San Francisco Department of Public Health officials are training a workforce — which they hope will eventually number in the thousands — to reach out to people who have been in close contact with COVID-19 patients and may be at risk for contracting or unwittingly spreading the virus.
“Contact tracing has always been a fundamental public health tool,” Dr. Grant Colfax, director of SFDPH, said Wednesday. “This capacity will enable us to move forward as a city now, and after the shelter-in-place order is lifted.”
Colfax said SFDPH is using software developed by Massachusetts-based tech company Dimagi, in collaboration with the Centers for Disease Control and Prevention, to assist with contact tracing.
The term “contact tracing” has taken on multiple meanings over the last month, as some technologists have advocated using GPS tracking on mobile phones to help slow the spread of the virus — despite warnings from privacy experts of the inherent dangers in such a system.
But the web-based software from Dimagi has nothing to do with Big Brother geotracking. Instead, think of it more as a case management system, or a trouble ticket system, to keep track of a list of people for health workers to follow up with.
“This is not the flashy new Bluetooth or GPS (technology) that people are talking about,” said Jonathan Jackson, CEO of Dimagi. “This is a traditional, supporting-public-health, contact tracing system.”
Contacts tracked in the system are all people who have been self-reported by a COVID-positive patient as someone they have been in recent, close proximity to, Jackson said.
The software itself is open source and freely available, however it needs to be customized for each client. Jackson said the customized version SFDPH is running was originally developed for Santa Clara County, and was later further adapted for use in San Francisco.
“When we built it with the original county next door, they were going to use DPH employees only, where San Francisco is taking the strategy of employing a lot of other people helping with contact tracing,” Jackson said. “So, we had to add features with how you share cases with a team of contact tracers, and how you develop that workflow.”
For example, he said, a COVID-positive patient may give the names of 20 people they had been in contact with. Those 20 people are now added to a queue of people who need to be contacted.
“Specially trained outreach workers will then follow up remotely by phone or text with any individuals who may have been in contact with the COVID-positive patient,” Colfax said. “These conversations will be voluntary, confidential, and culturally and linguistically appropriate.”
Colfax said case contacts would receive daily text messages or phone calls checking in on their health and symptoms over the 14-day monitoring period. Those contacts would also be able to self-report symptoms via text message.
More than 50 people have been trained on how to use the software to date, with 100 more scheduled to be trained over the next two weeks, Colfax said. Those workers include not only SFDPH staff, but also city librarians, city attorney staff, and UCSF medical students.
“Additional trainings are ongoing, with the ultimate goal of scaling up a city-wide and regional workforce,” Colfax said. “We hope that as many as thousands of people can be in this workforce, to get people the help they need, who may have been exposed to coronavirus.”
Colfax also pointed out that contact tracing is nothing new to San Francisco, which has employed it in the past to track other diseases, such as HIV.
“We’ve learned a number of lessons over the decades of doing this work,” he said. “I can’t emphasize enough how very important it is to have community support, to do this in a culturally appropriate way, and to do it in multiple languages.”
Today, the system supports English and Spanish, but Colfax said they are working to quickly implement Cantonese, Mandarin, and Tagalog.
“The history of infectious disease shows that this is a key tool,” Colfax said. “We are making progress, but there is still a long way to go.”
Update: This story has been updated to reflect that the county Dimagi originally customized their software for was Santa Clara County.