We Must Hire More Contact Tracers to Stop COVID, Global Health Doctor Says

AMY GOODMAN: This is Democracy Now!, democracynow.org, The Quarantine Report. I’m Amy Goodman, with Nermeen Shaikh. COVID-19 has infected more than 2.6 million people around the world, killed at least 183,000 people worldwide. These figures don’t anywhere reflect actually the proper numbers, because of the lack of testing and lots of inaccuracy. The head of the World Health Organization warned Wednesday that most of the world’s population still remains susceptible to the coronavirus, and it could continue to spread for a very long time.

TEDROS ADHANOM GHEBREYESUS: Most of the epidemics in Western Europe appear to be stable or declining. Although numbers are low, we see worrying upward trends in Africa, Central and South America and Eastern Europe. Most countries are still in the early stages of their epidemics. And some that were affected early in the pandemic are now starting to see a resurgence in cases. Make no mistake: We have a long way to go. This virus will be with us for a long time.

AMY GOODMAN: The World Health Organization recommends social distancing to control the spread of the virus. But these measures are nearly impossible for the poor in many countries, where families share single-room dwellings and lack running water to wash their hands. Many have limited or no access to life-saving medical facilities.

This comes as new efforts are underway not just to slow down but to stop the deadly spread of COVID-19 with contact tracing — finding who infected patients have been in contact with, so they can get tested and isolated and treatment. Well, here in the United States, in Massachusetts, they’re investing $44 million to hire and train a thousand people to call contacts and inform them they’ve possibly been exposed. Participating in testing and isolation is voluntary.

For more, we’re joined by someone who’s playing a key role in this effort: Dr. Joia Mukherjee, chief medical officer at Partners in Health, a Boston-based nonprofit known for its work in fighting infectious disease around the world. They have also run contact tracing projects, including for Ebola in West Africa. Dr. Mukherjee is joining us from Brookline, Massachusetts. She has just recently returned from Sierra Leone and Liberia.

Welcome to Democracy Now! It’s great to have you with us, Dr. Mukherjee. Partners in Health is well known around the world, in Haiti, in Africa, for the kind of work you do. We want to talk about the contact tracing project you have going in Massachusetts. But first, talk about what we’re facing right now in Africa, what people there are expecting and are going through right now.

DR. JOIA MUKHERJEE: Yes. So, thank you very much for having me on today, Amy. And thank you so much for highlighting the need to pay attention to this epidemic in some of the world’s most impoverished countries.

In Africa, in Asia, in Latin America, this kind of social distancing that we have now in the United States, which is also gearing toward a lockdown, really is intolerable for very poor people. You have to have the material means to quarantine or isolate. It’s a privilege to be able to have a home, enough food, a fridge to stock. And so, we’re exceptionally worried about the impact just the measures alone will have on the poor here at home in the U.S., as well as around the world.

But there are many countries, particularly on the African continent, that are doing a lot more on the preventive side than we did in the United States. And I just recently got off the phone with colleagues in Rwanda. And in that country, they have been so serious about contact tracing, quarantine, isolation, government support of people in quarantine and isolation with food and housing, that from the first case to one month later, they only had 134 cases. And that’s with lots of testing, so that’s not an underestimate. That’s with thousands and thousands of tests.

So, focusing on that early on is really the hope for impoverished countries. This is happening in Liberia, in Sierra Leone. And you mentioned I had just gotten back from those countries, where, in February, I was screened with temperature, my phone number, where I was going. In February, mid-February, I returned to JFK, and absolutely nothing. So, these countries are at least aware and experienced in cataclysm, and they are really investing in those upfront strategies, which we did not in the United States.

NERMEEN SHAIKH: And, Dr. Joia Mukherjee, you mentioned, of course, that these measures themselves can be and have been extremely dangerous for very large numbers of people in the world. And just to be clear, I mean, the International Labour Organization has said that 2 billion people around the world are dependent on daily wages, and if they’re not able to go to work, often that means that they won’t be able to eat. So, of course, it is imperative that other means of addressing this lethal pandemic are addressed.

I want to ask you about a specific proposal that was put forward by an Indian epidemiologist, who said, of course, that no country, no poor country, can afford this prolonged period of lockdown. He says you may be able to reach a point of herd immunity without infection really catching up with the elderly, who are the most vulnerable, and when herd immunity reaches a sufficient number, the outbreak will stop. Could you respond to that, Dr. Mukherjee?

