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SPECIAL SECTION: The COVID-19 Crisis


COVID-19, they will receive a verifi cation code to plug into the app, if they choose. Any other CA Notify users who have been within 6 feet for 15 minutes or more of the COVID-19 positive individual will get an anonymous notifi cation of possible expo- sure, explained offi cials from California Gov. Gavin Newsom’s offi ce. Another organization joining the fi ght to stop COVID-19 spread is Healthvana, a patient engagement solutions company that is working with the Los Angeles County Department of Health Services on rolling out a solution enabling individuals with a positive test to immediately and anony- mously notify anyone with whom they have recently come in close contact, using their mobile phones. Los Angeles County has partnered with


Healthvana since April 2020 on the delivery of test results for county-operated sites; test result notifi cations are sent via text mes- sage or email the moment the lab processes the sample. With this new added feature, individuals who receive a positive test result can simply click a link within the web-based patient portal to enter contact information for any recent close contacts. These close contacts instantly receive a notification from Healthvana alerting them that they may have been exposed to COVID-19 with links to resources, including locations where they can schedule a free COVID-19 test. The contact tracing feature will be initially rolled out to county-operated testing sites, accord- ing to county offi cials.


One of the most important elements of this solution is that the Healthvana notifi - cations to close contacts come in minutes or hours, rather than days, meaning there is a real opportunity to act right away as time is of the essence, says Clemens Hong, M.D., director of whole person care with the L.A. Department of Health Services, which oversees the county’s testing sites. Like many others, Hong believes that engagement is the most critical piece to any contact trac- ing strategy, because without it, no tool can make up for non-committed users. In the fi rst four weeks of the tracing program, more than 3,000 people were notifi ed of an exposure within hours from when the original posi- tive test result was recorded. And the vast majority of those 3,000 individuals open the exposure notifi cation within fi ve minutes. “So it pretty much touches just about every- one within the fi rst day,” says Hong. What’s more, about 30 percent of the close contacts who received a notifi cation click on a link to access a COVID test.


At the same time, Hong acknowledges that the 3,000 users who received notifi ca- tions represent just 3 percent or so of the


COVID-positive users. “So of the individuals who received a COVID test, 3.5 percent of those who were positive entered a contact [in the Healthvana app]. The majority of those who engage do enter [that information] within the fi rst hour, but it’s still not reaching a large percentage. So there’s a lot of opportunity for us to improve there,” says Hong. The early data also shows that about


three quarters of the most engaged folks on Healthvana are people of color, “and that’s where we’ve seen an overwhelming number of infections, as [the virus] has had a dispro- portionate impact on people and communities of color,” says Hong. The other data point he refers to is that respondents are notifying 1.3 contacts on average, “and if you look at our county data, that’s almost double what we have been seeing in terms of people who are notifi ed. So maybe there’s something about the anonymity [of this app] that’s encour- aging people to add more contacts,” Hong speculates.


Is there a “right” contact tracing strategy? So far, there doesn’t seem to be a one-size- fi ts-all solution to contact tracing in the U.S., with a big reason being that state and county resources can’t keep up with the surge in positive cases. Some are even asking resi- dents to do their own tracing and notifying. There were several common challenges and barriers to contact tracing mentioned in the aforementioned Reuters report, includ- ing: efforts to simply reach people who tested positive, let alone interview them; a lack of suffi cient staff and funds; and technical prob- lems and poor coordination. Per the report, one local health director in Wisconsin said responses her team got when calling positive patients ranged from “yelling and hanging up, to those telling us that they have already contacted all of their friends and will not give us those names.” The Pew research reinforced this anecdote in its survey, as just 19 percent of Americans said they generally answer their cell phones when an unknown phone number calls. About 67 percent said they don’t answer, but would check a voicemail if one is left. And 14 percent said they generally don’t answer and would ignore a voicemail. On the ground, some state leaders are quickly realizing this reality. In early December, New Jersey Gov. Phil Murphy reported that the number of New Jerseyans with COVID-19 who refuse to cooperate with contact tracers continues to grow; recent data showed that 74 percent of cases do not give information about recent contacts with oth- ers to government health employees who call them. Murphy called the non-cooperation “unacceptable.”


Although not the norm, there have been


some pockets of tracing success in the U.S. In San Francisco, more than 83 percent of COVID-19 cases and contacts are reached on a regular basis, according to a late October ABC News report. In September, more than 1,600 COVID cases there resulted in tracing more than 1,700 contacts. Close to 60 percent of those contacts then got tested, representing a signifi cant jump from four months prior, according to that report. The U.S. has more than 50,000 contact trac-


ers for the fi rst time since the coronavirus pan- demic hit, according to an October survey of states conducted by the Johns Hopkins Center for Health Security in collaboration with NPR. Public health experts have previously called for 100,000 contact tracers nationwide, a num- ber that’s also been mentioned by incoming President Joe Biden. This is where some experts believe that digital apps could help fi ll the gap by auto- mating the contact tracing process, but thus far there have mostly been low adoption rates and stymied progress. In Nevada, for instance, despite state authorities strongly recommending that residents download their contact tracing app, just 3 percent of the adult population has so far, and not a single exposure was registered in the app throughout the month of September, during which the state reported more than 10,000 new cases, according to a November report in Time. Hong believes that a combination of digi- tal technology with manual effort is likely the right approach moving forward. The Healthvana solution, he points out, enables the ability to get information out quickly, make contacts aware, and allow them to quarantine. On top of that, two days later they’ll get a call from public health offi cial who can do a much deeper interview that helps authorities identify where the person got infected and whether or not there are outbreaks that need to be chased. “So I think the idea is that these two pieces can really work together to address this, especially right now when we’re seeing so many cases,” he contends.


In the end, engagement is by far the most


crucial success factor, and to that point, Hong says Healthvana is working on deploying functionality where a second notifi cation is sent out to close contacts 24 hours after the fi rst one—perhaps at a different time of the day—with the goal to get more users and more responses. But Hong also touts that L.A County has already reached 3,000 people with the Healthvana app so far. “If we could have those 3,000 individuals stop spread to two people, you are changing the trajectory, at least within their communities, their families, or their workplaces,” he says. HI


JANUARY/FEBRUARY 2021 | hcinnovationgroup.com 21


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