A number of states facing worsening outbreaks of the coronavirus have not created robust contact tracing programs to help contain the spread, despite having bought weeks or months of time to prepare via costly stay-at-home orders.
Nor have the governments in question made public the details of their contact tracing programs, which identify people who may have come into contact with an individual diagnosed with the coronavirus and instruct them to self-quarantine. None of the states’ governors or health departments responded to inquiries from the Washington Examiner asking them to lay out the status of contact tracing in their states.
The Florida health department, for example, has not published plans to trace new cases across the state or to provide resources for county health departments to trace new cases. Meanwhile, the number of cumulative COVID-19 hospitalizations in Florida jumped from 9,424 on Memorial Day to 12,389 on Wednesday.
Public health systems in every state are struggling to keep track of each new positive test and potential contacts that an infected person had with others, Dr. David Celentano, epidemiology chair at the Johns Hopkins University Bloomberg School of Public Health, told the Washington Examiner. Individual counties, which have jurisdiction over their public health departments, “really haven’t yet put together the workforce that they need.”
“You know, you can look at places like New York, New Jersey, Connecticut, which really took the brunt of the COVID-19 epidemic, and they have trained out thousands of contact tracers,” Celentano said. “The same cannot be said of Florida, Texas, North and South Carolina. They’re all lagging, and it really is a function of the governors not making this a priority, and the counties don’t have the resources.”
Florida Gov. Ron DeSantis and other governors have argued that higher daily cases indicate that more people than ever are getting tested for the coronavirus, not because more people are getting sick. If that were the case, Celentano said, the number of positive tests would flatten and eventually decrease. However, almost half of the country is experiencing an increase in the rate of positive coronavirus tests. DeSantis, for instance, never published the criteria he followed ahead of reopening Florida, and a Miami Herald investigation found that a recent upward trend in cases could not be traced to more expansive testing.
North Carolina’s positive testing rate has stabilized at about 7.3%, but the state has only one contact tracer for each daily positive test. Arizona has a positive testing rate of more than 17%, up from 15.8% on Monday, and has less than one contact tracer for every positive test. The number of tracers needed to track new coronavirus cases effectively is between five and 15, according to data compiled by health policy experts at COVID Exit Strategy.
The Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials estimated in April that 100,000-300,000 contact tracers are needed to track new cases and contain outbreaks. In total, the United States has about 40,000 contact tracers, and only 16 states have hired more than 500 contact tracers, according to research from #TestandTrace, an organization that aims to accelerate the use of testing and contact tracing to eradicate COVID-19.
Other countries, such as Japan and Germany, have used contact tracing to curb the spread of the coronavirus. In March, German health departments began recruiting non-government workers to join contact tracing teams. The German government is working to put about 21,000 new tracers to work, about five tracers per 20,000 inhabitants. According to Bloomberg, Germany’s early investment in contact tracing has set the country up to repress any new infection as reopening continues.
Japan was able to avoid overwhelming its hospital system even without extensive testing and lifted its state of emergency on May 26, thanks to an aggressive contact tracing system, the Asia Times reported. Japan has reported fewer than 950 deaths and about 17,500 cases.
In the U.S., states that have endeavored to build up contact tracing infrastructure by hiring staffers to track new cases, such as Louisiana, which now has 700 tracers, still rely on responsiveness of their people. Contact tracers can’t guarantee that they will get all of the information they need to track viral transmission.
“The problem that we have been experiencing here in Louisiana, and I suspect it’s not an uncommon problem in other states, is that not everybody’s picking up when they’re called,” said Dr. Susan Hassig, an epidemiologist at Tulane University.
Lack of responses can be attributed to fears that personal information will be made public, Hassig said, adding that “there’s a component of distrust” in government agencies. Louisiana Gov. John Bel Edwards, a Democrat, said last week that worries about privacy violations are “unfounded.” Meanwhile, Republicans in the state legislature are pushing for measures to make sure people can opt-out of providing information about people they potentially exposed to the coronavirus. For instance, the Republican-majority state House passed a resolution last week requiring contact tracers to tell people they speak to that participation is voluntary, according to the Advocate.
In an effort to bolster resident participation in contact tracing without having to hire hundreds of case investigators, states have teamed up with tech companies to develop apps aimed at tracking the contacts a person who has tested positive for COVID-19 made. This issue of privacy protection, however, has made potential users apprehensive. States have yet to figure out how to draw in enough users, which the Brookings Institution says is about 60% of the U.S. population, to make the tracking apps effective.
“I’m not sold on the concept that [the app] is really going to do much,” Dr. Celentano said.
Celentano added that health officials should alter the way they present themselves when calling people with something as simple as changing the way officials’ phone numbers appear on people’s phones instead of contracting with Big Tech companies to create apps. In Maryland, Celentano said, when a public health officer calls a resident, “COVID-19” comes up on the screen, rather than a phone number that the receiver won’t recognize.
“That’s probably helping,” Celentano said. “Identifying their call to link it with a health department or something that will get people to pick up is what’s essential. Just having an anonymous telephone number is not going to work.”
The pitfalls of contact tracing programs must be remedied as soon as possible before a potential second wave of the coronavirus, epidemiologists say. State leaders are unlikely to reinstate stay-at-home orders if new coronavirus cases increase further. The rise in cases across several states is still part of the first wave of the pandemic, Celentano said, and the first wave is not under control.
