Was contact tracing just a money pit?
Elimination hinged on contact tracing - how do we know it worked?
I follow a Canadian journalist on Substack who recently did a post on how nothing works anymore and everyone is mad, “Dysfunction is now the water that we all swim in.” She also asked in her post, “Why are things such a mess?”
Covid is very much over.
But this response to Covid deserves attention as it really seems to have helped make everything worse. It was hard and costly on both personal and societal levels, yet we don’t seem to care to review it. Maybe things are a mess because we prefer to not look back, or to learn?
Many of the documents I’ve looked at are surprisingly murky on outcomes. Maybe I’d just pick apart anything that government legislated which curtailed freedoms, while spending incredible amounts of money that we now pay for through higher inflation, and a more divided society. But I find any metrics of success that pop up are more concerned with efficiency - which is not necessarily what I’d conflate with effectiveness. And even then - they often struggled to achieve them.
Contact tracing
Metrics of efficiency are really visible in documents on contact tracing.
In a March 31st 2020 session of the Inquiry into the Government response to COVID-19 Sir David Skegg stated, “…the capacity for rapid case contact tracing must be greatly expanded as a matter of urgency. Contacts need to be located, isolated, and tested before they start infecting other people.”
A Cabinet paper to improve contact tracing added, “British social data suggests that under normal circumstances, each person has about 36 close contacts but there is a wide distribution in this number.” And that on average a person would infect 2.5 other people and spread the disease exponentially.
In April 2020 the Government announced a $500 million fund to help protect New Zealanders and their health around Covid, and that included a near doubling in resources for 12 regional public health units to increase capacity for contact tracing. Public health units were given a 1-off funding allocation of $15 million, which was further supplemented a few months later with a 2nd 1-off funding allocation of $15 million.
But I assume contact tracing would have cost far more than the above funding, as companies were contracted to call people and had, “…more than 3,280 full-time equivalents (FTE) rostered over seven days.” Which excluded public health units or Ministry of Health staff who supported them.
A key metric of success for contact tracing was following up 80% of someone’s contacts within 48 hours.
Overall the metrics used are really just call center numbers and not whether, how and when, contact tracing stopped Covid (or even how people were treated when being a contact - was there a metric for that?).
They took this so far - they were recording contacts of contacts. Let me just say that again, they were spending time and effort to find people who’d been in contact with people who’d been in contact with cases.
New Zealand’s entire elimination strategy was predicated on contact tracing yet over and over again they couldn’t always determine linkages in clusters that cropped up at the height of Covid zero.
Which could imply that contact tracing is actually not very successful and/or there were false positives and/or the virus was sometimes circulating but not being explicitly caught.
Incredibly, almost half the population in New Zealand had been a contact by March 2023:
Yet the response for ‘how many contacts became a recorded case’ was, “there is no way to determine that it was that exposure that resulted in their COVID-19 infection.”
Sure, but then how do we know contact tracing was worthwhile?
(And what on earth is the point of recording over 2 million household contacts once the elimination phase had been canned?)
Reviews
Reviews were done of contact tracing - also based on metrics.
Following on from the remarks by Skegg, in May of 2020 Ayesha Verrall, who before becoming a Minister was an infectious diseases physician, did a rapid review of contact tracing capability across the country.
The review included interviews with Ministry of Health and public health unit staff. Verrall’s recommendations included further support to public health units so they could investigate 1,000 cases per day, and they should have access to the system the Ministry was developing. So they were prepared for having cases yet still thought it could be stopped by contact tracing the contacts of 1,000 people! The recommendations also included creating the Covid Tracer app and monitoring the app for cases who became contacts.
Confusingly, although the above OIA claimed there was no way of knowing if a recorded contact of a case went on to get Covid from that exposure - there was a response to Verrall from then Director-General of Health Ashley Bloomfield, acknowledging that there should be metrics for how many contacts became cases after their exposure to evaluate the success:
A noting paper described the contact tracing system that was stood up on the 6th of April 2020. A report on an issue with a time stamp shows that the system was built by….Deloitte. Yup, yet again the big 4 consultants raise their head for the Covid response.
Verrall’s review was reviewed too - a group chaired by Sir Brian Roche did a report on what happened after the review and included recommendations, like ensuring staff had holidays to be fresh. Allen+Clark also did a review in April and May 2020 focusing on 3 public health units to summarise what could be reviewed and improved.
And in November 2020 a case investigation and contact tracing assessment was sent to the Covid-19 Minister Chris Hipkins by a Police Detective Superintendent due to an August cluster of cases.
Why Police? At the start of 2020, Police were overseeing people who were returning from overseas - they performed a compliance check on returnees and their close contacts while in isolation at home for 14 days. They also monitored them using location based data that was developed for Search & Rescue which “…the system requests and is sent one-off information about the location of the person.”
I think that means you give them your cell phone number and they can geo-locate it? People could in theory refuse to use it, and also it was circumvented by people leaving their smartphone at home.
Overall the Police assessment was positive but called the sustainability of contact tracing into question due to the number of public health experts being limited.
But again, like masks and domestic vaccine passes I want to see something clearer - did this incredible amount of contact tracing stop cases? Was it worthwhile all through the response - as it seemed to crumble at 75 cases a day during the Delta outbreak. Why were contacts still being recorded in 2023? Has there been a review on when it was successful and when it was not?
I have so many unanswered questions and the more I read the more I get - but it seems like a huge expense that tried to stop Covid, yet couldn’t, and just added more drops to the dysfunctional sea we now swim in.
Contact tracing was 100% theater; being seen to ‘do something’. On a more sinister level it was about instilling fear and enforcing compliance; separating the sheep from the goats. In this instance the goats had it right. No one was ‘saved’ from Covid infection through contact tracing. It was as effective as the vaccines in preventing infection. But masking up, using your App and getting your booster was your passport to freedom, or was it serfdom? For most people the jury is out and the theatre season has closed, a miserable failure.
Never did it once, put name down as Jacinda Ardern.