State far short of recommended number of contact tracers
As unemployed workers are eager to get back to work and states are looking toward reopening their economies, the hope is that contact tracing will help prevent "small clusters or individual cases from turning into larger community outbreaks," according to Kristen Soto, an epidemiologist with the state Department of Public Health.
During a news conference Tuesday, public health officials announced plans to roll out a new system to trace COVID-19 infections. The idea, health officials say, is to test, trace and isolate by using a workforce of tracers and new technology to track who has come into contact with the virus and those they've been in contact with. Gov. Ned Lamont's office said Wednesday that the state also plans to provide resources, potentially including compensation for hotel stays and reimbursement for lost wages for essential employees, for individuals who choose to self-isolate after being notified through contact tracing that they've come into contact with the virus.
But according to estimates, the state's tracing workforce isn't nearly large enough.
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.
So far, the state plans to use 300 tracers from DPH and the 64 local health departments in Connecticut, according to Soto. DPH also anticipates recruiting 400 to 500 volunteers from academic institutions, including schools of public health, nursing, medicine and social work, she said, and will continue "to evaluate the need for additional volunteers or staffing."
Still, even after adding 500 volunteers, the state would be short of the recommendation.
An NPR survey asked all 50 states, Puerto Rico and the District of Columbia how many tracers they have employed and how many they're planning to add. The survey, to which 41 states and D.C. responded, found that only one state has enough tracers employed to handle the COVID-19 pandemic: North Dakota.
The survey found that altogether, the responding states and D.C. have 7,324 tracers employed with plans to grow the total workforce to 35,582. This would put the national average at 12 tracers per 100,000 residents — less than what the National Association of County and City Health Officials recommends for nonemergency situations, and less than half the number needed for an emergency.
One case can lead to many
A study conducted by the Johns Hopkins Center for Health Security estimates that each person infected with COVID-19 can infect two to three others on average. That means that if one person spreads the virus to three others, that first positive case can turn into more than 59,000 cases in 10 rounds of infections.
According to the study, the approach normally used for intervening in the spread of diseases like tuberculosis and measles won’t work for COVID-19. Stopping the spread of the virus, it said, will require “a massive expansion” of testing and “an unprecedented growth in a public health workforce,” without which stopping the spread of COVID-19 will be impossible.
“A contact tracing effort of this unprecedented scale and of this critical and historical importance to the functioning and reopening of society has never before been envisioned or required,” the study said. “And our current core public health capacity is woefully insufficient to undertake such a mammoth task.”
The study estimates that the national public health workforce needs to grow by about 100,000 employed or volunteer contact tracers that should be strategically deployed to areas of the greatest need and that the creation of such a robust workforce will require about $3.6 billion in emergency funding from Congress.
On Monday, a group of former government officials released a letter calling on Congress to recognize the need for an increased workforce and financial support for individuals self-isolating, funded by a federal economic package.
The letter, signed by Scott Gottlieb, former Food and Drug Administration chief for the Trump administration, and Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid for the Obama administration, and several other former government officials, stated that “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.”
Gottlieb and Slavitt estimated that the U.S. will need to increase the workforce by at least 180,000 contact tracers to halt the spread of COVID-19 until a vaccine is found and called on Congress to devote a $46.5 billion economic package to the contact tracing effort.
“Rolling out this economic package is the next step toward reopening the country while tracking and isolating infected populations,” the letter said. “It is important to begin to prepare to reopen the economy again and get Americans back to work — in a way that minimizes the risk of resurgence in cases, hospitalizations and deaths.”
The letter’s authors estimated that Congress should devote $12 billion in funding to increase the workforce and another $4.5 billion to cover the cost of hotel stays for individuals who are asked to self-isolate.
“In order to prevent spread, individuals will need to be provided with opportunities to self-isolate for two weeks,” the letter said. “Hotels are sitting idle at present and can provide local self-isolation sites.” The authors pointed out that the funding also would provide “a much needed stimulus for the hospitality industry.”
In addition to covering the expense of hotel stays, Gottlieb and Slavitt also estimated that 40% of individuals asked to voluntarily self-isolate for two weeks will need some sort of income support. The authors called on Congress to provide about $30 billion in funding for support, allowing for individuals to be paid a $50-per-day stipend during their isolation.
When asked on Wednesday if the state would be providing such resources, Gov. Lamont’s office said “we expect to provide support to individuals who should self-isolate and cannot do so at their homes” but did not provide further details or dollar amounts.
On Tuesday, Lamont had said the federal government “has been pretty good about reimbursing the state” for expenses related to COVID-19 and expects that support to continue as the costs of contact tracing initiatives are calculated.
State officials said they also will monitor the need for more contact tracers.
Soto said that all contact tracers will be able to provide resources to infected or exposed individuals and answer general questions about the disease and will be trained to handle health information in a confidential and secure manner.
As part of the tracing effort, the department has developed software with Microsoft called ContaCT that will enable the sharing of infection information among DPH and the local health departments, Soto said. The software is expected to be rolled out statewide by the third week of May.
After a person is identified as having come into contact with the virus, the software will be used to help tracers contact that person via email, call or text.
The goal, said Dr. Matthew Cartter, state epidemiologist and director of infectious diseases for DPH, is “to reach every case, to identify every contact and to ask them to participate in the contact tracing process and ask them to self isolate” to interrupt the chain of transmission of the virus.
Health officials said they hope that every person asked to self-isolate following exposure will do so for 14 days.
“DPH, as well as local health departments, can only do so much even with the best technology in the world,” Soto said. “In order for contact tracing to really work, we need the support of you in the public to help us with this endeavor.”