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Contact trac­ing: Bay Area, de­spite strides, faces hur­dles in map­ping who is in­fected

San Francisco Chronicle - - FRONT PAGE - By Mal­lory Moench

The Bay Area’s ef­forts to track coro­n­avirus cases and pre­vent the spread of dis­ease are show­ing early signs of suc­cess, al­though plans to di­rectly contact a vast ma­jor­ity of peo­ple who tested pos­i­tive still face daunt­ing chal­lenges,

Many lo­cal coun­ties are ap­proach­ing their goal of con­tact­ing 90% of the re­gion’s pos­i­tive cases, while oth­ers are still scram­bling to ramp up their contact-trac­ing op­er­a­tions. De­spite those ob­sta­cles, the Bay Area’s early progress is en­cour­ag­ing, even as coro­n­avirus cases spike across the state.

The rel­a­tively high rates of contact re­ported by coun

ty health of­fi­cials com­pare fa­vor­ably with other met­ro­pol­i­tan ar­eas hit hard by the pan­demic. In New York City, for ex­am­ple, less than half of cases reached pro­vided in­for­ma­tion about their close con­tacts, ac­cord­ing to the New York Times.

De­spite th­ese early vic­to­ries, Bay Area health work­ers say ex­ten­sive chal­lenges lie ahead, es­pe­cially when it comes to iden­ti­fy­ing con­tacts with in­fected in­di­vid­u­als and over­com­ing so­ci­etal re­luc­tance to par­tic­i­pate.

“We knew early on that there were go­ing to be chal­lenges with ef­fec­tively do­ing case in­ves­ti­ga­tion and contact trac­ing with this num­ber of cases in a pan­demic of this scale,” said Dr. Nick Moss, act­ing di­rec­tor of Alameda County’s Di­vi­sion of Com­mu­ni­ca­ble Dis­ease Con­trol and Preven­tion. “This is re­ally un­prece­dented com­pared to what health de­part­ments are usu­ally do­ing.”

Contact trac­ing is one of the pri­mary pub­lic health tools used to break the chain of coro­n­avirus in­fec­tion. Case in­ves­ti­ga­tors call peo­ple who tested pos­i­tive and work to quar­an­tine those in­di­vid­u­als, while also try­ing to iden­tify and contact oth­ers who may have been ex­posed. The end goal is cre­at­ing a data­base of cases and a road map to ex­po­sure and con­tain­ment.

It’s a chal­leng­ing job. Dr. Lu­cia Abas­cal pro­vides clin­i­cal sup­port to a team of San Francisco contact trac­ers, draw­ing on her bilin­gual skills to cold­call strangers. But that doesn’t mean they’re will­ing to talk.

Even if peo­ple with the virus, and their sub­se­quent con­tacts, pick up the phone, they may be re­luc­tant to give per­sonal in­for­ma­tion. Oth­ers worry about los­ing wages if they miss work, or live with fam­ily and can’t iso­late. One man wanted to make sure his in­for­ma­tion wouldn’t be shared with the fed­eral gov­ern­ment be­cause his wife is un­doc­u­mented.

Here’s how Bay Area coun­ties are cop­ing with a va­ri­ety of those chal­lenges.

Work­force: Be­fore the pan­demic, lo­cal health de­part­ments staffed a hand­ful of contact trac­ers to track HIV or tu­ber­cu­lo­sis in­fec­tions. When COVID­19 hit, the state and coun­ties em­barked on a huge mis­sion to mul­ti­ply that work­force. Health de­part­ments filled emer­gency staffing needs with vol­un­teers, county work­ers and state em­ploy­ees.

UCSF has trained thou­sands of contact trac­ers per week for San Francisco and the state. The Cal­i­for­nia De­part­ment of Pub­lic Health set a goal of 10,000 contact trac­ers by July 1. So far, that num­ber in­cludes 3,000 county em­ploy­ees and 3,300 state work­ers de­ployed to coun­ties for six to nine months.