DR. JOIA MUKHERJEE: Yeah. I think the talk of herd immunity is extremely dangerous and nihilistic. I think we can do better as humanity. We do not know, first of all, whether immunity is lasting in COVID, one. Two, we don’t know what proportion of the population would have to be immune to have what we call herd immunity. It may be as high as 60%. To have 60% of the population infected would — and we know that about 4%, 2 to 4%, of people die. So that’s a death toll in the hundreds and hundreds of millions. I think that is an unacceptable moral choice for us to make.

I think, rather, we should employ people to be contact tracers, to deliver the food to the sick. We should be ramping up PPE to protect people to do their work. If we harness the trillions of dollars that are needed right now to prop up the stock market and the global economy toward creating jobs that would actually end the epidemic and could be synergized with the needs of the vulnerable to end the epidemic, that is a far better moral choice, and it’s probably a faster choice to end the epidemic, certainly, and a much more moral choice than herd immunity. I think herd immunity is dangerous.

AMY GOODMAN: Of course, Boris Johnson followed that route at the beginning, before he got sick, his partner got sick. Now Britain is way behind when it comes to testing and having the proper gear available for doctors and nurses. But I wanted to ask you about Massachusetts, Dr. Mukherjee —

DR. JOIA MUKHERJEE: Yes.

AMY GOODMAN: — and what you’re doing there. We only have a few minutes. Explain what contact tracing is and how you’re planning to carry it out.

DR. JOIA MUKHERJEE: So, we have already hired and trained and paid 750 contact tracers to add to the function that the Department of Public Health is doing. All department of public health do contact tracing. It’s a staple. But they are unmatched by the speed and scale of this epidemic. And we have gutted our public health programs over 40 years in the United States and around the world as part of the neoliberal project. So we are trying to amplify and augment what departments of public health do — contact the people who are infected, go through the list of people they’ve been in close contact with, inform those people. And then it needs to be paired with support, social and material support, to isolate and quarantine. We’re working —

AMY GOODMAN: But how does this work specifically? I mean, you’re saying something like 300,000 people would be needed in the United States to do this.

DR. JOIA MUKHERJEE: Yes, yes.

AMY GOODMAN: And you actually go to a patient, and you say, “Who have you been with over the last” — what?

DR. JOIA MUKHERJEE: Yes.

AMY GOODMAN: And —

DR. JOIA MUKHERJEE: Yeah. So, since the time you were symptomatic and a couple of days before. And what we know is that with social distancing, this is a bit easier. Our average person in Massachusetts so far, in the two weeks we’ve been doing this, only has a couple of contacts, because people are adhering to social distancing. So, what you can do then is contact those people and then try to keep them safe.

So, for example, in my situation, my family, I live with my mom, who’s older, and so we would want to — if I had been in contact with someone, so I was out to do grocery shopping — if I had been in contact with someone, I would need to quarantine, which is different than social distancing. It means not sharing a bathroom. It means washing down all the counters, etc. And so, if I could not do that, then I would need a safe place to quarantine.

And here in Massachusetts, we’re looking at dormitories, hotel rooms. And many people want to do this. I mean, many health workers are begging for these kind of safe quarantine places, where you would then stay for 14 days as a contact, monitored regularly, fed — right? — have access to a cellphone so you can contact your family. And this is, again, all voluntary. But this is part of how we do epidemic control. This is how we fought Ebola. Fourteen days of tracing and monitoring, and then you can be released. But that way, you don’t infect your closest contacts, because most of this infection is spread through very close contacts — family members, etc.

AMY GOODMAN: Well, we want to thank you so much, Dr. Joia Mukherjee, for being with us, infectious disease specialist, associate professor of global health at Harvard Medical School, chief medical officer for Partners in Health.

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Democracy Now! is working with as few people on site as possible. The majority of our amazing team is working from home. Democracy Now! is produced with Renée Feltz, Mike Burke, Deena Guzder, Libby Rainey, Carla Wills, Tami Woronoff, Charina Nadura, Sam Alcoff, Tey-Marie Astudillo, John Hamilton, Robby Karran, Hany Massoud, Adriano Contreras and María Taracena. Our general manager is Julie Crosby. Special thanks to Becca Staley, Miriam Barnard, Denis Moynihan, Paul Powell, Mike DiFilippo, Miguel Nogueira, Hugh Gran, David Prude and Dennis McCormick. I’m Amy Goodman, with Nermeen Shaikh. Again, our website is democracynow.org, where you can see our podcast, listen to our audio podcast and read all the transcripts of all our shows. Thanks so much, and be safe.