1 of 25

Do you remember that second patient?

2 of 25

Would the same approach work with Lyft?

3 of 25

ORS 433.044

(3) The authority or local public health administrator may investigate a case of a reportable disease, disease outbreak or epidemic. The investigation may include, but is not limited to:

(b) Requiring a health care provider, any public or private entity, or an individual who has information necessary for the investigation to:

(B) Release the information to the authority or local public health administrator.

4 of 25

What was the final tally?

9 rides
14 people

13 fully immunized
1 person monitored

0 subsequent cases

5 of 25

“No, you were not exposed to measles.”

6 of 25

7 of 25

Is contact tracing through ridesharing going to be important?

Tuberculosis

Influenza

Pertussis

8 of 25

Is contact tracing through ridesharing going to be important?

30%

Of all Americans have used ridesharing

9 of 25

Is contact tracing through ridesharing going to be important?

45%

Of Americans 18–29 years old have used ridesharing

10 of 25

Lessons learned

Company data is rich and granular.

Ride details
Contact information

This was a new, unconventional request. Going in person helped limit misunderstanding.

11 of 25

Physical locations

Lyft

Uber

12 of 25

Limitations

The lack of pre-existing relationships slowed information gathering.

We cannot know if other subsequent passengers were exposed.

13 of 25

Conclusion

Establishing partnerships ahead of outbreaks helps us do better public health.

14 of 25

Acknowledgments

Alaska Department of Health and Social Services
Texas Department of State Health Services
Washington Department of Health

Clark County Department of Health
Skagit Count Department of Health
Snohomish County Department of Health

Clackamas County Public Health
Multnomah County Health Department
North Central Public Health District
Polk County Public Health
Washington County Department of Health and Human Services
Yamhill County Health and Human Services
Oregon Health Authority
Centers for Disease Control and Prevention

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

15 of 25

Supplemental slides

16 of 25

Attributions

https://www.flickr.com/photos/londonmatt/15339795662
https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/MM-11-17-17.aspx
Sneeze from: https://phil.cdc.gov/Details.aspx?pid=11162
Plane by Phạm Thanh Lộc from the Noun Project
Phone by Vallone Design from the Noun Project
DNA by Lloyd Humphreys from the Noun Project
Restaurant: https://www.pexels.com/photo/table-in-vintage-restaurant-6267/
Wedding cake: Photo by rawpixel.com from Pexels
Urgent care: Michael Rivera [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
E-hailing Application by Vectors Market from the Noun Project
Driver by mungang kim from the Noun Project
Taxi by Adrien Coquet from the Noun Project
Uber logo: https://dlpng.com/png/116518

https://en.m.wikipedia.org/wiki/File:Flag-map_of_Texas.svg self-made using Image:Flag of Texas.svg and Image:USA Texas location map.svg Author: Darwinek
https://phil.cdc.gov/Details.aspx?pid=9997
https://phil.cdc.gov/Details.aspx?pid=11823
https://phil.cdc.gov/Details.aspx?pid=22874
https://commons.wikimedia.org/wiki/File:Corporate_Woman_Shaking_Hands_With_a_Corporate_Man.svg

This image is not in the public domain. If you wish to use it anywhere other than on Wikipedia or other Wikimedia projects you are obligated to provide the following details along with it: Author: Videoplasty.com Corporate Woman Shaking Hands With a Corporate Man.svg from Wikimedia Commons; License: Creative Commons Attribution-ShareAlike 4.0

Photo credit Alex Singh

17 of 25

SOCO

This was a successful investigation of contacts of measles cases using information from ridesharing companies.
Obtaining information from the ridesharing companies was difficult, but it is important to figure out how to do this because these types of investigations will continue to happen.

18 of 25

Current status of relationships with ridesharing companies

Uber

Nothing established

Lyft

Informal agreement

19 of 25

20 of 25

21 of 25

20 minutes vs. 2 hours

Resources are limited.

Traceback is done by local public health.
Contact tracing is not the only method of identifying cases.

Provider outreach
Public outreach

Relative unknown: How might exposure dynamics be different in a car?

Planted question: Why do you say a space is contaminated for 20 minutes when the science says the virus can live on surfaces for up to 2 hours?

We acknowledge the science and the fact that transmission has been documented in that 2-hour window. The 20-minute window represents what we believe we have the resources to assess.

It is a balance between the capability to do this work and what we believe the risk is of not identifying a secondary case. Most of this traceback in Oregon is done by local health departments. In addition to contact tracing, we work with providers and send public messages. This helps ensure providers are ready to identify cases and the public can recognize if they might be affected and how best to seek care.

When we talk about a 2-hour window, we’re usually referring to a room. Cars are tighter quarters than, for example, an urgent care waiting room, which could increase the risk of transmission. On the flip side, perhaps airflow differences in vehicles mean that the virus is active, or even present, for a different amount of time.

(Anecdotally, EMS in NY uses 20 minutes. Their justification is air changes and cleaning practices.)

22 of 25

Other types of investigations

Foodborne disease investigations

Recruit cases
Recruit controls

23 of 25

Ridesharing availability is growing.

24 of 25

Questions

Measles genotype? D8
Did she get it from Thailand?
2019 measles outbreak questions?
Texas exposures?

25 of 25

Database	Strategy	Records 11/13/2018	Records 04/22/2019
Medline (OVID) 1946-	Rideshar* OR lyft OR (uber ADJ3 (car OR ride)).ti,ab. OR sidecar AND Contact tracing OR outbreak	0	0
Embase (OVID) 1947-	Rideshar* OR lyft OR (uber ADJ3 (car OR ride)).ti,ab. OR sidecar AND Contact tracing OR outbreak	0	0
PsycInfo (OVID) 1967-	Rideshar* OR lyft OR (uber ADJ3 (car OR ride)).ti,ab. OR sidecar AND Contact tracing OR outbreak	0	0
CINAHL (Ebsco)	Rideshar* OR lyft OR (uber N3 (car OR ride)) OR sidecar AND “Contact tracing” OR outbreak	0	0
Scopus	TITLE-ABS-KEY((Rideshar* OR lyft OR (uber W/3 car) OR (uber W/3 ride) OR sidecar) AND (“Contact tracing” OR outbreak))	0	0
ProQuest Central	TI,AB((Rideshar* OR lyft OR (uber NEAR/3 car) OR (uber NEAR/3 ride) OR sidecar) AND (“Contact tracing” OR outbreak))	0	0