The state set a goal of 15 trac­ers per 100,000 res­i­dents in each county, which some Bay Area de­part­ments al­ready ex­ceeded. San Francisco, Santa Clara, San Ma­teo, and Alameda are able to track nearly all cases with their cur­rent work­force, but are prep­ping for a pos­si­ble case surge.

Alameda County’s 83 contact trac­ers were able to reach about 85% of cases as of Wed­nes­day. They even­tu­ally want 300 work­ers, but it can take a month for train­ing. Santa Clara is still hir­ing and wait­ing for more state em­ploy­ees. San Ma­teo is ready to re­pur­pose state work­ers.

Other coun­ties haven’t met their goals yet and are fac­ing pres­sure to keep up. Marin County, which was swamped with new cases this week, reached 70% of con­firmed cases and only 46% of their con­tacts in the past two weeks.

“We’re get­ting snowed a lit­tle bit,” said Marin County Deputy Health Of­fi­cer Dr. Stephen A. Mccurdy. At one point ear­lier this week, he was one of only three work­ers mak­ing calls as the rest were trained on a new state soft­ware, which he said had some hic­cups. The county cur­rently has 39 contact trac­ers and wants to get to at least 50.

Con­tra Costa County con­tacted 74% of con­firmed cases and 68% of their con­tacts in the first three weeks of June. The big­gest hur­dle is staffing, as re­de­ployed county em­ploy­ees re­turn to day jobs and new staff trac­ers are hired, spokesman Will Harper said. By the end of the week, the county will have 146 contact trac­ers, Pub­lic Health Di­rec­tor Anna Roth said Tues­day, with a goal of 173 by Au­gust.

Pri­vacy: The first hur­dle contact trac­ers face is sim­ply get­ting in touch with peo­ple and con­vinc­ing them to par­tic­i­pate.

Mccurdy of Marin County said data on con­firmed cases from test­ing sites can take up to a week to come in. In Alameda, contact in­for­ma­tion is some­times spotty, with­out a phone num­ber or ad­dress, said Pub­lic Health Di­rec­tor Kimi Watkin­sTartt.

Even if contact trac­ers have a num­ber, not every­one an­swers an un­known in­com­ing phone call. Santa Clara County’s main lim­it­ing factor in reach­ing most, but not all, cases, is the will­ing­ness of the pub­lic to share in­for­ma­tion, a spokesman said.

Tech­nol­ogy could pro­vide an answer to that prob­lem. The state re­cently rolled out a new track­ing sys­tem called CalCONNECT, which five Bay Area coun­ties are us­ing. The pro­gram lists the caller ID on contact trac­ing calls as “CA COVID Team” and can also text and email. San Francisco uses soft­ware from a com­pany called Dimagi for sim­i­lar pur­poses.

Ap­ple and Google teamed up to de­velop a contact trac­ing app to help no­tify peo­ple of their ex­po­sure, but Cal­i­for­nia state and county contact trac­ing pro­grams don’t use any cell phone track­ing tech­nol­ogy yet.

For now, contact trac­ers may try the num­ber of a con­firmed case three times over the course of two days. Once some­one picks up the phone, San Francisco’s re­fusal rate to par­tic­i­pate is less than 2%. Marin County’s Mccurdy said peo­ple have im­me­di­ately hung up on him.

Contact trac­ers also never ask for So­cial Se­cu­rity numbers, bank ac­count in­for­ma­tion, or im­mi­gra­tion sta­tus, but some­times still need to re­as­sure peo­ple it’s not a scam and per­suade them to com­ply.

“They have to see it’s not just in their best in­ter­est, but in the in­ter­est of the com­mu­nity,” Mccurdy said.

