As Pandemic Surged, Contact Tracing Struggled; Biden Looks to Boost It

Yves here. I continue to be skeptical of contact tracing being effective in the US. The article below gives one reason we’ve mentioned repeatedly, that the contagion level needs to low enough that the contact tracing really is getting at exposures that were unique to that individual, and not community spread noise. The article does not address that test results confirming that the patient has Covid often come back so long after the individual became symptomatic that by the time he’s interviewed for his contacts and they are tracked down, they’ve already started shedding virus and/or are symptomatic.

Readers can pipe up, but I also wonder how many, if any, states have initiatives to assist with contact tracing. Maine, which has low population density (more roads per capita than any state), nevertheless requires restaurants to get the name and phone number of one diner at every table served to facilitate contact tracing in case someone with Covid visited that venue.

Another issue the article flags is some don’t cooperate with identifying their contacts. And finally, those who were exposed are asked to “isolate”. That does not sound specific enough to give useful guidance, like “Quarantine till the sooner of when you get symptoms or 5-7 days after you were exposed and get a Covid test then.”

The wee problem in America is most people can’t quarantine. Limiting interaction is better than nothing but well short of the standard in South Korea and Hong Kong where contact tracing was effective. You need to have your own bedroom and bathroom, use only them, and somehow get food delivered to your door for the entire quarantine period. The article cites a Pew study where 93% of respondents said they were told they had the virus, which is not the same as if they were exposed. And anyone who has done surveys will tell you that responses to questions like this are highly unreliable (just as “Would you buy XYZ product?”). Among many reasons, participants tend to say what they think the questioner wants to hear. And undercutting that 93%, one-third of the participants said it would be hard for them to do so.

To put it more bluntly, Americans don’t seem to understand what “isolate” and “quarantine” mean. A friend’s significant other returned to Poland to see her family last month. She had to stay in her parent’s home for two weeks. She was not allowed even into their yard. There were cameras on the house plus the neighbors were enlisted to watch. Her first violation would result in a 5000 euro fine. Her second would be 15,000 euros plus six to twelve months in jail. So with no teeth in the US contract tracing programs, what is the point? A mini Job Guarantee scheme?

By Steven Findlay. Originally published at Kaiser Health News

Contact tracing, a critical part of efforts to slow the spread of the coronavirus, has fallen behind in recent months as covid-19 cases have soared. President Joe Biden had pledged to change that.

Biden proposes hiring 100,000 people nationwide as part of a new public health jobs corps. They would help with contact tracing and facilitate vaccination. Experts said it’s not clear that would be enough tracers to keep up with another surge in covid cases, even if the vaccination rate increases at the same time.

As with everything covid right now — testing, vaccinations and hospital capacity — ramping up contact tracing has become a race against time as new, more contagious variants of the virus threaten to accelerate transmission of the disease.

In addition, as testing has steadily increased to around 2 million per day, so has the need for tracing. The two go hand in hand. Also, even conservative estimates put the number of people with undetected infection at two to three times the number with reported positive test results.

Such estimates translate to 75 million to 100 million infections in the U.S. Officials in California’s Los Angeles County reported Jan. 14 that an estimated third of the population of the county, the nation’s largest, was likely infected.

I have experienced the urgency of the pandemic up close. With a leap of faith, I became a foot soldier in the covid fight last June as a contact tracer in Maryland. Talking by phone to dozens of infected and exposed people every week, I hear about the impact of the virus on families in often sobering detail.

We tracers, for example, are often the first to reach people with their positive test results since labs and health systems frequently get backed up. For people already experiencing symptoms, our calls usually confirm what they suspected. For people without symptoms, though, we are the bearers of unwelcome news. That’s not an easy part of the job.

Still, almost everyone we interview takes it in stride. They agree to isolate and provide us with the names of people they’ve come into “close contact” with — generally, within 6 feet for more than 15 minutes — in the previous week or two. Those contacts then get a call, too. The aim is to reach as many people as possible within 24 hours, to break the chain of transmission by urging them to stay home and quarantine.

Of course, not everyone cooperates. Some decline to quarantine or give the names of close contacts. Most states do not report the number of uncooperative people. But a Pew survey of adults conducted last July found that 93% said they would quarantine if told they had the virus. A third, however, said it would not be easy to do so — usually because of work — and a quarter said they would not be comfortable telling tracers about places they had been or people they’d been in close contact with.

As such, contact tracing has inherent limitations, and quarantining isn’t enforced in the U.S. Tracing also becomes far less effective as the number of cases grows.

An analysis by researchers at Johns Hopkins University in Baltimore concluded that contact tracing in the U.S. can be fully effective in mitigating spread of the virus only when new cases are at or below 10 a day for every 100,000 people. The case count now exceeds that in most states. The national seven-day average as of Monday was 35 cases per 100,000.

“Tracing programs nationwide are overwhelmed right now,” said Crystal Watson, a senior scholar at Hopkins’ Center for Health Security. “States just don’t have enough people to keep up.”

Even so, Watson added, “every contact traced still means lives potentially saved. We can’t let up.”

Every state has a tracing program, but they vary widely. The Centers for Disease Control and Prevention has comprehensive covid tracing guidelines, but the Trump administration had neither data nor performance requirements for states to meet.

A White House spokesperson told KHN that the administration views contact tracing as “critical to efforts to reduce spread of the virus.”

Staffing is the most significant challenge. Researchers at George Washington University in Washington, D.C., evaluated contact tracing needs and how states and counties performed.

