As Covid-19 Patients Skew Younger, Tracing Task Seems All But Impossible

Yves here. More bad news as far as getting Covid-19 under control in the US is concerned.

By Anna Almendrala, Kaiser Health News, Correspondent, who previously worked at HuffPost and has also written for The Guardian, The Daily Beast, Medium, Sojourners and appeared on NBC and Univision. Originally published at Kaiser Health News

Younger people are less likely to be hospitalized or die of COVID-19 than their elders, but they circulate more freely while carrying the disease, and their cases are harder to trace. Together, these facts terrify California hospital officials.

People under 50 make up 73% of those testing positive for the disease in the state since the beginning of June, compared with 52% before April 30. That shift isn’t comforting to Dr. Alan Williamson, chief medical officer of Eisenhower Health in Riverside County’s Coachella Valley.

“It honestly worries me more because it means that this is now established in the community,” he said.

As the virus spreads throughout the United States, figuring out how patients were exposed becomes increasingly difficult, which makes it nearly impossible to stop viral transmission. Younger people with COVID-19 are also less likely to pick up the phone when a contact tracer calls, health officials say. And hospitals are seeing case numbers rise among staffers, who are getting infected in their communities, not necessarily at work.

Los Angeles and nearby counties, whose populations are heavily Latino, have been driving California’s COVID spike and account for a disproportionate number of its cases, as they have since the pandemic’s early days.

The massive wave of new infections has caused deaths among people ages 18 to 40 to slowly mount, from six in the first 10 days of May in Los Angeles County, for example, to 22 in the same period of July.

Hospitalizations have soared among the younger age group, which made up about 10% of people hospitalized in April but account for more than 25% now. Los Angeles County reported Wednesday that 2,193 people were hospitalized with the virus, the highest number since the pandemic started. It gave no detailed age breakdown.

The first wave of patients in March and April at Eisenhower Medical Center, Eisenhower Health’s 463-bed flagship hospital, were mostly nursing home residents and retirees who lived in the area part time. Most were white.

But in June, as the virus spread through the rest of the Coachella Valley — famous for producing dates, citrus and other crops — it also sickened people from the region’s year-round Latino agricultural workforce. While these patients are younger and usually don’t need hospitalization, Williamson has noticed a new trend among those who do.

“Quite frequently, there would be in their history that there are two or three or more other family members that are home and COVID-positive,” he said. “I didn’t see that before.”

In the eastern part of the valley, where multigenerational or multifamily households are common, COVID-positive patients don’t always have the space or resources to live in strict isolation as they recover.

“These are young people living in a household with little kids, teenagers and 70-year-old grandparents,” he said. “That’s not a good formula.”

Most of the younger patients have a benign course of illness. Johnny Luna, 34, who lives in a two-bedroom apartment in the Boyle Heights section near downtown Los Angeles, got tested for COVID-19 in May after experiencing what felt like a mild asthma attack, with shortness of breath and fatigue.

When he received a letter with a positive test result a week later, Luna was dumbfounded. He had no idea where he might have been exposed, since he, his partner and school-age daughter had followed public health recommendations to the letter.

“I washed my hands until they were chapped and dried, and took all the suggested measures,” he said. “In fact, this was the only thing in my entire life that’s gotten me to stop biting my nails.”

As cases mount, contact tracers are having less success getting COVID-positive patients to pick up the phone, said Dr. Jeffrey Gunzenhauser, chief medical officer at the Los Angeles County Department of Public Health. Contact tracers had been able to complete an interview with positive patients more than 70% of the time up until about three weeks ago, he said. Now, the rate is as low as 65%.

“It could be that older individuals who traditionally use phones are more willing to answer phones, whereas younger people might communicate through texting and other means, so maybe they’re less likely to,” he said.

To increase pickups, the department has asked telephone companies to label all calls from contact tracers as “LA Public Health” when they flash on a phone’s display. The department has convened focus groups among young adults to figure out ways to better communicate with them.

In Luna’s case, AltaMed Health Services, which administered his COVID-19 test, said it tried to call him three days in a row and left two voicemails before sending the letter. Luna said that he never received the calls or voicemails — and that the same thing happened to people he knows.

