Contact tracing, a critical part of efforts to slow the spread of the coronavirus, has fallen behind in recent months as COVID-19 cases have skyrocketed. President Joe Biden was committed to changing that.
Biden is proposing to hire 100,000 people across the country as part of a new body of public health jobs. The body would help with contact tracing and facilitate vaccination. Experts said it was not clear that this would be enough tracers to deal with another rise in COVID-19 cases, even if the vaccination rate rises at the same time.
As with any COVID right now – testing, vaccinations and hospital capacity – the acceleration of contact tracing has become a race against time as new, more contagious variants of the virus threaten to accelerate the transmission of the disease.
Photos: COVID-19 vaccination
In addition, as testing has steadily increased to around 2 million per day, the need for tracing has also increased. The two go hand in hand. In addition, even conservative estimates place the number of infected people undetected at two to three times the number of positive test results reported.
I have experienced the emergency of the pandemic firsthand. With a leap of faith, I became an infantryman in the COVID-19 fight last June as a contact tracer in Maryland. Speaking by phone with dozens of people infected and exposed each week, I hear about the impact of the virus on families, in often sobering detail.
We tracers, for example, are often the first to reach people with their positive test results because laboratories and healthcare systems are frequently backed up. For people who are already showing symptoms, our calls usually confirm what they suspected. For people without symptoms, however, we bring unwanted news. It is not an easy part of the job.
Yet almost everyone we interview takes it in stride. They agree to isolate themselves and provide us with the names of the people they have come into “close contact” with – typically, within 6 feet for more than 15 minutes – in the past week or two. These contacts also receive a call. The goal is to reach as many people as possible within 24 hours, to break the chain of transmission by urging them to stay home and self-quarantine.
Of course, not everyone is cooperating. Some refuse to quarantine themselves or give the names of close contacts. Most states do not report the number of uncooperative people. But a Pew survey of adults last July found that 93% said they would self-quarantine if told they had the virus. A third, however, said it wouldn’t be easy to do – usually because of the work – and a quarter said they wouldn’t be comfortable telling plotters where they were or the people with whom they had been in close contact.
As such, contact tracing has inherent limitations and quarantine is not enforced in the United States. Research also becomes much less effective as the number of cases increases.
An analysis by researchers at Johns Hopkins University in Baltimore concluded that contact tracing in the United States may only be fully effective in mitigating the spread of the virus when new cases are equal to or less than 10 per day for 100,000 people. The number of cases now exceeds that of most states. As of Monday, the seven-day national average was 35 cases per 100,000.
“Nationwide tracing programs are overwhelmed right now,” said Crystal Watson, senior researcher at Hopkins’s Center for Health Security. “The states just don’t have enough people to keep up.”
Even so, added Watson, “every contact traced still means potentially lives saved. We cannot give up.”
Every state has a tracing program, but they vary widely. The Centers for Disease Control and Prevention has comprehensive COVID-19 tracing guidelines, but the Trump administration had no data or performance requirements for states to meet.
A White House spokesperson told KHN that the administration viewed contact tracing as “essential in efforts to reduce the spread of the virus.”
Their end result, based on the most recent increase in the number of cases: The nation would need 928,000 contact tracers to keep up with the current number of cases – or 282 per 100,000 people.
But this projection, which takes into account many factors, is widely considered unrealistic. The current number of plotters, according to Johns Hopkins data, is 70,500.
“If we could get to almost half the ideal number, that would help a lot,” said Dr Amanda D. Castel, professor of epidemiology at George Washington University. “With luck, the vaccine will start to reduce the need.”
Most states don’t even come close to 140 plotters per 100,000 population. With 530 active tracers, the District of Columbia has 75 per 100,000 population, more than any other state. Fifteen states have 12 or less per 100,000. And the number of people who have received two doses of the vaccine is not yet large enough to significantly reduce the rate of infection.
State and county health departments are keenly aware of the deficit and have decided to hire more tracers or deploy existing state or county employees to this task. Maryland, for example, has hired several hundred tracers in the past three months and has as many as 1,550, said Katherine Feldman, director of contact tracing for the state. That still only comes down to 26 plotters per 100,000 people.
California recently moved 2,680 state employees to increase the 9,800 county-based plotters, bringing the total to 12,500 in a state of 40 million people. That’s 31 tracers per 100,000 people.
Nationally, states have hired about 17,500 tracers since October, according to data from Johns Hopkins.
Biden recommended hiring contact tracers and other public health workers as part of his proposed $ 1.9 trillion COVID-19 relief and recovery plan.
Those hired would keep their jobs once the pandemic subsides, to improve the country’s permanent public health corps and preparedness. The president’s proposal, however, does not specify how many people hired would initially be deployed for contact tracing. Administration officials did not respond to requests for comment on this point.
Last week, a group of Republican senators proposed a reduced $ 618 billion COVID-19 relief plan that includes resources for vaccine distribution, testing and tracing, but makes no mention of a body of public health services.
David Cotton, vice president of public health research at NORC, the University of Chicago investigative and research body that assists Maryland with its program, said that although the tracers did not Need medical or public health background, hiring and training the right people and nurturing their skills is not something to be taken lightly.
“The success of tracing depends on having people in the job who can gain people’s trust,” he said. “Plus, the job can be quite emotionally draining.”
States are also adapting their programs.
In Maryland, we shortened the questionnaire and prioritized geographies with high positivity rates. People also receive text messages inviting them to answer our first calls. These measures have sharply reduced a backlog of cases, Feldman said.
Nationally, traditional research programs successfully reach about 65% to 75% of people who test positive and 55% to 60% of contacts. Those numbers likely tend to drop over the past six weeks after the recent increase in the number of cases, experts and state officials said.
But no one knows for sure. This is because there is no national reporting requirement or strategy for tracing actions, and only 14 states release complete data on their tracing programs to the public.
This story was produced by Kaiser Health News, a nonprofit news service covering health issues. This is an independent editorial program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente. The story has been republished with permission.