- Contact tracing is detective work conducted by public-health workers to determine where and when people might’ve been exposed to a disease.
- In the US, there are roughly 2,200 contact tracers stationed nationwide. They typically respond to outbreaks of foodborne pathogens and trace back the sexual partners of people diagnosed with STDs.
- Right now, they’re tracing the contacts of just a fraction of the people who’ve been diagnosed with COVID-19, the illness caused by the coronavirus.
- Officials across the country are sounding the alarm that hundreds of thousands of contact tracers will be needed to get the country back to work.
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Test and trace.
These two actions, one after the other, are the backbone of public-health work. Both will be vitally important to help the US reemerge from its lockdowns in the weeks and months to come.
But there’s a major problem with this two-part solution to the coronavirus crisis: America does not have the capacity to test or trace in adequate numbers and find out where the coronavirus may be spreading. That’s putting hundreds of thousands of people at risk of disease and death.
The country doesn’t have nearly enough diagnostic tests available to know who has the virus in the first place, and the number of contact tracers in public-health departments – the disease detectives who can stop the spread of a virus before it takes hold in a community – is nowhere near adequate at the local or federal level.
Some states where coronavirus outbreaks are relatively small are already training more tracers and aiming to make contact with every single person who might be at risk of infection. Other coronavirus hot spots, or areas of the country with major deadly outbreaks, aren’t even bothering with contact tracing right now because their infection rates are so high.
But as those rates begin to slow in major US cities, thousands more tracers will be needed to allow people to get back to work safely. Wuhan, China, for example, had 9,000 tracers who helped the city of 11 million get out of its lockdown.
“We need an army of contact tracers in every community of the US to be ready to find every contact and warn them to care for themselves and stop spreading it to others,” Tom Frieden, a former Centres for Disease Control and Prevention director, recently told reporters on a conference call.
Contact tracers spend a lot of time rushing to the phone, figuring out where people have been
Contact tracing is time-intensive. The goal is to chat with every single person who’s contracted COVID-19, the disease caused by the coronavirus, and find out who they have been around. Then the tracers can tell those people that they might’ve been exposed to the virus and that they should stay home to avoid infecting others.
The coronavirus can be transmitted before people ever show symptoms, meaning there’s no time to waste in informing an infected person’s contacts.
Public-health workers have used this type of call-and-ask system in the US to trace the origins of foodborne-illness outbreaks and sexually transmitted diseases. Contact tracing has already proved effective at curbing coronavirus outbreaks in China, South Korea, Singapore, Taiwan, New Zealand, and Iceland.
The country has fewer than 2,500 contact tracers, a woefully inadequate number
In a recent New York Times op-ed article, Frieden suggested that roughly 300,000 US contact tracers might suffice. An April report from the Johns Hopkins Centre for Health Security said that “approximately 100,000” nationwide might be enough, a recommendation that experts from Harvard backed up on Monday.
The US right now has just over 2,200 tracers.
“Our current core public health capacity is woefully insufficient to undertake such a mammoth task,” the Johns Hopkins report said.
Before the coronavirus outbreak, there were roughly 600 federal CDC contact tracers dispatched around the country and an additional 1,650 at state and local health departments, according to the National Coalition of STD Directors. That’s nowhere near an army’s worth of tracers for a nation of 329 million people.
Some states, like Vermont, which had only one full-time contact tracer before the coronavirus outbreak, are already ramping up their disease-detective corps.
By the time the state’s first COVID-19 patient was identified, in early March, public-health workers there had been redeployed and doing drills for weeks – since the first patient was diagnosed in the US in January.
On March 7, the tracers there were ready, and they leaped into action.
“You can’t wait until the next day,” Daniel Daltry, a program chief at the Vermont Department of Public Health who does some of the state’s contact tracing, told Business Insider. “You’ve got to move.”
But while Vermont’s efforts are impressive, they aren’t nearly enough without more testing and tracing nationwide.
Contact tracing doesn’t work well when an outbreak gets too big
Some outbreaks, like New York City’s, are still too big to trace. But that could soon change.
Mark Levine, the chair of the New York City Council’s health committee, recently suggested on Twitter that dispatching contact tracers across the city could be “feasible” once the number of new daily cases gets down to about 500. (Right now the city is logging over 1,000 new cases every day, which is already a reduction from the 5,000 to 6,000 per day recorded early last week.)
Gov. Andrew Cuomo recently called contact tracing a “massive undertaking that we now don’t do,” but he said the state could start soon.
“We test Bernadette, Bernadette turns up positive,” Cuomo said during a press briefing, explaining a hypothetical version of contact tracing. “OK, who were you with over the past week? What family members were you with? Who do you sit next to in the office? You now have a list of 30 people. If it’s Bernadette, even more, because she’s highly social, has a lot of friends. Now somebody’s got to run down that list of 30 people – from one positive.”
Contact tracing could be a welcome job opportunity for thousands of people across the country who are newly out of work, but the endeavour would likely require billions in federal cash appropriations from Congress to fund state and local health departments’ hires.
Old-fashioned tracing can help contain a virus, but tracking and warning systems also may work
Vermont, a smaller state that doesn’t have a severe outbreak, is a prime example of where contact tracing works well. With fewer than 850 coronavirus cases and more than 50 tracers on the job, Vermont can still trace back all its COVID-19 contacts, meaning it’s possible to control the spread of the virus through testing and contact tracing.
“We are still in a phase of containment,” Daltry said. “Really trying to get ahead of it, before this spreads out too quickly.”
Rhode Island was originally doing the same kind of extensive, old-fashioned contact tracing as Vermont. But now, with more than 5,000 confirmed cases, the state is developing an app that can automatically survey residents, checking for symptoms a few times each day.
Gov. Gina Raimondo has also asked every Rhode Islander to keep a “contact tracing notebook” that logs where they have been and who they have come in contact with, just in case they get sick.
Another tech-forward approach to contact tracing that’s being tested in Europe uses Bluetooth data to alert people who’ve been in close contact with someone who has tested positive for COVID-19, suggesting they seek out testing too.
These kinds of coronavirus tracking and warning systems – done via an app or a tracer’s phone call – become less effective as an outbreak spreads out and moves into a phase that public-health experts call “mitigation.”
In the mitigation phase, instead of trying to control the spread of a disease, all public-health workers can do is tell people to stay home and away from others, watching the contagion burn itself out. That’s where most of the US is at right now.
There was a time in March when Daltry worried that might happen in Vermont, as the number of sick patients in the state began rising and there weren’t enough supplies to test every case.
“We went from one case every other day or every two days to suddenly getting 12 cases a day, 20 cases a day, 30 cases a day,” he said. “But then we had an influx of testing and were able to direct the contacts to testing. That happened towards the end of March. And that just gave us a renewed sense of hope and energy with what it is we can do in terms of our containment efforts.”
The same hope and energy that’s alive in Vermont is not available nationwide. In addition to the widespread test shortage, the US has, on average, just one tracer available for every 150,000 Americans.
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