Politics, fear keep some COVID-positive people from disclosing contacts. What’s the solution?

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With all but one county in Pennsylvania now in the green phase of reopening, public health experts agree that contact tracing is a crucial element to keeping people safe.

Locating infected individuals, identifying their close contacts, and asking those contacts to quarantine limits the spread of the disease without imposing sweeping stay-at-home orders.

But success relies on voluntary cooperation from the public, which has been hard to come by in some parts of the state. That diminishes the effectiveness of what is widely considered a sound public health practice.

For example, in Lancaster County, only 58% of the 670 people identified as contacts have answered or returned calls, according to Penn Medicine Lancaster General Health, which is leading the work. In eastern Pennsylvania, the Lehigh Valley Health Network said it has contacted thousands of individuals who tested positive, but many declined to share the names of their contacts, allowing only 42% of contacts to be traced.

And so far in June, 60 infected individuals have declined to provide their list of contacts to the Chester County Health Department.

“Certainly we’re not going to be able to contain the spread of the disease if we can’t do the contact tracing,” said Chrysan Cronin, director and assistant professor of public health at Muhlenberg College. “It will just run rampant through the population and we’ll have to depend on herd immunity or a vaccine — both of which are uncertain.”

Traditionally, contact tracers see much better response rates, Cronin said. But as politics and public health continue to clash at federal and local levels, more people are skeptical of government intervention and the true severity of COVID-19.

Some don’t want to share who they’ve been in contact with for fear of being blamed for spreading the virus or because it feels like an invasion of privacy, those on the front lines of tracing said. Others are concerned that they’ll be stigmatized even if they’re wrongly identified as a contact, said Rep. Russ Diamond (R., Lebanon), who was identified as a contact of another legislator who tested positive for COVID-19 in May.

But information on who is a contact is confidential. It is not published in any public realm and tracers are trained in federal laws that protect medical information, Cronin said.

Rep. Aaron Bernstine (R., Lawrence) said he’s concerned about technology that tracks people’s movements in order to compile a list of their contacts. Such apps have been introduced by Apple and Google, but Pennsylvania’s health department said it’s not currently using that type of technology.

Another common concern is that people have to work and can’t follow the recommended 14-day quarantine, Cronin said. While Pennsylvania does not have guaranteed paid sick leave, tracers in many cases can provide a letter to an employer explaining why an individual needs to quarantine, or can assist with social services like food and housing assistance.

Some counties are working with local nonprofits to provide these types of support.

Berks County contracted with Co-County Wellness Services, a nonprofit providing sexually transmitted infection services, to begin contact tracing in June. Tracers can connect individuals to mental health services, food banks, pharmacy deliveries, and more, said director Carolyn Bazik. So far, only two individuals called by tracers have refused to participate.

“We’ve been around for 35 years and we’ve safe-guarded HIV and STD information all that time,” Bazik said, “so that reputation makes people more likely to trust the process perhaps.”

Several other areas of the state have reported success in contact tracing, too. Erie County Health Department has traced 97% of contacts, and only had 12 infected individuals ignore calls or refuse to provide contact information. Allegheny County Health Department has reached 88% of contacts in the month of June, and the Penn State College of Medicine, which has been tracing patients in the Penn State health system, has reached 80% of contacts since March.

The key is building community trust, said Noble Maseru, a professor at the University of Pittsburgh Graduate School of Public Health and a former city health director in Cincinnati and Detroit. If the people doing this work are known and respected in the community, residents will be more likely to trust that their information is being used for a good purpose.

“You really want to convey that you are treating everyone fairly and no one is being singled out,” Maseru said.

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