1/5/2021 Contact Tracing and Assigning Blame



The 1970 film, M*A*S*H, includes a scene where Major Frank Burns, a pious surgeon, angrily blames an orderly for the death of one of his patients. He shouts, “You killed him!” The corpsman was devastated, in tears, and thinking of taking his own life. Fortunately, Hawkeye and Duke, two other surgeons intervened to assure him that he was not at fault. Burns often blamed others for his own mistakes. But, the power and knowledge disparity between that orderly and physician required these other surgeons to speak up.


Recently, a local public health announcement was printed in the Oregonian and News Review. The article detailed how one person went to work ill and was responsible for the deaths of 7 local people, two subsequent community COVID outbreaks and more than 300 people in quarantine. This is an egregious example of sampling bias, public shaming and misinformation. It is not consistent with the science.


According to the Oregon Health Authority (OHA), as of 12/13/20, only 37.8% of positive COVID cases in Oregon were traced to a known source. I think this is an overestimate by the OHA as it relates to their contact tracing abilities. COVID is a widespread, highly transmissible, airborne and droplet virus. Studies have shown that over 40% of infected individuals are asymptomatic.


During the timeframe in question, Oregon was averaging over 1000 positive tests per day. If this announcement was at the beginning of the pandemic, contact tracing might have been able to achieve this level of sophistication. But it is simply not an accurate process during the middle of a pandemic when over 50 thousand Oregonians already have confirmed positive tests.


We do not know the alleged ill originator, and do not condone the decision to go to work ill. But if this person’s name is made public, and the community and individual accept that blame as truth, it would be a travesty. Someone should inform this poor soul that this is a bogus conclusion.


In June, during increasing COVID-19 case counts, Dr. Dean Sidelinger, Oregon’s lead epidemiologist, was reported to say that although some individuals tested positive and attended demonstrations, the agency had not seen a large cluster in cases or gathered evidence of viral transmission in these settings. How can one know this when contact tracers were not allowed to ask individuals who tested positive if they attended demonstrations? In the Oregonian, Dr. Sidelinger reportedly said, “Protests and demonstrations may be a contributing factor, but evidence and case investigations just don’t show that is driving these large numbers”. This is a generous interpretation. There seems to be a double standard in assigning responsibility for viral transmission.


I hope Public Health has a grasp as to the limitations of their data. Do they truly believe they are aware of all COVID cases and contacts? It’s not even close.


This is our reality at Evergreen Urgent Care. There are some healthy young people without symptoms who want to be screened for COVID multiple times. But a significant number of hard working, financially disadvantaged individuals do not want to be tested for COVID-19, even though they probably have the disease. Some opt out of COVID testing to avoid being caught in a quarantine web. Many have children to feed, and financial obligations to meet. Despite the political promises, there are many barriers to securing public services and resources; and when they do, that help may be delayed and inadequate.


Perhaps we should focus on what we do know. COVID is a widely disseminated, highly transmissible, airborne and droplet virus that is well entrenched in our society. And it’s nobody’s fault.


Like a bad faith healer who blames the patient for his lack of healing, Public Health officials have consistently assigned blame with each new report of escalating case numbers. They say that we are not social distancing or wearing masks well enough. But, for a free society, the level of compliance that we see has been outstanding. Not perfect, but reality rarely is. There is another possibility. Perhaps, at this stage in the pandemic, what we are doing is ineffective. This statement would be consistent with worldwide and U.S. viral transmission data.


2021 will only be better if we are honest to acknowledge and learn from our own mistakes. And that doesn’t start with blaming others.


John Powell M.D. Tim Powell M.D.