
is able to remain quarantined? -
8:44 - 8:45That is critical.
-
8:45 - 8:47And so it's hard to say,
-
8:47 - 8:50"Well, it's not worth it
if it's just one person, two persons." -
8:50 - 8:52Every life matters,
-
8:52 - 8:57and all of their contacts in the community
of that person matters as well. -
8:57 - 8:58So that's one thing.
-
8:58 - 9:01The second about scale
is people need jobs right now. -
9:02 - 9:05And they want to be part of a solution,
-
9:05 - 9:07and some of the frustration we see,
-
9:07 - 9:09the antilockdown movement,
-
9:09 - 9:12is really out of anger and frustration
-
9:12 - 9:15and feeling, "What can we do?"
-
9:15 - 9:20And so this gives people this feeling
that they're part of a solution -
9:20 - 9:23and can provide thousands of jobs.
-
9:23 - 9:28And then third, I would say,
for us to reopen our schools, -
9:28 - 9:31our churches, our workplaces,
-
9:31 - 9:34we have to know
where the virus is spreading -
9:34 - 9:37so that we don't just
continue on this path. -
9:37 - 9:41And so contact tracing provides
the platform to control, -
9:41 - 9:44but also to see outbreaks
in real time popping up, -
9:44 - 9:45and then respond promptly.
-
9:45 - 9:50So there are many reasons
that we have to bring this to scale now. -
9:50 - 9:52Even though it is tardy.
-
9:53 - 9:57CA: So especially as we have
this pressure to go back to work, -
9:57 - 10:00like, contact tracing
has to be part of that strategy, -
10:00 - 10:04or we're just inviting another disaster
in a few weeks' time. -
10:04 - 10:08Whatever you make of what's happened
during this mitigation process. -
10:08 - 10:10JM: Exactly, exactly.
-
10:10 - 10:13Exactly, and so that's such
an important part, Chris, -
10:13 - 10:16and something that we are just really keen
-
10:16 - 10:20to look at the United States
in a different way. -
10:20 - 10:24What are the long-term
public health infrastructures -
10:24 - 10:29that we need to protect us
for the second wave, the third wave -
10:29 - 10:31and in the future, for future pandemics?
-
10:32 - 10:33CA: Whitney.
-
10:34 - 10:37Whitney Pennington Rodgers:
You know, to that point, -
10:37 - 10:39there is a question out there
from one of our anonymous -
10:39 - 10:40community members,
-
10:40 - 10:44about why contact tracing isn't already
part of our public health system. -
10:44 - 10:46It seems like it does make a lot of sense
-
10:46 - 10:49its a way to mitigate
the spread of disease. -
10:49 - 10:50Could you speak a little bit to that?
-
10:51 - 10:53JM: I think many people have said --
-
10:53 - 10:55and I am not a politician --
-
10:55 - 11:00that our American
health care infrastructure -
11:00 - 11:04is built on treatment and not prevention.
-
11:04 - 11:08It's built on procedures
-
11:08 - 11:10and not keeping people well.
-
11:10 - 11:13And some of that was driven by profit,
-
11:13 - 11:16and some of that was driven by need,
-
11:16 - 11:22but I think we need to rethink
how we deliver care in this environment. -
11:23 - 11:26WPR: "There is some fear and suspicion
about privacy and contact tracing. -
11:26 - 11:28How can we build trust in the process?"
-
11:29 - 11:31JM: Yeah, that's a great question,
-
11:31 - 11:34and I think there's fear about privacy
-
11:34 - 11:40and part of it comes from the idea
of what contact tracing is. -
11:40 - 11:44And I think that's why we feel strongly,
-
11:44 - 11:47is if you lead with the idea
that it's care -
11:47 - 11:51and it's trying to get
resources and information -
11:51 - 11:53and help to people,
-
11:53 - 11:55it seems very different
-
11:55 - 11:58than just, oh, who's sick,
and who's a threat. -
11:58 - 12:00And so fundamentally --
-
12:00 - 12:04and that's why we're so pleased
to be at this TED talk today -- -
12:04 - 12:06is it's about communication, right?
-
12:07 - 12:08It's not about surveillance,
-
12:08 - 12:11it's about communication
and care and support. -
12:11 - 12:13That's one thing.