New York City is start­ing to knock on doors to reach more peo­ple. Dr. An­thony Fauci, di­rec­tor of the Na­tional In­sti­tute of Allergy and In­fec­tious Dis­eases, said Fri­day that Pres­i­dent Trump’s coro­n­avirus task force is con­sid­er­ing ways to beef up contact trac­ing in per­son, the New York Times re­ported.

Sup­port: Even when peo­ple are on board with the idea of stay­ing at home, many who are most vul­ner­a­ble to the virus can­not do so safely if they live with oth­ers or can’t miss work. In San Francisco, only about 60% of peo­ple con­tacted through the pro­gram could ad­e­quately self­iso­late.

Contact trac­ers con­nect those iso­lat­ing with county so­cial ser­vices who can pro­vide ho­tel rooms and ar­range for food de­liv­ery. San Francisco also drops off medicine and clean­ing sup­plies to some peo­ple in quar­an­tine.

Marin County of­fers disas­ter re­lief pay­ments of up to $1,500 per in­di­vid­ual and $2,000 per fam­ily for in­di­vid­u­als iso­lat­ing who tested pos­i­tive. Mccurdy wants to see it ex­tended to peo­ple who quar­an­tine to mon­i­tor symp­toms.

A San Francisco pro­gram to give cash as­sis­tance to peo­ple who don’t qual­ify for fed­eral aid or paid sick time is in the late stages of de­vel­op­ment.

“The health de­part­ment has a re­spon­si­bil­ity to en­sure that our most vul­ner­a­ble cit­i­zens have ac­cess to re­sources,” said Dr. Darpun Sachdev, case in­ves­ti­ga­tion and contact trac­ing unit chief for the San Francisco De­part­ment of Pub­lic Health.

Cul­ture: The virus has dis­pro­por­tion­ately af­fected com­mu­ni­ties of color: In San Francisco, Lati­nos ac­count for half of the in­fec­tions in San Francisco de­spite mak­ing up only 15% of the pop­u­la­tion. More than half of contact­trac­ing calls are con­ducted in Span­ish. Sachdev at­trib­uted the county’s rel­a­tive suc­cess to the di­ver­sity of its staff such as Abas­cal, a Mex­ico na­tive who uses her lan­guage and cul­tural knowl­edge to build trust with other Lati­nos.

As coun­ties look for more contact trac­ers, they’re turn­ing to or­ga­ni­za­tions that speak the lan­guage and un­der­stand the cul­ture of vul­ner­a­ble com­mu­ni­ties. Alameda County is con­tract­ing with lo­cal health clin­ics. Santa Clara County wants to hire 65 peo­ple to ad­dress the needs of dis­pro­por­tion­ately af­fected groups. San Francisco al­ready trained four staff mem­bers from In­sti­tuto Fa­mil­iar de la Raza, a Latino or­ga­ni­za­tion in the Mis­sion District that can build on ex­ist­ing re­la­tion­ships to over­come the com­mu­nity’s mis­trust in the health sys­tem, said Rafael Velázquez, the cen­ter’s HIV ser­vices pro­gram di­rec­tor.

“The contact trac­ing for us is ab­so­lutely a pri­or­ity in terms of how we con­tin­u­ously flat­ten the curve and re­duce trans­mis­sion,” said Jon Ja­cobo, chair­man of the health com­mit­tee on San Francisco’s Latino Task Force. “We un­der­stand very well that com­mu­nity led ef­forts will al­ways have bet­ter re­sults be­cause the level of con­nec­tion is deeper than that of a gov­ern­ment agency.”

Paul Chinn / The Chron­i­cle

Dr. Lu­cia Abas­cal, a contact tracer, in­ter­views COVID­19 pa­tients from her San Francisco home.

Paul Chinn / The Chron­i­cle

Dr. Lu­cia Abas­cal pro­vides clin­i­cal sup­port to a team of San Francisco contact trac­ers. She uses her bilin­gual skills to cold­call peo­ple, but that doesn’t al­ways mean they’re will­ing to talk.

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