Connecting state and local government leaders
As governors look to loosen coronavirus restrictions, a key benchmark will be improving the ability to track and isolate new cases. That will include more “contact tracers,” investigators who track down those who’ve come in contact with infected people.
Before public life can return to normal in the United States, public health experts say the country will need a robust system in place to identify new coronavirus cases and track down and isolate people who came into close contact with the infected.
It’s a process known as “contact tracing” that has been deployed by public health departments for years on diseases like the measles. It requires investigators to track down each person who has come in contact with a contagious person, helping them isolate for a period of time to monitor for symptoms in order to stop the spread of the disease.
But the sheer size of the Covid-19 outbreak has already swamped state and local health departments, which in many places are tapping other workers like school nurses and disease intervention specialists to help. To boost capacity even further, some states are now looking to recruit new battalions of public health workers and volunteers.
“The capacity has been essentially overwhelmed,” said John Wiesman, secretary of health at the Washington State Department of Health. “We are looking to also shore up and build that capacity to do a much larger number of case and contact investigations.”
Across the country, state leaders are considering massive hiring sprees to give health departments the manpower they need to identify people potentially exposed to the virus.
Because many people who have been ill have not had access to diagnostic tests to confirm they had Covid-19, Wiesman said his state expects an increase in test access to accelerate the demand for contact tracing. More testing will mean more people confirmed to be infected.
“That means the public health system has to scale up and scale up very quickly,” he said on a call this week with reporters. “That’s the call for certain resources at the federal level.”
To improve their capacity, Washington state officials have been in discussions with local community partner groups over the last few days about collaborative efforts to scale up local tracing efforts, Wiesman said.
The state hiring across the country will boost public health departments that never fully recovered after the Great Recession. One report estimated that more than 56,000 jobs have been eliminated since 2008.
The idea that additional public health employees must be in place in order for the United States to progress to the next stage in the fight to contain the coronavirus has gotten more attention in the past week. The director of the U.S. Centers for Disease Control and Prevention said that in order to lift stay-at-home orders and social distancing measures that have crippled the U.S. economy, the United States will have to establish a "very aggressive" contact tracing system. The New York Times reported that the CDC is in talks to divert 25,000 Census Bureau workers to its agency to do contact tracing, but the Trump administration otherwise hasn’t indicated what kind of financial support it would provide for the effort.
The Johns Hopkins Center for Health Security estimates approximately 100,000 contact tracers will be needed to assist the nationwide effort—at a cost of around $3.6 billion.
Massachusetts was the first state to announce a partnership with a global health nonprofit that will allow it to rapidly hire 600 call takers and 1,000 investigators and researchers to conduct widespread contact tracing. In a state with upwards of 28,000 Covid-19 cases and nearly 1,000 deaths, the goal is to reach more than 840,000 people who were in close contact with infected individuals to learn about their interactions and warn those at high risk to quarantine, said Monica Bharel, the commissioner of the Massachusetts Department of Public Health.
“A key component of our work to be able to consider loosening social distancing measures will be our ability to do aggressive case identification, contact tracing and quarantine,” Bharel said on a recent call with reporters.
The hiring effort is in addition to work by Massachusetts’ more than 300 local health departments to enlist health workers like school nurses to boost local testing capacity.
“The unique aspect of this approach is that it aims to boost our existing strong testing and tracing efforts by the local boards of health and leverages an already highly coordinated infrastructure,” Bharel said.
In Maryland, Governor Larry Hogan this week introduced his state’s initial recovery plan, which relies in part on establishing a network of contact tracers. The state currently employees 250 people who are engaged in the work, but plans are underway to expand the workforce to at least 1,000 people using other state employees and bringing on contractors.
Public health experts say there are numerous opportunities for current state and local government employees to transition into contact tracing roles to help with efforts.
According to the National Coalition of Sexually Transmitted Disease Directors, the majority of the 2,000 STD disease investigation specialists employed across the country have already been detailed to coronavirus-related work, including contact tracing.
Bryana Fryczynski, a disease intervention specialist with the Michigan Department of Public Health and Human Services who is now focused on Covid-19 tracing efforts, said the work is very similar to tracking the community spread of STDs like syphilis or HIV, except she now conducts all of her outreach by phone, text or email rather than in person.
Tracers follow a general script to ask people confirmed to have the disease about their contacts and travels over the last two weeks. Building rapport with the person on the other end of the phone line is crucial to gathering the needed information.
“We have a very limited amount to time to make people feel comfortable,” Fryczynski said.
With a stay-at-home order in place in Michigan, Fryczynski said many of the people that contact tracers have reached by phone have already been isolated for days and are happy to talk.
“I think they realize they have the ability to make a huge positive impact on their community” by disclosing the information, she said.
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Andrea Noble is a staff correspondent with Route Fifty.