Contact Tracing, The Most Effective Tool to Stop Outbreaks

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By Alex Fox, MD

I have always had a fascination with the Ebola virus, ever since I read Richard Preston’s The Hot Zone at a very impressionable age (which was 10 if anyone is counting, and yes, my parents had read it and deemed it appropriate). Since that time I have watched with fascination and a bit of a sense of dread every time an Ebola outbreak has occurred. For people who were not avid Ebola watchers like myself, the 2014/15 outbreak in West Africa represented a frightening moment, where much of the general public was introduced to this disease.

 

The outbreak actually started in December 2013 in Guinea before spreading to Sierra Leone and Liberia. These incredibly poor countries did not have the health infrastructure, trust in government organizations, or a population with the health literacy necessary to help combat the spread of a disease like Ebola. It quickly spread to officially infect over 26000 people and cause more than 11000 deaths (although actual numbers are probably significantly higher, during the height of infection it became very hard to keep track, and people in rural areas resisted assistance from outside health workers). During the peak growth in infection rates in August 2014, the WHO released a report that essentially said “hey world, this outbreak has reached a phase of exponential growth, so we could really use some help here”. The rest of the world gave a bit of a sluggish shrug at that time, but began to give significant aid in September 2014, when the WHO released new estimates of infection rates and predicted that eventually Ebola could become endemic in West Africa unless significant interventions were made (this also happened to be around the time when the first infected individuals were identified in the United States and Spain, draw your own conclusions as to what sparked a more robust international response). Eventually the international community was able to pour in money, personnel, and supplies to prop up the wobbly health infrastructures in these countries, and eventually stem the growth of the outbreak.

 

During the height of the outbreak, newspaper front pages and the TV news networks were all focusing on Ebola, discussing its risks, high mortality, and the fact that it had appeared in the United States. This naturally lead to questions coming up daily in clinic. I was asked how to prevent its spread, if there would be a vaccine, who would get a vaccine, what would happen if someone in Utah got the virus, and many other questions. It was interesting to see the public respond so actively to all of the news coverage the outbreak was getting. Most of my answers were directed towards reassurance, encouraging people to get routine vaccines, and encouragement of further education about disease transmission prevention.

 

As I write this on December 29th, 2015, Guinea has officially declared that the original traceable line of disease going back to their first cases has been eradicated. This marks the first time that all three countries involved in the major 2014 / 2015 Ebola outbreak have all had their original outbreaks stopped at the same time. In the end the most effective tool to stop this outbreak was not some high tech device or new medical development, but instead one of the oldest and most low tech interventions in public health, a process called contact tracing. Basically this process means that once an individual has contracted the disease, a public health official goes back and tries to find and isolate all of the people the infected individual may have had contact with while they were contagious. This is tedious work, requiring an incredible amount of time on the ground, meticulous history taking, and the ability to convince people to go into quarantine for a disease when they likely show no symptoms. While this is not as glamorous as a new drug or vaccine, the fact is that the individuals that aided in this massive undertaking saved countless lives and possibly averted transition from this being a simple outbreak to an endemic disease in that region.
The announcement that this Ebola outbreak is finally contained has not been met with the same front page headlines and constant TV coverage that greeted the growth of the disease and in particular the news that Ebola had spread to the United States. I often wonder what the patients who asked me about the disease think of all this. Sometimes I worry that they simply forgot, or moved on to the next topic not realizing that for a few weeks in fall 2014 there existed the real possibility of continued exponential growth of this outbreak. Perhaps more worrisome than that, I also worry that maybe those individuals became calloused to this kind of disaster, so that next time a major outbreak happens they will think “oh yeah right, this is just like that Ebola thing a few years ago, that never turned into anything”. While this particular problem ended more with a whimper than a bang, I hope that people don’t forget both the danger of a pandemic spread of rare disease due to muted response from wealthy countries, or the heroic and tedious efforts that went into curbing the spread of this particular outbreak.

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Alex Fox, MD is a 3rd Year Family Medicine Resident at the University of Utah serving in the role as Chief Resident.

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