‘We should have gotten on this earlier’: Public health experts warn US lag in contact tracing could delay comeback

The number of coronavirus contact tracers in the United States is far short of what public health experts say is necessary to track new cases and expedite a return to a more normal life.

The public health workforce needs to add about 100,000 volunteers or paid employees to carry out widespread coronavirus case tracking, according to public health experts at Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials. A survey by NPR, however, found that states and the District of Columbia have hired or will hire only about 66,000 tracers in total.

Jeremy Konyndyk, a senior policy fellow at the Center for Global Development and former director of the U.S. Agency for International Development’s Office of U.S. Foreign Disaster Assistance under President Barack Obama, said a contact tracing system should have been implemented by the federal government when the first cases of COVID-19 arrived in the U.S.

“We should have gotten on this earlier, and I think we didn’t partly because we’ve really neglected public health capacity in this country for a very long time. … And it was very hard for local public health departments who actually do most of the actual legwork on this to keep up,” Konyndyk told the Washington Examiner.

Dr. George Rutherford, an epidemiologist at the University of California San Francisco, said 100,000 tracers were still too few, given the high rate of infection in the U.S.

“It’s more about the number of cases,” Rutherford said. “That’s what determines the need.”

Rutherford is the lead investigator of contact tracing at UCSF and launched the UCSF Pandemic Workforce Training Academy, which works in partnership with the California Department of Public Health to train new contact tracing staff. Instructors at UCSF will work with representatives from 58 counties and health departments in the state to train people from each jurisdiction who want to become tracers. The academy is currently training about 10,000 candidates, who will soon do what tracers have done in numerous past epidemics: Connect newly infected people to treatment services as well as alert contacts that may have been exposed and should get tested and self-isolate.

The process of contact tracing helped eradicate smallpox in 1980. Health authorities were able to find infected individuals and isolate them and then gradually vaccinate the surrounding population and those at highest risk of getting sick. Contact tracing is also effective at disrupting the spread of HIV by alerting people at risk of infection that they should get tested for the virus and take caution in the future.

The hope is that, with a sufficient army of contact tracers, the U.S. could handle the virus the way that South Korea, Singapore, and some other Asian countries have been able to, allowing for more normal economic and social conditions.

South Korea, which experienced a severe outbreak in mid-February, was able to flatten its curve within about 30 days without imposing stay-at-home measures like those in the U.S. Once a person tested positive for the virus, physicians retraced the patient’s steps and interviewed anyone the patient contacted who could have been exposed to the virus. Health experts were able to map networks of viral transmission early and quickly, giving people the confidence to go about their lives with less fear of getting infected.

Favoring aggressive contact tracing as a pro-business measure, billionaire investor Mark Cuban has championed hiring millions of newly unemployed workers to become contact tracers.

“Explain to me why in the midst of 50m people unemployed or under-employed, the gov isn’t hiring and training MILLIONS to do Tracking/Tracing, Caring/Supporting at risk populations and sanitization work?” Cuban tweeted this month.

The federal government has allocated trillions of dollars to help businesses and families recover from the economic impact of the pandemic. Konyndyk said spending money early on to bolster tracing to limit the fallout would have paid enormous dividends.

“When you consider the amounts of spending to keep the economy afloat right now, just to throw a few billion dollars at contract tracing, which is one of the things that could be a key to reopening and reducing our need for emergency economic support. … That would be a huge return on a pretty small investment,” he said.

More than 1,540,000 people in the U.S. have been infected, and tracing that many cases will be daunting. Rutherford said interviews with patients take about one hour each, and tracers usually have to contact at least three people who may have been exposed to the virus through a single patient.

To make a dent in that astronomical case count, Konyndyk said, the government will need to take a “targeted” approach. The South Korean government relied on digital surveillance and smartphone data to cut the number of cases in a matter of weeks. Americans would likely be less willing to adopt a similar surveillance measure.

The federal government set aside some funding to boost contact tracing systems in different states as part of the CARES Act, a $2.2 trillion cash infusion passed in March, but has yet to enact a nationwide contact tracing initiative. State public health officials, Konyndyk said, are ill-equipped to do the job that the federal government should have started months ago.

“It’s not clear how well these [statewide] findings are going to link together at a national level, and there hasn’t been much better leadership or support for it,” Konyndyk told the Washington Examiner. “And so what I think we should have been doing is getting this ball rolling in March.”

While South Korea acted quickly once the first cases were reported, the U.S. waited weeks to ramp up testing capacity after the first case was identified in Washington on Jan. 21, and the Trump administration has not set mass tracing as a goal.

Individual states have launched their own tracing programs without a uniform standard for data collection put forward by the federal government, Konyndyk said. State health departments may be successful in compiling case tracking data, but relying solely on data from individual states will create “an inconsistent patchwork, which will be less effective in controlling the virus than if we had a more consistent, more integrated national setup.”

A national tracing initiative could help the U.S. avoid another uptick in cases this fall. Government health experts, such as infectious disease expert Dr. Anthony Fauci and Centers for Disease Control and Prevention Director Dr. Robert Redfield, have said a second wave of the virus later this year is possible.

“I see no evidence that this is slowing down. Whatever is going on in the rest of the country is keeping it at a fairly high plateau,” Rutherford said. “The real virtue will come when the case counts are low and there are small outbreaks that pop up, and this is a group that can get on them quickly.”

Epidemiologists told the Washington Examiner that testing and tracing is the best chance the U.S. has to return to normalcy, short of creating and distributing an effective vaccine. Until then, Rutherford said, “We’re treading water.”

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