David J. Phillip / AP
The country needs as many as 100,000 contact tracers to fight the pandemic, the director of the Centers for Disease Control and Prevention told Congress in June. We need billions of dollars to fund them, public health leaders asked in April.
But in August, with coronavirus cases rising in more than half of the states, America did not have the staff or the resources to trace the contacts of each new case – a key step in the public health response. of COVID-19.
Call each contact tracers who have only tested positive and monitor their contacts to let them know their risk so they can be quarantined. They also often connect people with services to securely isolate. It takes manpower, time, and organization, but it has proven to be effective in controlling infectious diseases.
Despite some enthusiasm about tracking contact early in the pandemic, the strength of US-based communications continues to fall in anticipation. The latest NPR survey in all 50 states, conducted in collaboration with the Johns Hopkins Center for Health Security, found national workers have barely grown since mid-June. A previous survey found a total contact tracing workforce of 37,110.
The new survey found that by the end of July, 45 states and Washington DC had a workforce of 41,960. The actual sum is likely to be higher, as many states do not respond despite numerous requests, and 12 states indicate that their counts do not include county and local staff.
More than two-thirds of states use a bank of trained reserve staff to take on contact monitoring duties as needed; the 7,580 reserve staff number was a third smaller than six weeks ago. Eleven states say their contact tracing workforce includes unpaid volunteers.
“Slow growth” is how Danielle Allen described the numbers of workers. He is the director of the Edmond J. Safra Center for Ethics at Harvard University, and a co-author of a COVID-19 policy handbook. “We only reached half of our national goal for the amount of staff we should have in the area,” he said. “100,000 [contact tracers] the base the country needs and should always have going forward – forever. COVID or no COVID. “
Crystal Watson of the Center for Health Security, who cooperated with NPR in the survey agrees. “Interaction seems to have stalled – or has become less of a priority in many places,” he said. “That is – in many cases – understandable, given the case numbers we see, but I think it is still very important to have such workers in place.”
Only four states – Alaska, Maine, New Hampshire, and Vermont, along with Washington, DC – currently have enough workers to investigate their coronavirus cases, according to an NPR review of how demand matches in contact with staff. Three more states – Michigan, Montana, and Hawaii – are sufficient when reserve staff is included. And 38 states do not have enough.
The analysis, based on state case counts over the past 14 days, was conducted using the Contact Tracing Workforce Estimator developed by The Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University. As of June, NPR assumes that workers call 10 contacts per case and tracers reach 45% of the contacts and follow them daily. It is a conservative estimate, to reflect the real challenges in the world that health workers face.
Cases of surge and testing delays prevent efforts
High cases belonging to many states across the country are likely to contribute to staffing shortages. In Texas, Florida and California, for example, the NPR analysis suggests nearly 30,000 contact tracers will be needed in each state to maintain current spread.
“It doesn’t make sense to expect that kind of work,” Watson said. “What is really needed now is for the political leaders to take action to erase the curve again – lower the case numbers to a place where we can meet the demand with capacity for contact tracking.”
Nine states have reported that they need to adjust contact tracking operations due to an increase in cases or delays in testing. Under those conditions, it is more difficult for health workers to identify people who may be contagious and prevent them from exposing others.
“Increasing number of cases and rotating hours hinders our ability to slow the spread through contact tracking,” wrote Jane Yackley of the Tennessee Department of Health, in response to the NPR survey. In the NPR review, Tennessee will need seven times more contact tracers to maintain current transmission costs.
Watson said he has heard a lot of despair from public health workers in recent weeks. “I think the public health officials are tired and very discouraged and they feel that some officials are teaching contact monitoring as a public health failure,” he said.
In the midst of a case surge, other tactics may be more important – such as mask mandates, residence orders and closure or business restrictions. But Watson calmed down that contact tracking is still critical in the long run. Right now, he says, “contact tracking is not ‘the answer’ – it is a tool we must do to manage the pandemic in an ongoing way.”
A failure to share important data
Contact tracking is not only a tool for slowing down the spread of a virus, it is also an important source of data about where transmission occurs, which can be used to inform policy and educate the public. But most NPR survey states do not publicly share contact tracking data they collect.
“There was a big push in test data, there was a big push in demographic data,” Allen said, noting that the quality and transparency of public data in those two areas has improved a lot. Now, he says, contact tracking data requires a similar “serious push to get to a place where a common set of indicators is reported, and everyone understands that it is important to report that information to the public, the same way you report information to the public. “
According to the survey, most states are collecting data about how quickly and fully contact tracers successfully reach new cases and their contacts. This data may offer clues about whether more tracers, or public awareness campaigns, are needed.
Just under half of the states also reported data collection about how many contacts ended up testing positive for coronavirus, including how many new cases were linked to known positives. That information – including the data gathered from conversations with contact tracers about where people think they might be exposed to the virus – can provide valuable insight into what drives delivery.
“We all have a hard time understanding how to better control the spread of this virus,” Watson said. “I think a really important reason to share this information is for others to learn from it.”
But few states have reported to NPR that this information is available to the public on a government website. One of them is Utah – there, the public information transmission shows that 65% of cases are related to a known case, and of those, 59% came from household contacts, rather than a workplace or social. Louisiana public delivery information focuses on the location of community uprisings, and shows that bars and restaurants are tied to most uprisings, even account of food processing in food processing for most cases.
Allen notes that the public health system in this country is being pushed to adapt quickly to pandemic demands. “Work is needed to maintain your contact tracking programs, to boost expertise,” he said. “[We’re] taking a conventional public health procedure and doing it on a scale. I think of this as converting from using a network of country roads to using interstates. “
He added that governments – from the federal to the local level – need to do this work on top of continuing to build test capacity, developing effective therapies, and so on. “It’s really strenuous across different dimensions,” he said. “And we really need to get our mind and heart to accept it – and take care of our will by doing hard work.”
A positive sign, Allen pointed out, is that nearly three quarters of the state responded to the NPR survey report that they still plan to hire more contact tracers. “We have to keep building,” he said. “We should not stop here.”
Jessica Craig, Blake Farmer, Anh Gray, Jake Harper, Natalie Krebs, Aviva Okeson-Haberman, Troy Oppie, Alex Smith, Ruth Talbot, Sam Whitehead, and Julia Wohl contributed to this report.