STATES SCRAMBLE to hire enough contact tracers.
States need thousands to trace infections, but most agencies are understaffed
ATLANTA — As state after state begins to reopen, local health departments charged with tracking down everyone who has been in close contact with those who test positive for the new coronavirus are still scrambling to hire the number of people they need to do the job.
They are often hundreds — even thousands — of people short of targets for their contact tracing programs. Public health experts have consistently said robust programs to test more people and trace their contacts are needed for states to safely reboot their economies and prevent a resurgence of the virus.
Cook County, Ill., has just 29 contact tracers serving 2.5 million people living in suburban communities around Chicago. Los Angeles County, which at more than 10 million people has a population slightly greater than Michigan, has just 400 of the estimated 6,000 contact tracers it will need under California’s criteria for a broader reopening.
With 2.7 million residents and roughly 100 to 300 new covid-19 cases a day, Miami-Dade County has 175 people tracking down people who were potentially exposed to the virus.
“The whole point of the lockdown was to buy time to have a better way to keep numbers down,” said Jeremy Konyndyk, who led the humanitarian response to the Ebola outbreak in West Africa during the President Barack Obama administration. “And that’s why so many of us are screaming ourselves hoarse about testing and tracing.”
Public health experts say contact tracing systems should be in place before cases become widespread, so every new infection can be tracked and the person’s contacts identified, tested and isolated from the rest of the community.
Until recently, there had been scant federal guidance on what contact tracing should look like, and there is still no coordinated federal strategy. While other countries are taking a national approach to contact tracing, the U.S. is leaving it to states to devise their own programs.
The result has been a patchwork of efforts. An AP review in late April found little consensus among states on basic questions such as how many investigators are needed.
During congressional testimony last week, the nation’s top infectious disease expert, Dr. Anthony Fauci, reiterated his concern that parts of the U.S. might be easing restrictions too early without having the ability to respond effectively to an increase in cases with “good identification, isolation and contact tracing.”
The next day, the Centers for Disease Control and Prevention released general guidance to states on contact tracing. It said the number of case investigators and contact tracers needed in each community “may be large” and will vary, in part due to caseloads.
The document was released two-and-a-half weeks after Georgia and other states began lifting restrictions. It included recommendations on how to prioritize cases when staffing is limited and said communities that don’t have the capacity to investigate a majority of their new cases will have to consider reinstating measures such as stay-at-home orders.
A few states, including Utah, made contact tracing a priority before beginning to ease restrictions. In early April, Massachusetts launched a $44 million effort and enlisted Partners in Health, a Boston-based nonprofit known for its health care work in developing countries, to hire and train 1,600 people. They were to supplement the more than 600 case investigators already doing the work at the local level.
“If anything can be learned from Massachusetts’ experience, it’s that the process takes time and states need to start ramping up their contact tracing efforts well before reopening their economies,” said Dr. Joia Mukherjee, chief medical officer at Partners in Health. “We should have done this on day one.”