In the summer of 2020, a large urban public health department needed help managing the COVID-19 outbreak. Its staff was overwhelmed by the rapidly expanding caseload and wanted to find as many people with exposure to confirmed cases as possible, in time to slow community spread. Having previously worked with emocha on video DOT for tuberculosis, it hired emocha to support its contact tracing efforts.
Early in the pandemic, with millions of COVID cases, public sector agencies lacked the staff and training to successfully implement contact tracing, according to a June 2021 study published in the Journal of the American Medical Association.1 Although testing named contacts helped successfully find new cases, two out of three cases were either not reached for an interview or, when interviewed, named no contacts. The large urban public health department was experiencing the same challenges.
To the public health department, emocha brought:
Initially, the health department asked for emocha’s help only with contact tracing and kept case investigation in-house, funneling resources from other departments to support the effort. To ensure a seamless transition, emocha’s case investigators learned local and state reporting requirements and fully absorbed the health department’s processes to seamlessly adapt to existing policies, workflows, and data standards. As the pandemic wore on and fluctuated in intensity, the department asked emocha to also take on case investigation.
Throughout the engagement, emocha symptoms monitoring mobile app helped contacted individuals report any symptoms associated with COVID-19. emocha used analytics to show how quickly it could contact individuals, measuring success as well as hotspots.
The health department supplies emocha with index patients, and then emocha’s trained case investigators interview those patients to map their whereabouts and known contacts during the infectious period. Contact tracers then reach out to exposed individuals, following health department protocols, and inform them of testing options and their need to quarantine.
All contacts interested in using emocha for symptoms monitoring are enrolled and on-boarded over the phone. Residents can report any COVID-19 symptoms and their temperature readings using the mobile application; those that report symptoms also submit a daily asynchronous video check-in. If a symptom is reported, the health department is alerted regarding a new probable case, and these cases enter the contact tracing funnel back at the top as a case.
emocha’s analytics provide real-time updates on progress through dashboards displaying “time to contact” and “time to notification” from exposure date, measuring the promptness and effectiveness of contact tracing efforts. Other dashboards displayed the total number of contacts notified, those who were COVID-positive, and those who were currently quarantining. Data is segmented by age, race, and geographical location, providing the public health department with actionable data.
Early in the pandemic, most people were terrified to hear from a contact tracer. One call with a woman really stuck with the emocha team. She was quarantined in her house away from her children, while her husband was isolated in the ICU with COVID.
“This work is not just about getting information; it is about answering questions and sometimes just listening. You must be empathetic, even as you must gently herd that conversation along,” said Saket Munshaw, who managed the project for emocha.
Conversations with residents changed after vaccinations began in 2021. Beyond providing vaccine resources, emocha’s contact tracers worked to counter inaccurate information found online.
It had to be nimble as COVID fluctuated, appearing to be on a downward trajectory in the spring of 2021 but then spiking to new heights with the Delta variant. Staffing telescoped with each change.
COVID-19 may prove to be the only global pandemic in the lifetimes of those alive today, but it exposed a gaping hole in the public health infrastructure, which will have plenty of other challenges to come.
“Preparedness is the key concept here,” said Morad Elmi, Vice President of Strategic Partnerships and co-founder of emocha. “Public health agencies need to have a plan in place that can be operationalized quickly, so they can basically flip a switch and be ready to go.”
1 Lash, R.R., et al. COVID-19 Case Investigation and Contact Tracing in the US, 2020. JAMA Network Open. 2021;4(6):e2115850. doi:10.1001/jamanetworkopen.2021.15850