As a contact tracer in my home county in Iowa, it’s my job to provide people who have recently tested positive for the coronavirus with public health guidance and to help identify anyone else who might have been exposed. Doing that, however, can sometimes be more challenging than I would wish. On one occasion, the first time I called an elderly woman, I got her voicemail. I figured that she had dismissed the call from an unfamiliar number as spam, so I waited a minute and then called again. Thinking back to the plethora of times I’ve received back-to-back spam calls, I tried my luck one more time. She answered. Relieved, I introduced myself, fearing as I often do that I was talking with someone who didn’t appreciate public health.
She was skeptical of something, but it wasn’t public health. It was phone calls from unidentified numbers. She first asked how could she know that I actually work with the county public health department. She had only answered because her husband was on a bike ride and she wondered if he was trying to reach her as she watched the Iowa Hawkeyes play. Understanding her genuine mistrust of random callers, I reassured her about the information we were asking for, and all the ways she could verify our county department’s operations.
“I don’t mean to give working people a hard time—but if your number came through as ‘Public Health’ or something, I wouldn’t be as skeptical,” she told me.
I’ve had versions of this conversation many times. A significant number of contact tracers’ calls to confirmed cases and close contacts go unanswered. It makes sense: Many Americans are mistrustful of unidentified phone calls primarily due to being plagued by spam calls daily.
But this mistrust can come as a detriment to public health efforts. Here in Iowa, coronavirus cases are skyrocketing, and public health departments across the country are having trouble to keep up with contact tracing. Having to call people repeatedly and attempt other methods of communication wastes time we simply do not have right now.
It’s understandable that people are suspicious of numbers they don’t recognize. (I certainly am.) According to the Transaction Network Services, which publishes a robocall report twice a year, more than 100 billion unwanted calls were made nationwide between August 2019 and August 2020. While the number of unwanted calls in the first half of 2020 is down about 15 percent compared with the first half of 2019, primarily due to global shutdowns and less active call centers due to the COVID-19 pandemic, TNS says the number has been picking up again.
And some of them, as the elderly woman I called suspected, are fraudulently using the pandemic, even misrepresenting themselves as contact tracers. Bill Versen, the chief product officer at TNS, calls these “confidence men” calls, and says they include both robocalls and live-person fraud calls. Versen says that the confidence men “use a topical event, including the coronavirus and contact tracing, to try and defraud people.”
Versen notes that while the U.S. isn’t the only country that faces challenges with robocalls and spam calls, the magnitude of the problem is higher in North America compared with other parts of the world.
A result of all these unwanted calls is that people simply don’t pick up the phone. A recent industry analysis found that 75 percent of calls from unrecognized numbers go unanswered. Spammers often spoof local area codes, so even having a geographically proximate number is often not enough to make someone pick up the call.
Exactly how much these spam calls have negatively impacted contact tracing and accelerated the spread of the coronavirus is unclear.
“It’s hard to put a number,” said Crystal Watson, senior associate at the Johns Hopkins Center for Health Security and assistant professor in the Department of Environmental Health and Engineering. “But all jurisdictions in the U.S. have had to struggle with this [spam calls].”
Often, these spam calls are a mere annoyance. But it’s particularly dangerous at this moment, as new coronavirus cases are surging to all-time highs all around the United States and some county health departments have already given up on contact tracing.
“For contact tracing to truly be effective in controlling the coronavirus, we need to be recognizing and reaching the vast majority of cases, and break chains of transmission,” Watson said. “If that’s not happening, and there are large number of cases that are going unrecognized—then contact tracing alone won’t control large spreads of the virus.”
I sometimes hear from healthy but worried residents who want to know the local contact tracing team’s phone number, just so they can put it in their phone and be sure they’ll pick up. Unfortunately, it’s not really sustainable for public health departments to get a massive number of calls for this purpose at a time when other pressing work needs to be done. Additionally, most organizations use a block of phone numbers, not just one.
Contact tracers have some tricks, like calling someone back to back, the way I did with the elderly woman, or using text messages. But these quick fixes are not enough to reach everyone. Text messages are also not infallible given similar perceptions of spam. Furthermore, contact tracing must be a conversation between a public health worker and the person who tested positive or their close contacts.
The good news is that another less intensive solution may already exist: public safety branded calling.
TNS identifies unwanted, spam calls and works with phone carriers and organizations to identify numbers used for legitimate work. Those numbers are then added to TNS’s analytics engine to make sure they don’t get caught in carriers’ safety nets to catch spam calls. (These are the systems that, for instance, make some numbers show up as “Likely Spam” on your phone screen.) Those unfamiliar numbers may still look like spam calls, of course, so the next step is a brand: putting some specific name or information about the organization like “New York State health department – COVID-19 tests results” on the identified phone numbers when a call is made, which are further authenticated to make sure from the call is actually coming from the number that shows up on your screen.
This may be coming soon to your local health department. While TNS said that while it couldn’t share the names of specific public health agencies, it is “working with various health agencies in New York, New Jersey, Pennsylvania, Massachusetts and California, among others” to implement their branded call service.
While branded calling may be a promising practice, whether for contact tracing or other needs, we still need research to determine whether it can improve call pickup rates for public health uses.
Some experts also caution that a solution may not be as simple as making your phone display “Contact Tracer.” Spam calls “are so inoculated in our culture now—it could take many years for the public trust to follow,” said Jeff Engel, executive director of the Council of State and Territorial Epidemiologists.
TNS and other organizations including the Federal Communications Commission are working to tackle that broader problem by monitoring and criminalizing fraudulent calls, which could help bring back trust. The nationwide problem with spam calls is another example of how, in a pandemic, strong guidance and leadership from the federal government can make a bring difference.
“It’s been a real push for public health departments to develop a workforce, not to mention managing mobile challenges,” Watson said. “A lot of states have had to go alone, and have not had the comprehensive guidance to improve testing or contact tracing, or to reduce issues associated with robocalling.”
For all its challenges, contact tracing can be rewarding. Just recently, the child of a concerned, single mother of two tested positive for the coronavirus. I called her multiple times, but didn’t get an answer and couldn’t leave a voicemail. I sent a text message informing her that as the county public health department, we were trying to reach her in regards to her child’s case. Shortly after, she called back. She was almost in tears, relieved that we were trying to reach her. She told me she had no idea what to do after her child tested positive. Following our conversation, her fears were eased and her uncertainty was lifted because she knew what to do for her child and family.
In recent weeks, we’ve seen promising news about vaccines, which makes me hopeful that we are in sight of the end of the crisis. I’m also optimistic about the idea that technology may help us make contact tracing more efficient. For now, though, I’ll keep making those phone calls. Perhaps you can help out your community by following public health guidelines, minimizing the spread of the coronavirus even if it means not traveling, and picking up the phone—especially if an unfamiliar number calls you multiple times in a row.