July 10th, 2020

Why Contact Tracing Fails and What to do About It

When it comes to contact tracing, every major public health organization, from the CDC to WHO to John Hopkins University, agrees that time is of the essence. Every day that passes without quickly and accurately tracing contacts exposed to COVID-19 increases the risk to lives and livelihoods. If state and local contact-tracing organizations cannot reach contacts effectively, COVID-19 cases will continue to rise and compel even stricter mitigation strategies.

Estimates vary on the number of contact-tracing staff required per 100,000 citizens, with the total national number of needed staff estimated between approximately 100,000 and 300,000. After years of budget cuts to state and local health programs and further cuts seeming likely due to COVID-19’s impact on states’ sales- and income-tax revenue, it is vital that contact-tracing organizations operate as efficiently as possible.

Unfortunately, legacy challenges well known to outbound dialing organizations limit the potential effectiveness and efficiency of contact-tracing initiatives. State and local governments will squander time and money until they mitigate these challenges.

Legacy challenges hamper contact-tracing efforts

COVID-19 becomes infectious days before the case shows symptoms. Contact tracers need to reach 75% of potentially infected individuals within 24 hours in order to mitigate painful lockdown measures. The more infected contacts tracers reach, the less opportunity the virus has to spread. Unfortunately, contact-tracing organizations lack complete and up-to-date contact information on each contact, often call the wrong number or at the wrong time, and struggle with errant call blocking and spam-mislabeling (see chart).

Note: "No relevant contacts" indicates that either the case does not have contacts to name, or that he/she has not been symptomatic for weeks and therefore does not have relevant contacts to provide – possible that faster outreach would improve contact relevance. Source: NYC press conference held 6/16; data is based on sample of 5,347 scaled down to 100 for simplicity; NYC data was compiled from 6/1-6/15

Contact information incomplete or out of date

Cases often do not know the phone numbers or addresses of their contacts, or they may refuse to provide this information. On average, 36 percent of contacts’ records will not have an accurate phone number. Every month, between five and fifteen percent of records in a typical contact database go out of sync. Every year, 75 million people change their phone carriers, 45 million people change their phone numbers, and 60 million people relocate. About 25 percent of answered calls go to the wrong person.(1) If tracers’ calls go unanswered due to poor or lacking contact information, then they may have to visit contacts’ residences. These in-person attempts sap efficiency and delay outreach to other contacts, allowing the virus more time to infect other people. Failed attempts result in fewer successful notifications and more potential for community spread.

When the correct contact does answer a tracing call, tracers often authenticate the contact by asking the contact their county of residence. Contacts may not understand the authentication question due to a language barrier, or they may not know their county of residence. Tracers cannot ask about a language barrier until the contact is authenticated. Without access to more detailed information about the contact, the tracer has no alternative means of authentication and may have to give up on tracing an infected contact.

Those contacts who know their county and comply with authentication are asked for more information, such as whether the contact’s number is a cell phone or landline, which number is best for reaching the contact, whether tracers can send SMS messages, and the contact’s primary email address. This rote activity increases the duration of the call, wasting time that the tracer could spend on more valuable actions.

Calls to wrong numbers or placed at the wrong time

Most attempts by contact tracers to reach contacts will fail. Roughly half of calls go unanswered.(2) Disconnected numbers mean more lost contact opportunities.

A contact’s record may contain multiple phone numbers. Some may be associated with an employer. Some may have been reassigned to other people. One may be the contact’s preferred point of contact, while another is valid but mostly ignored. Without knowing which is which, tracers will waste time and effort calling numbers that won’t be answered.

Contacts’ records lack the days and times when each individual is most likely to use his or her phone—a tremendous gap in outbound dialing intelligence. Some contacts are most likely to answer their phones on Saturday mornings. Others may be unreachable outside of weekday afternoons. A contact tracing organization that applies a one-size-fits-all dialing strategy will only reach the segment of contacts that happen to fit the parameter. With tracers working from home, moved from other functions to meet demand, or freshly hired, contact-tracing organizations may incur unnecessary costs if staff scheduling practices do not align with contacts’ phone behavior.

Tracers’ calls blocked and spam-mislabeled

In a commissioned study conducted by Forrester Consulting on behalf of Neustar (Why Consumers Won’t Take Your Call, July 2019), respondents said that consumers do not answer calls from unrecognized numbers for fear of fraud (50 percent), call spoofing (48 percent), and robocalls (35 percent). COVID-19 has aggravated all of these problems, giving contacts even more reason to distrust calls from unrecognized numbers. Contacts have ignored multiple early tracing efforts, thereby prolonging the period when infected contacts could transmit the virus.

