California is spending more money on COVID-19 contact tracing, but is it too late?

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Intensive contact tracing has helped contain COVID-19 outbreaks in some Asian countries. People test positive, they are quarantined, and people they have been in contact with are tracked down and asked – or, in some countries, forced to – quarantine as well.

The United States has spent billions on contact tracing, and California alone will have spent $300 million on it in the next fiscal year. But researchers found that 2 of 3 people with confirmed COVID-19 in the United States were not contacted or did not name contacts during the interview, and public health authorities were not able to monitor enough cases to stem the tide.

Now, as the pandemic enters its third year, the highly contagious omicron variant is spreading like fire through dry grass. The incubation period can be as short as two days. The Centers for Disease Control recommend isolation for as little as five days. More and more people are testing at home — the cases authorities aren’t even counting in their tallies — and some officials are raising their hands and suspending contact tracing.

“(T)omicron’s speed of transmission means people are exposed, infected and then contagious before the local health department can even identify an outbreak, let alone notify those who are exposed,” officials said. Multnomah County in Oregon. “Because of this dynamic, contact tracing has become much less effective in reducing the risk of COVID-19, especially when cases are rising so high and when spending time in an indoor public space is essentially considered exposure for anyone is not up to date. -date on their vaccines.

Decreasing financial commitment

Financial commitment for contact tracing in California appears to be declining, but remains. The governor’s proposed budget shows $258.3 million spent on contact tracing in the first two years of the pandemic, and another $38.9 million through the end of the next fiscal year.

Current and future spending breaks down into a projection of $20.6 million for this fiscal year and $18.3 million for next fiscal year, said Sonja Petek, senior finance and policy analyst for the Office of the legislative analyst.

Riverside County Contact Tracing Program Coordinator Juan Landeros-Tavera makes a call Friday morning, July 17, 2020 from the County Administrative Center in downtown Riverside. (Photo courtesy of Riverside County)

“Contact tracing remains one of our many key tools in responding to the spread of COVID-19,” said a statement from Governor Gavin Newsom’s press office. “It is also an important measure used in high-risk and congregational settings. Contact tracing helps notify exposed individuals of possible post-exposure treatment, testing and quarantine in a timely manner.

Overall, Newsom’s budget proposes $110 million to increase public health and humanitarian efforts at the California-Mexico border — including vaccinations, testing, isolation and quarantine services — “and the expanded statewide contact tracing activities to help keep Californians safe and slow the spread.

Currently, 268 state employees have been redirected to contact tracing efforts, the governor’s press office said. But experts aren’t sure the investment will bring big returns – at least not yet.

Climb uphill

“As increasingly higher levels of COVID-19 transmission occur in a community, the importance and effectiveness of contact tracing diminishes and outstrips the ability of health services to effectively conduct such tracing. in a timely manner when staff are overwhelmed by the large number of cases,” Dr. Robert Kim-Farley, professor of epidemiology and community health sciences at UCLA’s Fielding School of Public Health, said by mail. electronic.

“Furthermore, with such asymptomatic spread, contact tracing of known cases becomes a smaller part of the total transmission occurring in the community. Under these circumstances, everyone should take heightened precautions (e.g. vaccination, masking and testing) assuming that some of the people they come into contact with may be infected.

Kim Farley is not alone.

The CA Notify app can send notifications to a user’s mobile phone to alert them if they have been near someone who has tested positive for coronavirus. (Photo by Leonard Ortiz, Orange County Register/SCNG)

“Omicron has an average incubation period of about three days,” said Dr. John Swartzberg, clinical professor emeritus in UC Berkeley’s division of infectious diseases and vaccinology, via email. “Individuals can be contagious for up to 48 hours before becoming ill. Thus, many infected people will spread the virus within a day or two of being infected. This would represent a time challenge for effective contact tracing. »

Andrew Noymer, an epidemiologist and demographer at UC Irvine, agrees.

“It is now widely understood that omicron is the most contagious COVID variant to date,” Noymer said via email. “I think how its shorter incubation period (which is probably not unrelated to contagiousness) works synergistically to drive the explosiveness of the current omicron wave is underestimated. Which brings us to the question of contact tracing.

“Public health experts are often loath to denigrate the usefulness of contact tracing because it is a fundamental tenet of our field. But the sheer contagiousness of omicron, along with its shortened incubation period, both affects the margin of error for contact tracing on a case-by-case basis and really cripples it overall. At this time, doubling down on contact tracing is not where I would allocate additional resources. The money is better spent securing N-95 masks for those who want to wear them, who aren’t already, and making testing available to safety-net populations.

Richard Carpiano, a public health scientist and medical sociologist at UC Riverside, laments the nation’s underinvestment in vital pieces of the pandemic puzzle — especially clear communication and public education to combat rampant misinformation and misinformation — and believes passionately that we need to direct more money there.

SOURCE: OFFICE OF THE GOVERNOR

Before

Much of the work is done at the county level. San Bernardino County, for example, has spent $16.5 million on contact tracing through the end of 2021 and has 183 contact tracers on staff. That’s down from the 440 plotters it had at its peak, spokesman David Wert said.

The omicron push may hurt the effectiveness of contact tracing now, but Berkeley’s Swartzberg has hope for the future. The injection of money will allow the government to make contact tracing more robust, and “as the number of omicron cases decreases, contact tracing should become a much more powerful public health tool”, a- he declared.

Dr. George Rutherford, professor of epidemiology and biostatistics at UC San Francisco, is also in this camp.

“Once we hit the milestone in the next two weeks, contact tracing will be feasible again,” Rutherford said by email. “I would probably focus primarily on schools.”

In total, California expects direct COVID‑19-related expenditures—testing, contact tracing, vaccine distribution and administration, increased hospital and medical expenses—to total $3.2 billion this year. fiscal year and $1.3 billion in the next fiscal year, according to the latest legislative analyst report. analysis.

The governor’s budget matches the state’s total response to the pandemic — including items like medical supply purchases, housing for the homeless, food programs and support for small businesses — at 9, $5 billion. Of this amount, about $235 million, or about 2.5%, was spent on community engagement.

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