Impact of COVID-19 contact tracing on human resources for health – a Caribbean perspective

Contact tracing (CT) and quarantine have been recognized as important non-pharmaceutical interventions (NPI) in controlling the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) and COVID-19. The World Health Organization (WHO) described three main elements of CT: contact identification, contact listing and contact follow up (World Health Organization, 2017). Quarantine has traditionally been used to reduce spread among those who have been in close contact with a known case and during the global SARS-COV2 pandemic it has also been used as an additional form of border control to restrict movement of visitors from countries with community spread. Modelling studies suggest that CT has the potential to be highly effective in controlling the spread of SARS-COV2, but requires 70% of contacts to be successfully traced, assuming a basic reproductive rate (R0) of 2.5 (Hellewell et al., 2020). However, achieving this level of effectiveness, particularly in low-resourced settings, may create an unmanageable human resource demand. Most countries have attempted to implement CT as part of their COVID-19 outbreak response, but success has been varied (Economist, 2020). Countries such as South Korea, Vietnam and Germany which have been praised for their management and containment of COVID-19, all placed technological and human resources into CT and isolation (Tech, 2020, Pollack et al., 2020). While a vaccine may prove critical in curbing the spread of SARS-COV2, difficulties with access and availability in developing countries makes it likely that NPIs will remain critical in at least, the first half of 2021. In addition to CT, movement restrictions have also been critical to reducing and delaying spread of the COVID-19 (Flaxman et al., 2020). Most countries in the Caribbean prevented community transmission of COVID-19 during the early phases (April to June 2020) of the disease in the region by restricting movement through early border closures and enactment of stringent stay-at-home orders in country (Murphy et al., 2020). However, this success has come at a high economic price to these tourism-dependent nations. In 2019, travel and tourism contributions to the gross domestic product(GDP) in the Caribbean ranged from 4.2% (Puerto Rico) to 73.6% (Aruba) and 17 of these nations recorded GDP tourism contributions above the global average (10.2%) (Lopez, 2019). Now in part due to successful containment and economic necessity, these Caribbean Small Island Developing States (SIDS) are re-opening borders and easing movement restrictions. Post border reopening, many Caribbean nations have seen outbreaks of COVID-19 that have threatened to overwhelm their health care systems while others have managed to maintain relatively low numbers using NPIs; particularly testing, contact tracing and quarantine. SIDS have limited absolute resources, therefore, CT, quarantine and isolation must be cost efficient as well as effective. Digital technologies are available to complement labour intensive and time sensitive CT efforts. These technologies have been promoted as tools to increase CT effectiveness, and may also be valuable in increasing the efficiency of a CT team (ADA Lovelace Institute, 2020). Specific functions of these applications include identification of potential contacts, documenting symptoms of those already traced and location tracing of contacts who need to undergo mandatory quarantine (ADA Lovelace Institute, 2020). Modelling suggests that mobile app technology can reduce delays in CT thus increasing effectiveness (Kretzschmar et al., 2020). Systematic reviews and expert opinion suggest that digital technologies are unlikely to replace manual tracing methods because of challenges with uptake(most less than 20%) (Anglemyer et al., 2020). These challenges may be due to privacy concerns, intermittent network connectivity in some communities and the digital divide that may be greater among those most vulnerable (Gasser et al., 2020). We have two main aims: to estimate the future human resource needs for a small population (Barbados) to effectively implement contact tracing given the reopening of their borders to tourists, and to quantify the extent to which CT supporting technologies can modify the workforce needs for CT. We have used Barbados as our Caribbean exemplar country because of its ready data availability and adequate initial COVID-19 outbreak control before border re-opening (Murphy et al., 2020). Barbados re-opened borders to its key tourism markets (United Kingdom, United States, European Union) which, as of December 2020, have ongoing community spread. In-country movement restrictions have been relaxed in Barbados, allowing for mixing of visitors and residents.