Contact Tracing Aided by Automated Monitoring

August 6, 2020
Frank Diamond

Maine health officials relied on an automated system to provide contact tracing for COVID-19 to a relatively sparse and spread out population. It worked.

Contact tracing helps contain the spread of coronavirus disease 2019 (COVID-19) and infection preventionists consider it one of the major tools in their arsenal against SARS-CoV-2 and other pathogens in containment efforts both inside and—increasingly—outside of the hospital setting.

In the cover story to be published in the September print issue of Infection Control Today®, Saskia v. Popescu, PhD, MPH, MA, CIC, writes: “In hospitals, it is common to have infection preventionists manage contact tracing and COVID-19 has been no exception.”

Other points Popescu makes is that IPs might start to help public health officials with contact tracing in the community and that the challenges inherent in contract tracing may present an opportunity “for technology to perhaps innovate a new approach to tracking interactions and movements within healthcare.”

One entrant into the race for new contact tracing has arrived, according to a recent study in Morbidity and Mortality Weekly Report (MMWR), a publication of the US Centers for Disease Control and Prevention. CDC investigators found that an automated COVID monitoring system helped identify those with the virus. In addition—and perhaps more importantly—most Maine residents contacted seemed to buy into the idea.

“Automated symptom monitoring promptly identified COVID-19 diagnoses among monitored contacts,” the MMWR study states. In this case, necessity was the mother of invention or, at least, innovation. Maine health officials did not have the resources to conduct contract tracing in the traditional manner, and Maine’s relatively sparse, and spread out population also presented obstacles.

The technological answer to these problems is called Sara Alert, an automated, web-based symptom monitoring tool. Maine began enrolling contact patients in Sara Alert on May 14.

“Maine found that using automated symptom monitoring as a part of the state’s contact tracing program was well received, with the majority of monitored contacts (96.4%) agreeing to automated symptom monitoring,” the study states.

The contact tracing team telephoned contacts to provide quarantine recommendations, enroll them in Sara Alert, and instruct them to report symptoms daily via the Sara Alert questionnaire for the remainder of their quarantine.

Maine health officials looked out for symptoms that included “cough, difficulty breathing, fever, chills, shaking with chills (rigors), muscle pain, headache, sore throat, and new loss of taste or smell.”

From May 14 until June 26, state health officials enrolled the 1622 people who had had contact with 614 people who had COVID-19. Eventually, 190 people (11.7%) of those who’d had contact with a COVID-19 patient came down with the disease themselves.

Sara Alert automatically sent out daily symptom questionnaires via the contacts’ choice of e-mailed weblink, text message, texted weblink, or telephone call until completion of their quarantine, which was recommended based on symptoms and also the level and duration of contact with someone known have had COVID-19. Enrollees who reported symptoms or tested positive for SARS-CoV-2 were epidemiologically tested.

Of course, enrollment was not 100%, and Maine health officials needed to expend a lot of effort to help those who wouldn’t or couldn’t use Sara Alert.

“The contact tracing team attempted to directly monitor contacts who refused or were unable to be enrolled,” the study states. Health officials tried to call or text enrollees who did not respond to the questionnaire within 24 hours. All of which made the automated monitoring system that much more appreciated, according to investigators.

“Because contact tracing can be resource intensive, using an automated symptom monitoring tool can reduce needed resources,” the study states. “…These findings suggest that using a symptom monitoring tool with options to accommodate enrollees’ preferences for monitoring method, time of day, and language, might be important for increasing enrollment and improving contact monitoring.”