Increased testing and fewer cases, but contact tracing still ‘ramping up’
As COVID-19 testing increases and the number of new cases of the virus is falling statewide — but climbing in New London County — Connecticut’s contact tracing efforts are “still ramping up,” according to the state Department of Public Health.
The state began its first phase of reopening this past week, with the governor announcing that all benchmarks laid out for the reopening had been met: at least 42,000 tests are being done each week, surpassing a total of 200,000 in the state; there were at least 14 days of declining hospitalizations of COVID-19 patients and the state’s contact tracing program has launched.
However, the contact tracing program is not yet operating at full speed, according to DPH.
DPH could not provide exact metrics for current contact tracing efforts, but when asked what percentage of people who test positive are being contacted by a tracer, Kristen Soto, epidemiologist and the syndromic surveillance coordinator for DPH, said that “right now, the percentage is pretty low.”
Soto said the department’s “ultimate goal” is to interview at least 90% of people who have come in contact with the virus, a number she called “really ambitious.” The department would be “really working to ramp-up” in the next week toward that goal, she said.
Rather than trying to tackle a backlog, tracers will be working on contact tracing only for people who tested positive after about Monday, May 18, Soto said, “because those are people who potentially have recently had exposures to other people, where effective control measures can be put in place to prevent the spread of (COVID-19) in their communities.”
The state has so far credentialed 55 of the state’s 64 local health departments to access the system.
According to Soto, there are 507 people working on contact tracing currently, and another 200 volunteers and 50 staff members from local health departments queued up, for a total of about 750 contact tracers soon to be on the job. That number is lower than the 300-person workforce and 500 volunteers the governor and DPH announced in late April, which already fell short of experts' recommendations.
According to the National Association of County and City Health Officials, each state needs an estimated 15 workers for every 100,000 residents to provide effective contact tracing in nonemergency situations. In emergencies, such as the COVID-19 pandemic, each state needs at least 30 tracers per 100,000 residents. So, Connecticut, which has a population of 3.5 million, according to the U.S. Census Bureau, would need about 1,050 tracers.
That recommended number may still be reached, Soto said, if DPH deems it necessary.
“As we continue to roll out the system and scale up to our full capacity, we will be evaluating the workload that’s occurring,” Soto said. “If we’re finding that we do not have enough staff to call all people and reach them as we would like to, we can scale up our efforts and bring on additional staff to accomplish that.”
Soto said the department is working to bring on more volunteers from academic partnerships across the state.
Sten Vermund, infectious disease epidemiologist and dean at the Yale School of Public Health, said that his school has trained about 400 volunteers from its emerging infections program to conduct contact tracing, and has faith that the state will ramp up its program to the necessary size. However, he said he thinks the state also should hire more tracers.
“A volunteer workforce only carries you so far, so we would like a professional workforce working for the DPH,” he said, recommending that the state follow the lead of neighbors, including Massachusetts and New York, that each have hired at least 1,000 tracers.
As of now, he said, “we do not have enough contact tracing in the state to meet all the demands, that’s a fact.”
Slowing the virus
Vermund said that although contact tracing is a vital part of slowing and stopping the spread of a virus like COVID-19, “it isn’t the end-all, be-all.”
It is, instead, one of five pillars he thinks are necessary to tackle the COVID-19 pandemic: physically distancing, mask use, hand and environmental hygiene, outdoor living and testing and contact tracing.
Relying too heavily on contact tracing isn’t a good idea, Vermund said, because only a fraction of contacts reported are successfully contacted. People are often unreliable in remembering their contacts, or they come into contact with people they don’t know intimately and don’t know how to contact. Contact tracing also is ineffective if contacts are not reached quickly, especially with a virus that’s commonly asymptomatic — if a person doesn’t know they’ve come in contact with the virus, they will continue to spread it to others unknowingly.
According to Soto, the goal is to reach contacts within two to three days of a person feeling sick, or two days of a test being performed. She said “there’s definitely room for improvement” on that front. As testing capacity increases, she said she thinks the state can get to that point in a few weeks.
Soto said contact tracers typically will make three attempts to contact an individual before considering them lost to follow-ups, and they make sure at least one attempt to contact is on a weekend or at night, outside of normal 9 to 5 hours. They’re also monitoring how responsive people seem to be to electronic contact attempts via email and text, she said.
DPH has started loading statewide data into its system as of this past week, to align with the reopening initiative, and hopes to have the system at full capacity as of June 1, she said. The department opted for a “sort of scaled rollout” to ensure that local health departments and tracers had the opportunity to get familiar with the state system, she said.
Scott Gottlieb, former Food and Drug Administration chief for the Trump administration, joined Lamont during a news conference this past week and said the state should expect to see a rise in coronavirus cases after reopening.
Gottlieb in April co-signed a letter to Congress calling for more than 180,000 additional contact tracers nationwide to halt the spread of COVID-19 until a vaccine is found. “The existing public health system is currently capable of providing only a fraction of the contact tracing and voluntary self-isolation capacity required to meet the COVID-19 challenge,” the letter said.
Gottlieb declined to comment on whether he thought Connecticut was currently employing enough contact tracers but said the state has to continue to ramp up testing and track down the contacts of those who have the coronavirus. The state needs to encourage people to get tested and focus testing efforts among at-risk populations, he said.
State Chief Operating Officer Josh Geballe said that while local health departments have been working on contact tracing since the beginning of the pandemic, not all departments could handle the number of cases they saw.
“As the pandemic really crested, contact tracing kind of got overwhelmed,” Geballe said. “So now as we come down the back of that curve, what we’re doing is standing up this new infrastructure so that as we come through the summer, we can have the right protections in place, make sure that we’re isolating contacts and preventing that rebound as much as possible.”
Soto said that the department has been overwhelmed by the response of community members wanting to volunteer as contact tracers, but DPH is not currently accepting volunteers outside of its partner academic institutions. She said those interested in volunteering should register on ctresponds.ct.gov so they can be contacted in the future if that changes, as well as explore other volunteer opportunities.
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