- As public health departments across the country work to contain COVID-19 outbreaks, contact tracers – the people who warn others they might’ve been exposed to an infectious disease – are in short supply.
- Many public health department workers who typically trace HIV and STD cases are being redeployed to trace coronavirus cases.
- Business Insider spoke with contact tracers and public health experts who are worried that the country is barreling towards some new record-high STD and HIV rates.
- Fewer people are getting tested and treated for sexually-transmitted infections during this pandemic.
- Visit Business Insider’s homepage for more stories.
Jenine Clements used to spend her workdays visiting local jails, knocking on front doors, making phone calls to labs and clinics, and taking to people who walked into her local health department.
Some of the people she spoke to, over the phone, on their doorsteps, and in state facilities, would tell her they were experiencing troubling changes in their bodies, like feeling a burning sensation when they peed, or noticing that painless, but firm, round sores or rashes were appearing on their skin. Others would report feeling and looking perfectly fine.
Whether they suspected it or not, many of the people Clements spoke to had been exposed to sexually-transmitted diseases like syphilis, chlamydia, and gonorrhea, and her conversations with them were an integral part of a critical public health alarm system, warning them they should get screened.
Clements is a contact tracer, and she works with people in her Michigan county who have contracted, or been exposed to, sexually transmitted infections. Her goal is to get the people who might be most at risk of developing an infection (through sexual contact, or needle sharing) tested for STDs and HIV, so that if they are positive, they can then be connected to treatment for diseases that, left unchecked and untreated, can lead to infertility and death.
But as the coronavirus has taken centre stage at public health departments across the US, much of the work that Clements used to perform is going undone, a lapse that could have serious, long-term consequences for the country’s sexual health.
“I still receive the STD and HIV cases, but the case load is not as heavy as before,” she said, citing a “great decrease” in reported STD cases where she works.
Clements’ situation is not unique. As clinics and health departments across the country have shuttered during the coronavirus pandemic, the nation’s roughly 2,200 disease detectives, the so-called “contact tracers” of infectious disease outbreaks, have been re-deployed to track where cases of COVID-19 – the disease caused by the novel coronavirus – are spreading, to try to stop those outbreaks in their tracks. It’s a necessary shift, but one that may have serious, long-term impacts for the country’s sexual health, and for President Trump’s year-and-a-half-old plan to “eliminate” HIV from the US by 2030.
“Anecdotally, I don’t think people have stopped having sex necessarily, although the number of partners may have gone down,” David Harvey, executive director of the National Coalition of STD Directors (NCSD) said. “But we’re really worried about the larger issues of people not getting tested, people not getting treated, and what that means for inadvertent spread of infections in the future.”
Contact tracers are having to focus more on COVID-19 cases
According to a recent NCSD survey of HIV and STD disease tracers around the country, 83% are forgoing their usual field visits as a result of this pandemic. Two-thirds of the country’s clinics (66%) have also reported decreases in health screenings and testing due to COVID-19.
Clements, for one, says she used to consistently have “somebody to contact at least every day,” about an STD like syphilis, but that’s no longer the case, which worries her, especially because many infections are completely symptom-free, and undetectable without a test.
“A lot of things are gonna go unnoticed,” she said. “I think after all of this is over, there may be an influx of positive tests because of the fact that a lot of people may not be going in to get tested.”
Daniel Daltry, who is the program chief for HIV and STDs at the Vermont Department of Public Health, has similar concerns that many STDs in his state are also quietly going untested.
“I am absolutely worried about what might be happening within the pandemic that we’re not seeing or not knowing about now,” he said.
In Vermont, the state has had to rapidly ramp up its disease-tracing force within just a couple of months – from just one full time STD contact tracer before the coronavirus showed up – to more than 50 who now fight that state’s outbreak. Daltry said as a result of the influx of coronavirus work since March, the state can no longer trace all its new gonorrhea cases.
It’s a worrisome gap in disease prevention, because people who develop STDs like gonorrhea are at far greater risk of contracting HIV in the future, a link that’s especially prevalent among men who have sex with men. Daltry said it used to be the case that gay men diagnosed with gonorrhea in Vermont were quickly notified of their status, encouraged to get tested for HIV, and linked up to services for drugs like PrEP, a prophylactic drug that prevents new HIV infections, when taken regularly.
“It’s a beautiful service, I think it has an impact,” Daltry said. “But guess what we’ve not been doing since March 7th?”
Before the pandemic, there weren’t enough contact tracers to meet the rising rate of STDs
The US had about 2,200 contact tracers on the job nationwide when the coronavirus crisis began, a far cry from the 100,000 to 300,000 disease detectives that experts say are needed to contain the coronavirus pandemic.
“We were already struggling with not enough resources to contain outbreaks in this country,” Harvey said.
More Americans than ever were already developing drug-resistant strains of gonorrhea, chlamydia cases were at record highs, and in 2018, 94 newborn babies died from syphilis, a 22% uptick from 2017, the Centres for Disease Control and Prevention reported.
The scarcity of disease tracers may have also only further compounded the country’s early COVID-19 outbreak, as widespread contact tracing for the coronavirus simply wasn’t possible, even with a majority (57%) of the country’s disease detectives, like Clements, being shuffled over to coronavirus tracing.
“There’s a massive redeployment of STD contact tracers toward COVID for good reason,” Harvey said, explaining that the same skills contact tracers use to track down STD or HIV cases are easily dispatched to quell other outbreaks as they emerge.
Contact tracers have successfully tracked down where foodborne illness outbreaks originate at restaurants, farms, and meatpacking plants, and they have followed potential cases of other contagious diseases, including ebola, Zika, and tuberculosis. The only thing that contact tracers must always adjust during a novel outbreak like the coronavirus pandemic is their knowledge of what each illness looks like (its signs and symptoms), and exactly how and when it can be transmitted from person to person.
“Whenever there is a local infectious disease outbreak, you will see a disease detective at work trying to understand what’s going on with transmission in the community, or within a group of people,” Harvey said. “Then, doing the work that is needed to get people into care, to identify their contacts, to help isolate people, and break the chain of infections.”
Clements said she uses many of the same skills she’s honed over 17 years of contacting STD-positive people and their partners when she calls people who’ve been exposed to the coronavirus. But there’s no such thing here as “trying to follow the script,” she said.
“People are upset,” Clements said. “People have had to deal with death.”
The people she speaks with now about COVID-19 infections are often isolated at home and scared, and many are hungering for human conversation.
“I use my interviewing skills by, first, coming to them where they are,” she said. “You know, ‘Oh, thank you so much for sharing that with me, can you tell me more about that?'”
COVID-19 could rewind decades of progress on HIV around the world, with deadly consequences
New models from the World Health Organisation and UNAIDS suggest the US is not the only country at risk of a major sexually-transmitted infection outbreak because of COVID-19. It’s possible that COVID-19 could rewind more than a decade of progress both diagnosing and treating HIV infections in Africa, ultimately leading to 500,000 extra deaths in 2020-2021, if people can’t get the necessary drugs, testing, and treatment to fight back against HIV.
“What a price we’re paying for not investing in public health,” Harvey said of the current coronavirus situation. “If we had a lot more contact tracers and DIS [disease intervention specialists] in place, I would like to think that we could have saved many more lives.”