Testing down, tracing spotty: Is COVID fatigue setting in?
Nearly eight months into the global pandemic, a reduction in demand for testing and low participation rates in contact tracing efforts signal that many in South Florida have become complacent or experiencing COVID fatigue.
When South Florida’s summer COVID-19 surge hit Miami-Dade County with full force in July, public officials had little capacity to track down the contacts of the thousands of new infections reported every day and stop the spread.
But by August, the health department had built up the county’s contact tracing workforce and shifted its testing strategy to dramatically cut turnaround times. Now there’s another problem: Many of the people contact tracers try to reach won’t respond to questions that could help cut infections in Miami-Dade.
As of mid-August, about 14,200 people cooperated with contact tracers, according to a health department report. But nearly double that number — about 27,150 — chose not to participate or could not be reached. It is not clear whether those were people infected with COVID or their contacts or both.
At the same time, fewer people are being tested for the disease despite state-run testing sites having more capacity than ever. Testing statewide has dropped about 31% from an average of 93,600 a day during the last week of July to an average of 64,100 last week.
Despite the virus’ enormous toll in Miami-Dade — where more than 155,000 people have been infected and 2,372 have
died of the disease — public health experts say there is a natural human tendency to become exhausted, and in some cases, complacent, in the face of a prolonged crisis. And as more portions of the economy reopen, including restaurants and professional sports, there’s more to suggest that regular life is resuming.
This week, Miami-Dade Mayor Carlos Gimenez said he would allow restaurants to resume indoor dining at partial capacity. And on Monday, the governor announced that 13,000 fans would be allowed to attend NFL and college football games this year at Hard Rock Stadium in Miami Gardens.
After more than a month of spiking cases, deaths and national media coverage, Florida appears to have reached what public health experts are calling “COVID fatigue,” and Jason Salemi, an associate professor of epidemiology for the University of South Florida in Tampa, said he sees it playing out in the Sunshine State.
“People are taking a big exhale,” Salemi said. “They’re exhausted with all of this.”
Michael Mina, a pathologist and infectious disease expert with Harvard T.H. Chan School of Public Health, said COVID fatigue has spread across not just the public but academia, too. And he noted that pandemic conspiracy theories and misinformation are only giving some people more reason to tune out.
“It’s not been just fatigue. We have active groups speaking out against paying attention to COVID and inappropriately dealing with it,” he said.
Still, he added, COVID fatigue is real.
“It’s an extremely difficult thing to deal with. There’s an immense amount of it,” he said. “Scientists are getting sick of it. ... The public is getting tired of it. Everyone is getting tired of it.”
LITTLE COOPERATION WITH CONTACT TRACING
The Florida Department of Health’s daily COVID-19 reports reflect a drop in people tested over the past month. Statewide, an average of 64,000 Floridians have been tested each day in the past week compared with an average of 79,000 people a day during the first week of August and 93,000 people a day during the last week of July.
In Miami-Dade, an average of 9,000 people a day have been tested in the last week, according to the health department. That’s down from an average of 10,700 a day during the prior week.
Contact tracing in Miami-Dade has yielded mixed results, according to a recent summary of results that the health department provided to county officials. Contact tracers start with the person who tested positive for COVID, then reach out to their contacts and also to people their contacts may have exposed.
The summary shows that as of Aug. 13, the health department’s contact tracing vendor had investigated 37,541 positive cases. From those cases, investigators identified 7,155 contacts — people who have been exposed to a COVID-infected person — but workers were only able to reach 1,627, or about 23% of those people.
The health department reported that 14,204 people completed interviews with case investigators and provided information for their close contacts, but nearly twice as many — 27,149 people — had either declined to participate or could not be contacted.
The drop in demand for testing, and the confusion created this week by the Centers for Disease Control and Prevention’s revised guidance that asymptomatic persons not be tested for COVID — a recommendation that the federal health agency later walked back — led MiamiDade’s mayor to issue a statement Thursday encouraging residents to continue getting tested, wearing masks and avoiding crowds.
“At this time, we have more free testing sites available throughout the county than ever before, and the wait at drive-up and walk-up sites is minimal because fewer people are seeking testing,” Gimenez said.
He closed with a plea to residents: “Please, don’t get complacent during this pandemic.”
With hospitals preparing for a potential resurgence of COVID-19 in the fall when flu season begins, public health experts emphasize that the public should not abandon personal behavior changes that cut infections, such as wearing masks, social distancing and avoiding crowds.
Amesh Adalja, a physician and infectious disease expert with the Johns Hopkins Center for Health Security, said the public’s waning interest in the pandemic is partly due to widely reported problems with testing, from long lines at test sites to long waits for results that rendered them useless.
But he added that lifting stay-at-home orders and reopening businesses in May also may have sent a mixed message to Floridians and caused them to let down their guard, only to see cases surge again in mid-June through July.
That resurgence nearly overwhelmed hospitals, and led to a rise in deaths, which in turn caused people to re-evaluate and adjust their behavior.
“That’s what you see in a lot of states, this seesaw between denial that the virus is there, then coupled with a surge and a much more measured approach to how we think about it,” Adalja said.
STAYING ON MESSAGE
Jared Moskowitz, director of Florida’s Division of Emergency Management, which oversees the state’s COVID testing program, said he too has noticed a flagging interest in COVID among Floridians.
“They have disaster fatigue from the pandemic. They have disaster fatigue from the shootings we’re watching on television. They have disaster fatigue from the riots they’re watching on television,” he said. “They have disaster fatigue from the hurricanes.”
Moskowitz said Florida has also gotten past the wave of people being tested to return to work or college, and the spike in testing that followed the big surge of new cases in July.
“What we’re down to,” he said, “is people who are symptomatic and people who believe they might have been exposed to somebody with COVID.”
Moskowitz said rapid and efficient testing is key to re-engaging Floridians with testing and contact tracing, and he expects that recent improvements in test turnaround times will help.
Public health experts agree that Florida’s and the nation’s inefficient testing program during the pandemic has led to a chain reaction of failures that has left many people feeling that their tests are not meaningful.
Barry Bloom, an immunologist and infectious disease expert with Harvard T.H. Chan School of Public Health, said slow turnaround times for test results and ineffective contact tracing have caused many to lose confidence in the usefulness of their participation.
He said that “when the numbers of cases are high, contact tracing simply can’t come to grips with it. When results take days and the public knows the answer is useless, it’s hard to generate confidence.”
On a conference call with reporters this week, Bloom said a new generation of tests that can turn results in minutes and not hours or days, such as the BinaxNOW made by Abbott Laboratories that received emergency approval from the Food and Drug Administration this week, could mean that tests are returned quickly enough to inform decisions about whether to go back to an office or a school.
“An awful lot more confidence could be generated if a not-so-sensitive test could be done on every school child three times a week,” he said. “The way to engage the public is ... having ready access to rapid tests.”
Bloom said contact tracing can be especially helpful as cases decline because public health workers aren’t spread as thin. But he emphasized that government will not end the pandemic; individuals will, and they take their cues from leaders.
“Control of the epidemic is really not in the hands of public health authorities,” he said. “It’s in the hands of the public. ... Empowering the public to take responsibility for their own safety is the way these curves are going to get bent.”