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How Contact-Tracing Works – It is up to the People

30.03.2021

“Contact-tracing” during an epidemic like the Coronavirus is vital to containing its spread. But, what factors contribute to making it work? Why do so many countries fail? How did Mauritius succeed in the first wave of Covid? Are we heading for a catastrophic failure this time?


When you think about it, participating in contact-tracing is not easy. We are asked private questions. Where did you go? Who did you meet? Usually, this is not someone else’s business. Yet, people participate. In La Caverne last week, ordinary people queued up to be tested, gladly offering personal details. They, like most Mauritians, understand the concept of public health. They know it is, so far, the only way to contain the spread of Covid. It is part of Mauritian culture that we recognize our role in halting contagion. People “know” they must participate to make it work. How do we know this? Let us find out while looking at three elements on which the success of contact-tracing relies.


1. A culture of preventive health care


A high proportion of people in any given society need to understand contact-tracing for it to work. They need to believe in it. In reality, it works only to the extent that it is part of the people’s culture, and not just imposed by the State, when it becomes repression. One’s culture in turn depends on one’s history. 


Malaria


Mauritians’ history of collectively having eliminated malaria is what made contact-tracing work in containing the first wave. Older people have experienced how they, themselves, worked together to get rid of malaria. They mobilized against the disease, and lived to see the results. Malaria was the biggest killer in the 1940s and ’50s. People then, acting collectively, eradicated its vector, the anopheles mosquito, and lived to see the difference. By the ’60s and ’70s family and friends were no longer sick and dying of malaria. Mothers no longer lost children to malaria fever. Importantly, they knew it was the result of all the voluntary work of gathering up empty cans, cutting of bamboo at the node, digging canals so water would not stagnate, getting rid of damp breeding grounds for mosquitoes.


 This experience, in turn, created a generalized culture of preventive health, a culture that lives on, but now demands nurturing. For a start, we all share a mental category of “public health”. We know, in a deep cultural sense, that malaria is not just something “cured” by a “patient” taking his “medicine”. Instead, the spread of malaria is halted by collective action. The mind-set is quite different.


Bilharzia


In the village of Bambous in the ’70s, when we were part of a health co-operative, we together eradicated bilharzia. We all cleaned up a particular stretch of a canal, removing one-by-one the snails that host the worms that give us bilharzia. The Authorities gave a hand.


The point is that neither the malaria or the bilharzia epidemic could have been contained by individuals visiting a private doctor, paying him, then going to the pharmacy for some pills to take. A culture of public health is the deep knowledge that it is our understanding of an infectious illness and then our acting collectively that works. We have that in Mauritius, still. France and the USA, which both influence Mauritian culture, do not.


Covid


For Covid, the vector is, of course, neither mosquitoes nor snails. The virus is passed from one of us, unknowingly, to others when we do ordinary things we cannot stop doing, like breathe, talk, yawn, cough or sneeze. The virus travels in invisible droplets from the nose or mouth of someone contagious and in aerosol particles hanging in the air until someone else breathes them in. Some droplets land on surfaces that others then touch, and then put their hands to their mouths or noses, and spread the virus. We need to know this to break the chain of transmission. 


In the malaria mobilization, there were the equivalent of the “red zones”, so people know about this, too. When there was a new outbreak, people would focus on that zone. In Bambous, it was by interviewing every single family along the canal about the private matter of checking for blood in their urine, that we could delimit a “red zone” where the snail vectors resided. This was how we eliminated them. 


Flu Vaccines


People over 60 or with chronic illness already get flu vaccinations every year in their neighbourhood. Social Security sees to this. It is free. This, too, is part of our culture. This culture prepares us, in turn, for all public health measures and also for the ultimate protection against the new corona virus: the Covid vaccines. 


Universal free health care


There is another aspect to this consciousness about public health. We live in a country where we all have access to universal free health care. We already have the category in our minds of “collective health care”. This, too, makes us see health not just as “curing individuals who are sick, in exchange for money” but as “caring for the health of all”. Anyone, whoever it is, is cared for. If one needs brain surgery, renal dialysis, open heart surgery or dental care, one gets it. It is free at the point of delivery.


All this to say that in Mauritius, we share a history of seeing “health” as something we share. So, most of us, as if “naturally”, participate in the present exercise of contact-tracing. It is essentially this that makes it work. Our culture. And this is much deeper than party-politics. 


2. The Authorities Need to be Trusted


For contact-tracing to work in an epidemic like the Covid-19, people need to have confidence in the Authorities. People will only tell the truth to contact-tracers if they trust them. When the Authorities say please come forward if you were at X place or met Mr. Y, people need to trust them. So far, the Health Ministry has, itself, clearly told the truth about the epidemic, publishes reliable statistics, and does have people’s confidence.


However, the profligate emergency-buying done by the Government during the first lockdown has shaken some people’s confidence in the Authorities.


This means the Government would be strongly advised to have a hospital doctor talking to the public during the daily briefings. He could then play the key role played so well in the first wave by Dr. Gujadhur, as a scientist.


3. Keeping Rumours in Check


For contact tracing to work and thus for the epidemic to be contained, it is also important that society maintains its own capacity to control rumours and fear-mongering, and to keep calm and rational – even during the difficult circumstances of a lockdown.


There are two realities that have made this epidemic difficult to contain, in particular in France and the USA:


a) Too many people spread the lie, mostly on social media, and too many others believe it – that Covid-19 is supposedly “not serious” or “just a hoax”.


b) Too many people tell, or fall for, lies and conspiracy theories about vaccines supposedly being dangerous.


So, in France and the USA big proportions of people defy the Authorities on specious grounds. 


In Mauritius, there was an additional problem – a bizarre agitation about elections having been “stolen” painted the MSM-ML government, as a whole, as “illegitimate”. Then, post-Wakashio there was mobilization behind a populist. The failure of the Jugnauth regime to address issues like job creation and food production, and systemic corruption did not help. All this to say that opposition forces in a country also have a role to play – while criticizing the Government, they must contribute to containing the epidemic. On MBC TV on Thursday night, to his credit, Opposition Leader Xavier Duval made a reasoned plea for people to respect health measures. This helps encourage people to co-operate with contact-tracing. As did Mr. Bhagwan’s words addressed to people in Canot, part of his Constituency.


Conclusion


All this to say that we are at a possible tipping point in the second wave. There are new Covid cases in the South. Everyone needs to co-operate with contact-tracers, giving all our contact details. We need to come forward for testing the minute we feel feverish. We, in the opposition, need to keep a rational attitude towards the health authorities.


If we do not, ourselves, contain the second wave by our own actions, we will risk not just more illness and more deaths, but also more repression.


So, we all need to act for the common good. 


This pandemic will not go away by itself, but only when most of us get vaccinated. For the months ahead, before we all get vaccinated, we need to follow public health measures to slow the spread: social distancing, wearing masks, avoiding grouping, opening windows at work, at home and on the bus, and washing our hands scrupulously. We have the advantage that public health, as a concept, is embedded in our shared culture.


Ram Seegobin and Lindsey Collen, 27 March, 2021, for LALIT.