At the beginning of the pandemic, infected patients usually had a good sense of where they were exposed to the virus, and by whom, said Patricia Marquez Sung, an epidemiologist with USC Verdugo Hills Hospital, a 158-bed facility in Glendale, in L.A. County.

People showing up at the Verdugo Hills emergency department with COVID symptoms in June were significantly younger than earlier this year, hospital data shows — and more ER patients say they have “no idea” where they could have contracted the virus, Sung said.

“What that’s telling me is that, potentially, we’re getting a little bit lax with the vigilance in masking, staying home and hand-washing,” Sung said. “People have gotten restless and their perceptions of risk are a lot lower than three or four months ago.”

Even health care workers are getting restless and venturing out more. Verdugo Hills’ sister hospital, the 401-bed Keck Hospital of USC near downtown L.A., is seeing a rise in health care worker infections from community spread. During the last 10 days of June, 20 staffers tested positive; the hospital’s in-house contact tracing team determined that none of them were exposed to COVID-19 patients at work. In the previous 3½ months the hospital had recorded a total of 68 positives among staff.

Public health officials and political leaders are urging younger people to refrain from parties and large gatherings, and emphasizing the possibility of asymptomatic or pre-symptomatic transmission to more vulnerable populations.

These cautionary messages are especially urgent amid a growing consensus that the virus can linger in the air indoors, said Chris Van Gorder, CEO of Scripps Health, a large nonprofit health system in San Diego County. Previously, leading public health groups like the World Health Organization had said the virus was mostly transmitted directly from person to person, in respiratory droplets that rapidly sink to the ground unless they’re inhaled.

The shift in thinking has painful implications for people — including health care workers — eager to return to indoor restaurant dining and other businesses, said Van Gorder. Some 201 COVID-19 infections were reported among county health care workers in the first week of July, compared with 72 in the last week of May.

Van Gorder learned that some hospital employees went to casinos when they reopened, and another group “decided to go off to dinner together in Little Italy. They know better, and they got sick.”

“I think California was doing a phenomenal job flattening the curve, but there was so much pressure to reopen that we reopened too fast,” he said. “We’re seeing the consequences of that now.”

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17 comments

  1. ambrit

    The “Party Like It’s 2019” urge isn’t a new thing in Terran Human populations.
    There is a scene in the beginning of Murnau’s silent film “Faust” where the plague is wreaking havoc in the town and many of the people are reacting with wild partying and ‘reckless abandon.’ The urge to “have some fun” before doom strikes is all too understandable. It betokens a hopelessness and subsequent abandonment of social ‘norms.’
    America might not be at the “Plague!” point in the process, but it is coming. What is surprising to even this Geriatric Cynic is how long the process takes. The virus holds to it’s own timeline, not ours.
    The mention by the medico that the virus seems to have become established in the population is the defining theme. The Dreaded Pathogen is here to stay.

    Reply
    1. arte

      Plague parties are indeed not something new, nor are they a fiction created centuries after the fact – Decameron, written just after the Black Death hit, mentions things like:

      “Others, inclining to the contrary opinion, maintained that to carouse and make merry and go about singing and frolicking and satisfy the appetite in everything possible and laugh and scoff at whatsoever befell was a very certain remedy for such an ill… “

      Reply
  2. Ignacio

    This is a good description of “community transmission” when you cannot longer trace events into clusters. At this point, and surely many Californian counties have reached it, contact tracing helps but cannot avoid further spread. It has to be complemented with stricter measures regarding masks, closing hot spots and trying to avoid meetings as much as possible, including familiar meetings or even forbidding some/many/all events. The picture is complex. It can be argued, for instance that extensive use of masks helps some unnoticed spread because they don’t warrant full protection and can lead to a rise in mild cases which is at the same time good and bad news. It could be particularly bad news if this ends with a rise in more severe cases next winter: In any case not wearing a mask will increasingly result in higher personal risk. Now, let’s talk about schools…

    This is a nightmare!

    Reply
    1. Yves Smith Post author

      Nassim Nicholas Taleb deemed contact tracing not to work once the infection level got too high. I confess I have not gone back to see if he gave more specifics, but I would assume it’s a function of the R0 and the level of infection in the community. My sense is that in a lot of the US, some combination of mask wearing and activity restriction will have to occur for contact tracing to have a hope of being productive (oh, and we have to get testing fixed too….)

