Sun Sentinel Palm Beach Edition
Florida falls short in contact tracers
Work is seen as critical tool for reopening state
As Florida takes steps toward reopening, the state still falls short in a crucial category of disease fighter: contact tracers.
These are the ground troops in the fight against communicable diseases, performing the tedious but necessary work of locating each person with whom an infected person came into contact. Their goal is to ensure that individuals infected with or exposed to someone with COVID-19 isolate themselves for two weeks to contain a disease that passes easily from person to person.
But there are only 500 contact tracers for the entire state, far short of what experts say Florida needs to effectively contain the disease. Shamarial Roberson, deputy secretary of health with the Florida Department of Health, said there are no immediate plans to hire more. And it’s unclear how effectively the state is tracking down the contacts of infected people.
A report from the National Association of County and City Health Officials says states should have about 30 tracers per 100,000 people. The District of Columbia, Michigan, Nebraska and North Dakota plan to surpass that goal. But not Florida. Florida has 2.3 per 100,000.
The overall state average is 12 per 100,000, according to National Public Radio, which conducted a stateby-state survey. Other large states have vastly more than Florida. When accounting for planned hires, Texas will have 13.8 per 100,000 and California will have 25.3.
Massachusetts, with a third of the population of Florida, recently announced plans to hire an additional 1,000 workers just to conduct contact tracing. With those hires, the state would have close to 20 per 100,000 residents.
For Florida, the health official recommendation
would translate to a contact-tracing workforce of 6,450, a number that would require a major hiring effort. But that’s exactly the sort of massive increase that experts are calling for.
“We estimate the necessary contact tracing workforce needs to be expanded by 180,000 until such time as a safe, effective vaccine is on the market,” states an April 27 letter to Congress from 16 public health experts, including a former surgeon general and two former commissioners of the Food and Drug Administration.
A report by the Johns Hopkins University Bloomberg School of Public Health also calls for a huge national increase.
“In order to trace all contacts, safely isolate the sick, and quarantine those exposed, we estimate that our public health workforce needs to add approximately 100,000 (paid or volunteer) contact tracers to assist with this large-scale effort,” states the report.
Roberson, the deputy health secretary, said the state has 500 contact tracers, although not all are engaged full time in the COVID-19 response. Some continue to work on other infectious diseases. At least 230 are university public health students and faculty contracted to help, typically undergoing a few days of training.
Roberson said the state does not immediately plan to hire more contact tracers. “That will depend on the case numbers,” she said. “We are assessing the situation to see what we are seeing in Florida to make that determination.”
The state also does not have a plan at this time to incorporate technology to alert people who come into contact with someone who has the virus, she said.
Since the end of March, nearly 100 public health workers in New Mexico have spoken to more than 150,000 people as part of contact-tracing efforts to stem COVID-19. Roberson said her team of 500 has spoken to about 35,000, the total number of positives in the state.
Roberson said the Department of Health will monitor where new cases arise and reassign epidemiologists and contact tracers from less affected counties as needed.
Gov. Ron DeSantis gave contact-tracing some of the credit for the state’s ability to avoid the worst predictions for the epidemic.
“I think one of the reasons the outbreak hasn’t been as significant outside of southeast Florida is because they were doing the really tough work to contact trace, isolate the people that test positive and identify people who were in the contacts who may develop symptoms,” he said in the news conference where he announced plans to start reopening the state.
DeSantis said Florida’s health department already has built its ranks with students from public health schools. “We’re probably going to add even more if circumstances warrant it,” he said. “Contact tracing was always part of our strategy.”
But there’s evidence Florida’s contact tracing may not be comprehensive.
After contracting the disease, Larry Taylor, a CPA in Aventura, spent eight days on oxygen in late March at Memorial Regional Hospital. After being discharged, the state health department got in touch to ask questions.
“It wasn’t that detailed,” he said. “They wanted to know if I’d been out and about. I hadn’t been.”
Taylor suspects that he was exposed to the virus by a friend. He says the health department did not contact the person who he suspects gave it to him. “I think they’re scrambling out there,” he said.
Sheila Curren, whose husband Richard was the first to die of the virus at Atria Willow Wood, a Fort Lauderdale assisted-living facility that has seen a deadly cluster of infections, and who herself tested positive for the virus, has yet to be contacted, according to her attorney, Aaron Rothenberg.
“Currently the clients have not had contact tracing,” said Rothenberg, who is in the process of trying to prove that the Currens were infected at the nursing home. “It’s something we are having to do on our own.”
Roberson, the state’s deputy health secretary, also left unclear just how thoroughly contact tracers track down contacts.
Asked the total number of people in Florida who the contact tracers have reached, Roberson said the number is the total number of positive cases on the state’s online COVID-19 dashboard.
“We contact their contacts as needed,” she said. So what is the total? “We are assessing a metric for that number, but right now we don’t have that information to show individuals and how many secondary contacts because some of the fields,” she said. “It’s not like a straight number you can pull out of the system.”
Victory Bryant, a graduate student at Florida International University, who was part of a team of students bolstering Florida’s contact-tracing efforts, described how she did her job.
She informed the person on the other end of the phone that they had tested positive for the virus, something they usually already knew. But she does not call the people they came into contact with, but simply advises the infected person to do so.
“I ask them what places they went to, if they went to work and what symptoms they have,” she said. “I give them guidance on home isolation and answer their questions. I let them know they need to tell whoever they have come into contact with that they are positive.”
Lacking a vaccine or a cure, authorities have few effective weapons against the epidemic. That puts particular importance on the weapons that can be deployed, such as testing and contact tracing, especially as the state’s restaurants, stores and other enterprises respond to Gov. Ron DeSantis’ decision this week to start lifting the lockdown.
Once stay-at-home orders lift, every state will see more transmission and need more people to engage in contact tracing, said Crystal Watson, senior scholar at the Johns Hopkins Center for Health Security, and lead author of a report on contact testing and coronavirus.
“We need an unprecedented scale up of this workforce,” she said.
Once people return to work and become infected, public health officials will need to ask them to isolate at home while they are sick — and ask their contacts to do the same, Watson said. “Ideally we want to test contacts, but we don’t have enough tests to do that.”
“Some people may need access to medical care and supplies, groceries and other necessities. Financially, they may need to get back to work. They will need support from public health to not break quarantine.”
Watson said contact tracing is the key tool for keeping the outbreak to a minimum, for now.
“Unfortunately we don’t have many tools to control its spread. It’s novel and we don’t have a vaccine or treatment. This is the tool we have — cased based management of the virus. We either do that or we have social distancing at the population level,” she said.
“We will see cases of the virus continue to pop up until we have a vaccine,”
With contact tracing, close contacts are told to stay home and quarantine for 14 days.
“Aggressive case investigation will be really important to keep the numbers low,” said Mary Jo Trepka, an infectious disease epidemiologist with Florida International University. “If we just relied on testing, we would have to be testing everyone in South Florida every couple of days. It would be expensive and time-consuming. One has to be targeted about it and test as they start popping up again.”