Contact tracing would be critical in new wave
Connecticut sustained one of the lowest rates of COVID-19 infections in the country through the summer, but the recent increase in test positivity and hospitalizations has revealed the fragility of this position.
The recent outbreak in Danbury and Three Rivers nursing home should be viewed as warning signs of what might lie ahead. Each outbreak is an ember on dry tinder — many will subside on their own, but the risk of widespread transmission of the virus remains.
At this time, we must examine our ability to respond effectively to large numbers of COVID-19 infections. With no vaccine or definitive treatments for COVID-19, public health measures like contact tracing, mask wearing and social distancing are the keystone interventions to curbing the spread of the virus.
Contact tracing is a tried-and-true intervention for controlling infectious disease. When an individual is thought to have a disease, all the people that person has been in contact with whom are at risk of being infected are contacted, told to isolate themselves from others to prevent further transmission and may undergo additional testing or symptom monitoring.
When COVID-19 first emerged in Connecticut and was at its highest level of transmission, there was no statewide contact tracing response because the vast number of cases overwhelmed the limited public health staff. Connecticut established a statewide contact tracing system in June, when COVID-19 cases were substantially lower than during the peak of transmission.
While our neighboring states of New York, New Jersey and Massachusetts hired thousands of additional workers for their contact tracing programs, Connecticut considered utilizing volunteer workforces
and ultimately decided to defer the work of contact tracing to the staff at local health departments. This strategy has been effective through the summer, and the state has met goals for calling contacts of those who test positive for COVID-19 in a timely manner.
Relying on the already limited staff of local health departments, however, raises significant concern for this system’s capacity to keep up if the number of COVID-19 cases continues to increase in the coming weeks. We must remember that local health departments, already chronically understaffed and underfunded, must continue to provide all their core services of monitoring food-borne illnesses and sexually transmitted infections, providing health screenings and providing services for substance use while
also addressing the new challenges of COVID-19.
Even though contact tracing is simple in theory, it requires a huge amount of human resources. Each phone call may take 15 minutes to an hour. Each person with COVID-19 may have between five and 30 clinically significant contacts, meaning that even small increases in the number of cases of COVID-19 increases the amount of contact tracing work by an order of magnitude. To illustrate this, if Connecticut were to have an increase in daily COVID19 cases from 150 per day to 300 per day, and each case has on average 15 contacts, 2,250 additional contacts would have to be reached every day. If cases continue to rise through the fall, local health departments will not have the staffing to effectively trace contacts and mitigate further spread of the coronavirus. Volunteers could only offer limited and temporary relief, as college and professional students have returned to their studies and many individuals who would be willing to engage with this work would only be able to do so if they were paid.
To face a future rise in COVID-19 cases, we must look critically at the state’s response in March and April when there was widespread community transmission. Effective contact tracing was infeasible because of limited staffing available to do this critical work. While testing capacity has increased since then, there is substantial risk that the current COVID19 contact tracing program, relying on already strained public health infrastructure, would be overwhelmed if cases were to increase.
Without effective and quickly scalable contact tracing, more draconian measures like lockdowns may be necessary to curb transmission of the virus. Connecticut must look to its neighbor states, who have successfully funded and hired an expanded, specially trained contact tracing workforce. The benefit of this strategy is two-fold — the capacity to respond to larger numbers of COVID-19 cases is extended, and it would offer a muchneeded employment opportunity to many Connecticut residents at a time when unemployment remains high.
We may hope that a second wave of COVID-19 never comes, but we must be ready if it does. Expanding the contact tracing workforce is a vital an urgent component of this preparedness. Our lives, and the lives of our loved ones and our neighbors, depend on it.