-
12:13 - 12:16And we'll be hearing from our colleagues
-
12:16 - 12:17on the tech side.
-
12:17 - 12:21There's ways to add tech, even to care,
-
12:21 - 12:27that it can be a resource
for caring and communication. -
12:27 - 12:30But there are ways
to protect people's privacy -
12:30 - 12:32and also to provide care,
-
12:32 - 12:36and public health has many
laws attached to it. -
12:36 - 12:42This is all done within the constructs
of our state public health laws. -
12:42 - 12:45And so I think some
of the communication around this is, -
12:45 - 12:47how do we take care of each other,
-
12:48 - 12:50how do we take care
of the most vulnerable. -
12:50 - 12:53And if we frame contact tracing as care,
-
12:53 - 12:56I think that starts
a different kind of conversation. -
12:57 - 12:58CA: Mm.
-
12:59 - 13:01So, Joia, can you just talk
in a bit more detail -
13:01 - 13:06about what it is that you are advising
Massachusetts to do -
13:06 - 13:08in terms of contact tracing.
-
13:08 - 13:10Give us a sense of the scale of it.
-
13:10 - 13:13JM: Yeah, so the scale -- thank you.
-
13:13 - 13:19You know, we are able now
to make about 10,000 calls a day -
13:19 - 13:20to contacts.
-
13:21 - 13:23So every new case that comes in,
-
13:23 - 13:27the case is investigated
by someone on the phone, -
13:27 - 13:29and then those investigations
-
13:29 - 13:33means writing down the names
and the phone numbers of the persons -
13:33 - 13:36you've been in contact with
for the time you were sick -
13:36 - 13:38and a couple days before.
-
13:38 - 13:40And with those numbers then,
the contact tracers -- -
13:40 - 13:44And that's what we really redoubled
the workforce and really expanded, -
13:44 - 13:46more than doubled,
-
13:46 - 13:49to support the department of public health
-
13:49 - 13:51to do that contact tracing.
-
13:51 - 13:57So we have 1,700 people employed
full time, with benefits, -
13:57 - 14:01to call those contacts
and say, "Are you OK? -
14:01 - 14:03This is the information you need,"
-
14:03 - 14:07and then, and I think
this is the critical piece, -
14:07 - 14:10when someone doesn't have the information,
-
14:10 - 14:15then we have another cadre of people
we call the resource care coordinators, -
14:15 - 14:18who help that person, that contact,
-
14:18 - 14:21to do the things they need to do
to protect themselves. -
14:21 - 14:22It might be food delivery,
-
14:23 - 14:25it might be filing
for unemployment benefits, -
14:25 - 14:31it might be trying to get them
medical care or a test. -
14:31 - 14:34That piece is the care piece.
-
14:34 - 14:39And that is what turns social distancing
from very regressive -- -
14:39 - 14:42look at me in my beautiful house,
social distancing -- -
14:42 - 14:44to something that's progressive
-
14:44 - 14:47and paying attention
to those who need the resources. -
14:47 - 14:49So the scale is massive,
-
14:49 - 14:52with 1,700 employees hired to do this,
-
14:52 - 14:53but they are connected
-
14:53 - 14:57with local community food banks
and churches and facilities -
14:57 - 15:01and primary health care centers as well.
-
15:03 - 15:04CA: Thank you so much, Joia.
- Title:
- How to quickly scale up contact tracing across the US
- Speaker:
- Joia Mukherjee, Chris Anderson, Whitney Pennington Rodgers
- Description:
-
Contact tracing -- the process of identifying people who may have been exposed to the coronavirus in order to slow its spread -- is a fundamental tool in the fight against COVID-19. How can we scale this critical work across the entire United States? Joia Mukherjee, chief medical officer of Partners in Health, discusses how her team is working with public health agencies to ramp up contact tracing for the country's most vulnerable communities -- and shows why it will take a compassionate approach to be truly effective. (This ambitious plan is part of The Audacious Project, TED's initiative to inspire and fund global change. The conversation, hosted by head of TED Chris Anderson and current affairs curator Whitney Pennington Rodgers, was recorded May 27, 2020.)
- Video Language:
- English
- Team:
closed TED
- Project:
- TEDTalks
- Duration:
- 15:17
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