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Medical News & Perspectives
May 21, 2020

Building an “Army of Disease Detectives” to Trace COVID-19 Contacts

JAMA. 2020;323(23):2357-2360. doi:10.1001/jama.2020.8880

As state and local governments deliberate how and when to get back to business, much discussion has centered around contact tracing to rein in coronavirus disease 2019 (COVID-19).

Health departments have used contact tracing—the practice of identifying and monitoring people who’ve had close contact with infected individuals—to control communicable diseases such as tuberculosis, syphilis, and HIV infection. But, in terms of the sheer number of cases and the ease with which it spreads, COVID-19 presents special challenges.

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    2 Comments for this article
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    Trust and Reliability
    Bill King, BSME, BSEE | None
    My apologies to all for my dissent on this, but the whole concept of using this technology is severely flawed. Are we supposed to simply 'trust' all these newly hired 'detectives" Who vets them? Anytime you do mass hiring, as is clearly happening now, qualifications and background checks become irrelevant and time- consuming. Even with that, giving humans access to others' information is beyond foolhardy. There is absolutely no way you can even remotely guarantee proper use, zero errors, misreporting, or data theft. Not only is the technology flawed, but the approach itself is. First of all, the disease is showing that it actually has a much lower mortality rate (CDC now publishes it at 1% - and dropping as testing increases). Do the research, make a vaccine, give it to those who want it, and stop trading civil liberties to prevent obscure health risks that have clearly been blown out of proportion. Protect those who are most vulnerable, and let the rest of the nation alone.
    CONFLICT OF INTEREST: None Reported
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    Weekly PCR Screening
    Dag Olav Dahle, MD, PhD | Oslo University Hospital, Rikshospitalet
    Weekly screening by PCR of pharyngeal/nasoparyngeal swabs has been suggested for all health-care workers, to prevent nosocomial spread (1), and it seems Britain will pursue this strategy (2). Others have suggested a similar strategy for larger populations to stop the outbreak altogether (3). To overcome testing limitations, one may consider pooling of samples (4), i.e. several samples are pooled, and if this pooled sample is positive, the group is quarantined and/or re-tested individually. To overcome time constraints and usage of PPE (for the personnel undertaking the swab-tests), one may consider self-testing. Hopefully saliva samples will soon be validated, enabling self-testing also for non-health-care workers.

    REFERENCES

    1) Black et al. COVID-19: the case for health-care worker screening to prevent hospital transmission. The Lancet, e-pub April 16th. https://doi.org/10.1016/S0140-6736(20)30917-X
    2) Seven days in medicine: 6-12 May 2020. BMJ 2020;369:m1885 14 May 2020 https://www.bmj.com/content/369/bmj.m1885
    3) Peto et al. Universal weekly testing as the UK COVID-19 lockdown exit strategy. Lancet 20. April. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30936-3/fulltext
    4) Lohse et al. Pooling of samples for testing for SARS-CoV-2 in asymptomatic people. Lancet Infectious Diseases, e-pub April 28th. https://doi.org/10.1016/S1473-3099(20)30362-5
    CONFLICT OF INTEREST: None Reported
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