Letter of the Day | Contact tracing is critical to tackle COVID-19

THE EDITOR, Madam:

I am borrowing the title Little Fires Everywhere from author Celeste Ng to illustrate my thinking about the approach to COVID testing and compliance with measures to reduce the spread. Health Minister Christopher Tufton has been quoted as saying, ‘The fact is that, beyond a certain point you really are testing with the same results, because that’s the way the statistical modelling works … I do agree that there is a level at which you should not go below, but there are optimal levels, and there are levels at which diminishing return sets in, unless your objective is to test to determine infection as opposed to prevention of the infection.”

It is true to say that at some stage you get diminishing returns when it comes to statistical analysis of data. What difference does it make if it is 1,000 vs 10,000? The Ministry of Health and Wellness (MOHW) would have us believe that the objective is to know the incidence, prevalence, and rate of spread and the positivity rate. These are important in making policy decisions about allocating resources but are not the be all and end all of the exercise of testing. The WHO, in its February 2021 Interim Guidance on Contact Tracing, states ‘Contact tracing remains an important activity in high-incidence scenarios, where capacity to trace and follow-up all contacts may be at the breaking point. Contact tracing activities should be targeted rather than abandoned. It is possible to prioritise tracing of higher-risk exposure contacts based on capacity.’

Little fires everywhere. This is what we need to create. Fires of COVID everywhere, if they do indeed exist, need to be individually identified, rapidly, as an effective tool to lessen the spread and promote what the MOHW is asking for – personal responsibility.

The closer one gets to the fire is the hotter one feels, and right now one problem is that not enough people are feeling the heat from the fire. Frontline workers and the MOHW are well aware of the heat. They are standing right next to the fire. They see COVID cases day in, and out, up close. They do not need convincing that it is real. Anyone who has a loved one or friend, or neighbour, or co-worker diagnosed, knows the heat as well. It suddenly becomes very real to them. They usually take steps to limit exposure or spread at that point. Simply because they know of a case.

If you do more testing and trace more contacts you will, still at this stage, achieve your stated goal of personal responsibility. If indeed COVID is widespread, we need it to have a face, a name, an address. The more this happens is more real it becomes to more people. It becomes personal.

Vaccines, yes, they are particularly important. Yet, we are faced with an uncertain supply and a very long timeline for achieving herd immunity. So, as we vaccinate, in the early to mid stages, we are really protecting a select few and not yet the many.

We must create little fires everywhere, so more people can feel the heat sooner. Testing and tracing should continue in earnest. Expand the capacity rapidly and actively offer new testing methods. So many of these are being approved worldwide and are easier to carry out reasonably accurately. Now is too soon to pull back on this.

DR MIKE MILLS

President

Association of Consultant Physicians of Jamaica