      Reply
  3. William Hunter Duncan

    If Trump were any kind of leader, and there were any leadership in Congress, they would unite and say, OK, $6,000 (or whatever) a month for the next two months for everyone making under $100,000, everyone is taking a stay-cation. Everything that can stop for the next two months stops, and everyone in public wears a mask.

    They are going to print 20 trillion probably before this is done, anyway. They might as well just print 3 trillion, pay for the economy and lock it down, and put a stop to this as much as we can before winter.

    But then I guess pigs would have to fly over Washington and Wall Street before such a thing happened?

    Reply
  4. rjs

    not just because they’re younger…we have 3,984,032 Covid cases at last count, where are we going to get the work force to trace all their contacts?

    sorry, we lost the handle on this thing long ago…

    Reply
  5. Oso

    Yves Smith thank you for this article. I liked “To increase pickups, the department has asked telephone companies to label all calls from contact tracers as “LA Public Health” when they flash on a phone’s display”. Possibly organizers in the Latino and Black communities could get the word out to pick up these calls.
    there are local efforts being made for movement contact tracing, jail support to include access to free testing and support for those needing to be quarantined. obviously movement contact tracing to fill the need for timely contact tracing but also due to fear and security needs.

    Reply
    1. Arizona Slim

      How hard would it be to spoof a caller ID? Methinks that such a dirty deed would be quite easy for a motivated scammer.

      Reply
  6. kareninca

    “Younger people with COVID-19 are also less likely to pick up the phone when a contact tracer calls . . .”

    I guess if our representatives are not willing to block robocalls and prosecute scam calls, and if they impose on us a surveillance state, then people won’t be willing to respond when important questions are asked. I don’t answer the phone; I wait for a message to be left and then call back or don’t. If someone claimed to be a “tracer” I would not believe them (or call them back), any more than I would believe someone who said s/he was a pollster. And I’m a middle aged person, not a young person.

    Reply
    1. rjs

      there’s a way of dealing with that…when you get an obvious scam call, ask the caller to “hold on a minute”, and just put the phone down…go back in a few minutes and ask if they’re still holding, and if so, repeat the ‘hold on a minute’ request…i’ve kept them tied up for more than ten minutes that way…

      and when the robocall says ‘if you want to talk to a representative, please press one’, always press it…never let them off scott free…

      Reply
    2. Janie

      I’m old and do the same. Don’t check voice mail that often b/c anybody i want to talk to texts or is in contacts.

      Maybe tracers should use a dedicated phone and just text.

      Reply
      1. kareninca

        I don’t text.

        I realize that I may be coming off as anti-tracing here. I’m not, really. I sign in where I volunteer, so that I can be contacted if someone turns out to have been infected. However, I would expect to be contacted by someone I know, who volunteers there. If I get some random-seeming call from a “health department” I’ll figure it is just the latest scam.

        Reply
  7. kareninca

    “To increase pickups, the department has asked telephone companies to label all calls from contact tracers as “LA Public Health””

    I have an old clamshell phone. It doesn’t display anything about who is calling. If I did get a call from “LA Public Health” as such, I’d be about as convinced as I am by the calls that tell me my “account” has been hacked.

    Reply
    1. Math is Your Friend

      Exactly.

      Anything that increases the chance of picking up a call will swiftly be adopted by scammers and attackers.

      And it’s not an easy problem to fix…

      Reply
  8. Bob Hertz

    Los Angeles County has a population of 10 million.

    22 dead in one week from Covid does not seem alarming enough to call for another stay at home order.

    If the number of fatalities doubles each week, it would reach 1,408 in six weeks.
    Still pretty small for 10 million residents.

    I would probably not be a good public health officer.

    Reply
    1. Oso

      bob hertz
      “22 dead in one week from Covid does not seem alarming enough to call for another stay at home order”. might or might not. the fact that it was 50 today (per DPH) is alarming enough for me.
      and you’re right. you wouldn’t be a good public health officer.

      Reply
  9. LAS

    There’s too much infection too widely around, with too slow testing, and finally too little behavioral cooperation for contact tracing to work. The USA has shot too many holes in the boat it might once have used for escape.

    Reply

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