Natalie E. Dean, PhD+ Your Authors @nataliexdean Assistant Professor of Biostatistics at @UF specializing in emerging infectious diseases and vaccine study design. @HarvardBiostats PhD. Tweets my own. Jun. 14, 2020 1 min read + Your Authors

Partners in Health @PIH is used to working in the poorest regions of the poorest countries. Now they are leading Massachusetts' contact tracing. Their experiences remind us of the importance of "support" in test, trace, isolate, support. (A thread 1/8) 

Twenty-two thousand people have applied to work with PIH, some "comically overqualified" for the job. Hires are divided into three job categories.

Category 1: Case investigators quickly call people who have tested positive and interview them extensively about their contacts. 2/8

Category 2: Contact tracers call each of these contacts, ask them to isolate, and then follow up frequently to make sure they were doing so and to check for any symptoms. The essential part of their job is to persuade the contacts to isolate at home. "Voluminous coaxing." 3/8

Category 3: Care-resource coordinators help people solve problems that might prevent them from being able to isolate themselves - how to get food or find a place to stay. "Without helping people to isolate, you would never persuade them to do so." 4/8

A tracer needs "a long list of agencies supplying various services, and volunteers willing to run errands for people who can’t. Much of his day is spent finding someone to pick up a particular bag of groceries from a particular food pantry, or a nebulizer from a pharmacy." 5/8

Importantly, the work is difficult because of the missing social safety net. People have "tested positive because their jobs required them to be caregivers... Now we’re requiring them, in terms of solidarity, to flatten the curve, to stay home. But they... can’t get food." 6/8

My editorial comment - I think the most valuable solutions are not going to come from scientists, but rather from people experienced in implementation and the "public health slog." We have a set of tools that we know can help. How do we make them work more effectively? 7/8

"Having once brought Boston-style medicine to Haiti, now PIH was trying to bring some elements of Haiti-style medicine to Boston. 'Reverse innovation.'"
It's a call for us to spend more time listening to the collective wisdom of people who've done this before. 8/8

You can follow @nataliexdean.


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