Spam calls increased in the United States by 108 percent year-over-year in 2019. To combat the years-long rise of unwanted call volume, many carriers have implemented free call-blocking services and developed applications to combat spam. Carriers may activate these initiatives by default on behalf of their customers.

Legitimate callers’ numbers—especially those spoofed by criminals—are being errantly identified as spam as more aggressive call-blocking tools have been introduced. Inaccurate call-blocking and spam-mislabeling happen when call number reputation and calling behavior are mistakenly flagged by call management systems. In many cases, contact tracing organizations’ outbound numbers aren’t registered as trustworthy across contacts’ telephone carriers. Tracers’ calls that aren’t blocked outright may appear as ‘Spam Risk’ on contacts’ devices.

The combination of the legacy challenges described above wastes resources and increases the risk of infected contacts missing tracers’ calls, allowing COVID-19 to spread further and contributing to a resurgence.

How contact-tracing organizations can reach contacts more quickly and effectively

Contact-tracing initiatives will improve results if they leverage available technologies that have been vetted by outbound dialing organizations in the private sector. Despite differing use cases, the underlying strategies remain the same: ensure the most accurate and complete view of each contact, call the right number at the right time, and mitigate errant call blocking and spam-mislabeling.

Ensure the most accurate and complete view of each contact

Given the gaps in consumer contact information in a typical database and the rate at which those identifiers change, contact tracing organizations must implement strategies that make certain that contacts’ information on file is complete and accurate prior to calling. A clean and robust contact record streamlines outbound dialing processes and increases right-party contact (RPC) rates. Organizations are better positioned to make contact sooner when they have contacts’ most current data pushed to their databases automatically.

Neustar’s unique data assets continually corroborate U.S. identities in real-time, filling in gaps, and correcting inaccuracies in provided contact data. This ensures tracers have the most complete and accurate information about each contact prior to calling. Having complete and accurate contact data streamlines the authentication of contacts, improves tracers’ dialing efficiency, and expedites the preliminary collection of contacts’ information.

Call the right number at the right time

Efficient outbound call centers adjust dialing schedules according to the periods of the week when contacts are most active on their phones. Their operations must account for the widespread pandemic-driven disruption to contacts’ daily routines, the presence of multiple phone numbers in each contact’s record, and the probability that some contacts will change phone plans due to financial hardship. Insights into phone behavior support optimization of tracer scheduling, reduce costs, and increase RPC rates.

Neustar provides phone intelligence about the best number to use and the best time to reach each individual. These predictive phone behavior insights—not found anywhere else—come from Neustar leveraging unique relationships with telecom providers and powering over 90 percent of caller ID in the U.S. When a contact’s record lists several phone numbers, Neustar scores the quality of each number according to the likelihood of it being answered. This reduces wasted calls for outbound dialing organizations by an average of 16 percent and improves RPC rates by an average of 33 percent.

Mitigate errant call blocking and spam-mislabeling

To prevent inadvertent call-blocking and spam-mislabeling, contact tracers must ensure that phone numbers used for outbound calling are included in an authoritative list of registered business numbers. Phone numbers used for inbound calling only—Do Not Originate (DNO) numbers—can be added to authoritative blacklists to combat phone scams that spoof these numbers. Increasing contacts’ trust in calls drives up answer rates, making contact-tracing efforts more effective.

Almost 90 percent of individuals say they are more likely to answer a call if they can be certain of who is calling. With direct relationships to over 850 voice service providers and caller ID apps, Neustar ensures accurate and consistent caller displays over landline and mobile phones, and registers outbound calls so that they are not errantly blocked or spam-mislabeled. This approach improves outbound dialing organizations’ RPC rates by as much as 19 percent.

When contact tracing organizations have complete and accurate data about each contact, layer phone behavior intelligence into their dialing strategies, and address errant call blocking and spam-mislabeling, more infected contacts are reached and supported to self-isolate or seek care earlier. Every measure taken today to increase the effectiveness of contact tracing will pay off in lives saved and economic disruption mitigated. With so much at stake, it is critical that contact-tracing organizations establish trusted connections early with as many contacts as possible. Neustar enables these trusted connections.

(1) Source: Neustar-sourced contact tracer interviews, May–June 2020
(2) Ibid.

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