Happy New Year.
Below are some thoughts on Contact Tracing covering surge workforces, brown sugar recalls, and how contract tracing works in sexual health clinics.
As always - I am not an expert on any of this - but always keen to learn, so please feel free to comment 
The Surge
During the 2020 lockdown I was part of a team that established the Contact Tracing Reserves. I was one of many health workers who were locked out of their clinics or their community practice. We were stuck working from home, perhaps doing telehealth part-time if we were lucky. This seemed an ideal workforce to be used for contact tracing.
The problem of course was that we were not trained and had no relationship with the Public Health Units, DHB’s or MOH.
We tried to build those relationships and did access some basic online training. We were frustrated that we were unable to help in the first wave - many of us were drawing a benefit for the first time in our lives - and it seemed odd that there were not more opportunities to contribute to the pandemic response. Many of us signed up to the official Surge Workforce as well, but most of us were not called on, and we did not know who else was in that database. There was no opportunity to build community.
After the dust settled we pitched the concept to various people within MOH and the DHB. We asked to be considered like a rural volunteer fire-force or Surf Livesaving - people who would come together regularly to train to use the tools, and build a social community around a common purpose - as volunteers.
We figured there could be interaction with the professional contact tracers periodically (ie. training programs would be developed centrally (MOH) but delivered locally (PHU) with the professionals and the volunteers working and interacting together. The professionals would get to know who were the most serious and committed volunteers. Our thinking was that we would develop a pipeline of people in each province, with those most engaged volunteers ready to step into the public health unit on a contract basis during an outbreak, at the same time as others in the wider group would be pulled through the training program in real time (master and apprentice style) and deployed progressively as the outbreak escalated.
From a technology point of view, we pulled together a number of tools to manage the Contact Tracing Reserves, including Jitsi and Discourse. This is where I met @NathanK who was super helpful and knowledgeable about online community building.
Despite our efforts, we were unable to get any real traction with the concept, and life returned to relative normal, despite some smaller outbreaks.
When the August 2020 Delta outbreak happened, we were disappointed in ourselves that we had not pushed harder with the idea. It was pretty frustrating watching the contact tracing teams be overrun.
The plan was to shuffle internal DHB staff - but training had been adhoc, it took a week to get started, and urgent recruitment of contact tracers only happened once the Auckland outbreak was in full swing. It takes time to train how to be a contact tracer. The rural fire force does not wait for the school to start burning before training people how to use the firetruck.
We rebuilt the website, got together again and this time got a little bit more interest. Towards the end of the August wave I personally had some time training with my local PHU, and 15 of us joined one of the private companies who were doing remote contact tracing/close-contact calling. This was all really interesting, we did some actual training using the NCTS (Salesforce) - but the concept did not gain traction as the company could not resource someone to continue the training program. No one was actually deployed to the frontlines.
We still think the concept is valid. We understand there has been a shift to investing more heavily in private companies to be Case Investigators - but does it make sense to have huge numbers of people paid to be on standby in between outbreaks - can you ever afford to have enough people ready? Is it ideal to have remote tracing teams when the concept of trust is so important? Do we have the ability to localize the response?
What if you could build a huge community of volunteers that were trained and ready to deploy?
Perhaps those that were actually deployed to the front lines could be paid on a contract basis, reducing the need for wage subsidies for those people (remember their normal work fizzles in an outbreak).
People could move from a less urgent allied health roles (e.g. musculoskeletal physiotherapy) into a more urgent pandemic role (e.g. contact tracing) for a period of time - surging to meet the demand, and only costing the government when actually deployed. Once an outbreak stops - they go back to their normal business.
There will be still be holes in this strategy of course.
In saying all of this - our thinking on contact tracing has evolved. Omicron is much more infectious and the model above could still fall over pretty quickly.
And we learned that we might need to be careful to organize contact tracing as a separate function. Of course it is very dependent on a positive test result, and in turn getting positive test results are dependent on people coming forward for testing. Trust is always important in a contact tracing system. Could contact tracing be more integrated into the front-end community response?
Please note - we still not updated the website - we have never actively recruited as we have not had a proper “next step”, ie. training program to offer people who apply. It will change soon to reflect our latest thoughts.
Brown Sugar
If any of you are keen bakers you will recall the terrible sugar shortage last year. Huge batches of sugar were contaminated with lead affecting many products, and this triggered a large recall. MPI was involved, media releases were made…
Most of us heard about it in these sorts of channels. It washed over us in our household for some reason. Must have been too busy baking afghans.
Until we got a call from my mother-in-law. She had got a text message from Countdown advising her she had brought an affected bag of sugar. How did they know this?
And I thought they were just using those cards to sell us more stuff, or perhaps to help our insurance company decline cover one day. No! - they were looking after our health and safety the whole time
My mother in law suggested we look it up which we did. Turns out social media was also doing its thing and providing information to the community…
And what do you know - we did have a bag of that sugar!
Unfortunately it was almost empty - eaten by my oldest son - he puts it on his breakfast. He is a tall, skinny athletic young man so we have not been keeping an eye on how much sugar he has been eating. Turns out it is quite a lot! So he probably consumed some lead - but he does not appear to be anymore sleepy than normal - so hopefully he will be ok!
But - on display here was the utility of mainstream media, identity databases, social media - and of course personal relationships (my mother-in-law!) when it comes to contact tracing. These things all played a part in us identifying an exposure to a health problem.
Sexual health
Luckily, contact tracing for sexually transmitted diseases appears to be a much more private process. Someone develops symptoms, they go to their GP or a sexual health clinic for a test, and once they know what they are dealing with, they get treated and have a conversation about informing the persons sexual partners.
If the affected person is confidant, they will go about notifying their previous partners themselves. Tricky conversations - but with the main objective to get partners to have a test and to break the chains of transmission. If there is a reason they don’t want to notify someone in particular - an abusive person for example - the nurse/doctor could do this for them anonymously.
Contact tracing has been a public health tool for a long time - originally used to control Syphilis. Contract tracing is based around trust - there have been many missteps over the years in the use of contact tracing - the history is interesting - read here.
Where does technology fit in? Well that is a moving beast at the moment and I am sure MOH people on this forum are busy working on the new strategy now. I understand there is a move towards email and text notifications, and also discussions are had about people doing their own contact tracing. This would certainly be a way to scale up contact tracing - using infected individuals themselves to do the work. But - what if people do not want to notify contacts? And what if there is a shortage of professional contact tracers?
At the Wellington Sexual Health Service on Cuba St, the team uses a product called SXT. This has been profiled on the HINZ website here.
This looks like a useful tool whereby in the office, the sexual health practitioner and patient can type email addresses and phone numbers into a web portal - the tool notifies the partner that they are at risk, then helps them find the nearest testing clinic with a link.
Or - the person can be encouraged to use the tool themselves at home as they identify further contacts that need to be notified.
Interesting concept and well worth exploring to see what the parallels might be in controlling a Covid-19 outbreak at scale.
But perhaps we should not forget - that digital technology will always have its limits. Not everyone has a phone, credit, or the internet. How does contact tracing work for those people? This may well still have to be a (socially distanced) face-face effort.
How far forward can we bring the process - e.g. if someone seeks support for food while they are unwell at home, could “contact tracing” be deployed at the point of dropping off food supplies? In the new contact tracing model we understand that people will be encouraged to do their own contact tracing which makes sense.
Sorry - that was a long post. Have a good day. Ben.