海角大神

Typically, Lisa Hermann is a psychology master鈥檚 student. But times are far from typical in the town of L眉beck in northern Germany.

With the federal government desperate to keep the coronavirus contained, her university circulated an ad seeking students to help with contact tracing. Having finished her degree half a year early, Ms. Hermann submitted an application. One interview later, she鈥檇 signed up for a 39-hour-a-week gig as one of Germany鈥檚 newest 鈥渃ontainment scouts,鈥� paid 鈧�2,325 ($2,749) a month to help with efforts throughout the country.

鈥淚t鈥檚 similar to the job I want to do in the future, which is help people get through psychologically difficult times,鈥� Ms. Hermann says. 鈥淏ut sometimes the work is very stressful.鈥�

In Ramle, Israel, Liora Valinsky, the director of public health nursing for the Health Ministry, is training a very different set of contact tracers: soldiers. Israel鈥檚 traditional contact tracing was underfunded and understaffed, with its efforts initially focused on mass cellphone tracking. After the COVID-19 infection rate spiked over the summer, the government called in the army to lead a new, multipronged effort of testing, tracing, and quarantining.

As case numbers now tick upward in Germany and Israel, the two countries are putting considerable resources behind their contact-tracing efforts in order to contain COVID-19 鈥� albeit in different ways. While Germany has called on civilians and Israel the military for additional reinforcement, it is becoming clear that holding the disease at bay is only as effective as a multifaceted, flexible strategy that includes tracing: identifying who鈥檚 infected and who they鈥檝e spent time with, quarantining, and tracking cases.

An early, rigorous start in Germany

In mid-April as cases were spiking, the German government decreed a team of five tracers must be assigned for every 20,000 people. Execution would be left to each of Germany鈥檚 16 states, and extra help from the federal government would be doled out for hard-hit areas.

鈥淥ne problem was how were we to implement this?鈥� says Dr. Isolde Piechotowski, head of infection protection at the聽Ministry for Social Affairs and Integration in Baden-W眉rttemberg, Germany鈥檚 third-most populous state. They came up with a 鈥渇lexible personnel planning鈥� strategy.

They began by shifting personnel between government departments, pulling people out of retirement, asking part-timers to ramp up hours, and recruiting new applicants to help contact trace. In all, they鈥檇 identified about 2,400 people available if needed, says Dr. Piechotowski.

That preparation has paid off, now that infections are again trending upwards. 鈥淭he number of people we have had to trace has doubled since the beginning of May,鈥� says Dr. Piechotowski.

Countrywide, the strategy also morphed over time, as more information surfaced about the virus and how it spreads. Tracing teams learned on the fly, with one example being the streamlining of how authorities communicate with infected persons.

鈥淎t the beginning, we鈥檇 send a written ordinance that they鈥檇 need to go into quarantine, says Dr. Jakob Schumacher, deputy public health officer of the Berlin district of Reinickendorf. 鈥淣ow people get phone calls.鈥� Calmer times were used to train and reorganize.

In April, a points system was implemented to help determine who would get a free test. Those in Category 1, or at highest risk of infection, include people who have had at least 15 minutes of face-to-face contact with an infected person. Lower-risk Category 2 might include someone who sat a couple of rows away from an infected person on an airplane.

鈥淲e give points depending on risk factors,鈥� says Dr. Schumacher. 鈥淲e couldn鈥檛 keep up with tracing and testing 鈥� this score makes [our efforts] more efficient.鈥�

Health officials in Baden-W眉rttemberg are now also testing asymptomatic people, as well as those outside the typical risk categories in 鈥渧ulnerable鈥� settings, such as nursing homes. Germany can do this, in part, because of a concerted effort to increase test availability and lab capacity. More testing can reduce tracing workload, says Dr. Piechotowski. 鈥淲e think that this way we can reduce the numbers.鈥�

Calling in the cavalry in Israel

When the initial outbreak of COVID-19 occurred this spring, Israel managed to quash it with a swift and severe lockdown. But over the summer, new daily cases have rocketed as high as 2,000 鈥� similar to daily counts in Germany, a country with nearly 10 times the population.聽

鈥淭here was a false sense of assurance that somehow we found the formula to beat the dissemination of the virus,鈥� says Dr. Ran Balicer, director of health policy planning at Clalit, Israel鈥檚 largest health care organization.

That鈥檚 part of the reason why, at the beginning of April, only 27 nurses nationwide were charged with contact tracing, and then reinforced later that month with 300 more. At that time, Israel had been relying predominantly on an atypical, controversial type of contact tracing while a swift and effective lockdown helped lower infection rates. The government had asked its intelligence service, Israel鈥檚 version of the FBI, to deploy mass surveillance capabilities to monitor COVID-19 patients and those who have come in contact with them.

Also used in counterterrorism, the practice has come under fire for being what critics say is dangerous government overreach. It also appears to be wildly inaccurate. According to data provided to the Knesset in July, some 50,000 out of 415,000 Israelis sent into quarantine via the surveillance methods were found to have been contacted in error. It was later determined they hadn鈥檛 come into contact with infected individuals after all.

Pleas for additional staffing to help with traditional contact tracing were repeatedly blocked by government bureaucracy, Ms. Valinsky says, as they operated on a 鈥減re-pandemic mindset.鈥� 鈥淚t鈥檚 like we are living in two different worlds,鈥� says Ms. Valinsky. 鈥淥ne is the emergency world of COVID and the other is the bureaucratic system, and the two just don鈥檛 meet.鈥�

As pressure to reopen the economy built, a spike in cases soon followed as Israel was transformed into a cautionary tale cited around the world for how not to transition from lockdown.

Now, soldiers have been added for contract tracing. In Ramle, a city in the center of Israel, an army unit that deals with civilians has erected a contact-tracing center. It is part of the central command being established to ensure information is shared between government agencies and public health services.

鈥淭he big advantage of the army is that they can do things quickly,鈥� says Ms. Valinsky. Contact tracers are drawn from the army鈥檚 pool of university graduates as well as its teachers鈥� corps, and subsets of the first 300 soldier recruits are already in training.

The Health Ministry has hired nearly 300 medical and nursing students, along with 350 civilians, among them furloughed employees from El-Al, Israel鈥檚 airline, for the work. Their hope is to soon have more than 1,000 contact tracers on the task.

Maximizing their strengths

Back in Germany, Ms. Hermann is finding that questions now roll off her tongue, having undergone hours of video, PowerPoint, and online training: Where was contact with the infected person? What was the context? Inside or outside? For how long? Did you drink from the same glass?

Ms. Hermann is pleasantly surprised by how knowledgeable the people are on the other end of the line. 鈥淭heir information is high quality,鈥� she says, recalling conversations about the impact of air conditioning and the aerosolized method of virus spread.

Ms. Hermann also liaises with airlines 鈥� with an additional colleague responsible for holiday returnees 鈥� and submits data to the Robert Koch Institute, the federal agency responsible for overseeing coronavirus control. 鈥淚鈥檓 the one doing statistics, and others write texts very well and communicate with quarantined individuals. Some have kids, so they specialize on school-related issues,鈥� she says. 鈥淲e鈥檙e moving around on the team based on individual strengths.鈥�

In the end, Ms. Hermann is happy she can help fill an urgent societal need. 鈥淚t鈥檚 an exceptional situation.鈥�

Editor鈥檚 note: As a public service, we have removed our paywall for all pandemic-related stories.