Their bottom line, based on the most recent surge in cases: The nation would need 928,000 contact tracers to keep up with the current number of cases — or 281 per 100,000 people.

But that projection, which takes many factors into account, is widely viewed as unrealistic. The current number of tracers, according to data from Johns Hopkins, is 70,500.

“If we could get close to half the ideal number, it would help greatly,” said Dr. Amanda D. Castel, a professor of epidemiology at George Washington University. “With luck the vaccine will begin to reduce the need.”

Most states aren’t even close to 140 tracers per 100,000 people. With 530 active tracers, the District of Columbia has 75 per 100,000 people, more than any state. Fifteen states have 12 or fewer per 100,000. And the number of people who have received two doses of the vaccine is not yet large enough to appreciably reduce the rate of infection.

State and county health departments are keenly aware of the deficit and have moved to hire more tracers or deploy existing state or county employees to the task. Maryland, for example, has hired several hundred tracers in the past three months and is up to 1,550, said Katherine Feldman, director of contact tracing for the state. That’s still just 26 tracers per 100,000 people.

Nationally, states have hired about 17,500 tracers since October, according to Johns Hopkins data.

Biden recommended hiring contact tracers and other public health workers as part of his proposal for a $1.9 trillion covid relief and stimulus package.

Those hired would keep their jobs once the pandemic eases, to enhance the nation’s permanent public health corps and readiness. The president’s proposal does not stipulate, however, how many of those hired would be initially deployed to contact tracing. Administration officials did not respond to requests for comment on this point.

Last week, a group of Republican senators proposed a scaled-back $618 billion covid relief package that includes resources for vaccine distribution, testing and tracing but makes no mention of a public health service corps.

David Cotton, vice president for public health research at NORC, the University of Chicago  survey and research organization that assists Maryland with its program, said that while tracers don’t need medical or public health experience, hiring and training the right people and nurturing their skills is not something to be taken lightly.

“The success of tracing depends on having people in that job who can gain people’s trust,” he said. “Plus, the work can be quite emotionally draining.”

States are also adjusting programs.

In Maryland, we have shortened the questionnaire and prioritized geographic areas with high positivity rates. People are also being texted to prompt them to answer our initial calls. These steps have sharply reduced a backlog of cases, said Feldman.

Nationally, traditional tracing programs successfully reach about 65% to 75% of people who test positive and 55% to 60% of contacts. Those numbers are likely trending lower over the past six weeks after the recent surge in cases, experts and state officials said.

But no one knows for sure. That’s because there is no national reporting requirement or strategy for tracing metrics, and only 14 states make full data on their tracing programs public.

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  1. carl

    The barn door has been open for a year, and now we propose to close it, despite the horse having galloped four counties away.

  2. Arizona Slim

    The article describes the experiences of a contact tracer who was using the telephone to contact people.

    How quaint.

    I don’t know about the rest of you, but if I get a call from a number I don’t recognize, I let it go to voice mail. And, guess what? Most of the callers don’t leave voice mails — unless they’re robocallers.

    As for texting, well, I hate to break the news, but the scammers are all over that one. In the past couple of weeks, I got some sort of text that purported to have information about the COVID vaccine. But there was no mention of the entity sending the text. It also had a link.

    To me, that smelled like a phishing scam. So I deleted it.

  3. Don Cafferty

    To be effective contact tracing requires the correct metric. Last week’s article about the NFL proving that people can become infected in less than 15 minutes means that the metric identified in this article needs to change. The population also needs to become better aware of the NFL’s experience. Aside from the one-day announcement in the media of the NFL study conclusion, nothing more has been said.

  4. Bob Hertz

    Thanks for mentioning the details of a Polish quarantine. I have been trying to tell people for months that this is what it takes to get to zero covid.

    The chance of America adopting such protocols has always been zero. We will have to muddle through in some other fashion.

    1. Grumpy Engineer

      And to stay at “zero covid”, we’d have to essentially seal our borders, only letting people into the country after a strictly-enforced two-week quarantine, with rigorous testing at both beginning and end. The chances of America doing that is also essentially zero.

    2. PS

      And it’s not even that muddling through is that difficult. It basically comes down to mask wearing and social distancing. If everyone did that diligently life can be almost normal-seeming.

      I must admit, while I wouldn’t want to live in Florida or Texas due to their right-wing lunatic tendencies, I am grateful that they exist in this county to keep a check on what otherwise would be over-the-top covid theater histrionics.

  5. Synoia

    Well, from the Plutocrat point of view (AKA Washington Consensus), less useless eaters is a plus.

    Let’s be brutal: Genocide is a game Plutocrats play.

    1. Dwight

      Last April, a women at a ReOpen Tennessee protest carried a sign “Sacrifice the Weak: Reopen TN.”

      Nashville’s Fox affiliate, owned by Sinclair, prominently showed this sign but did not comment on this heinous message, either on video or in the caption shown in the above article.

      The same photo and caption, calling the fascist sign “sharp criticism,” was publicized by Sinclair’s Fox/ABC affiliate in Chattanooga. The Kansas City Star didn’t comment either, other than implying “sacrifice the weak” and “give me liberty” were similar messages of “protest.”

      Nashville’s ABC affiliate, owned by Nexstar, also prominently showed the sign, as shown in the above article. I don’t know if they commented on it.

      Maybe the camera crew thought it was interesting and didn’t think much about it, but the editors had to have known they were broadcasting/publishing a fascist message and should have clearly condemned it if they broadcast it at all.

      Our federal and state governments’ policies, beginning in New York, have effectively been to sacrifice the weak.

  6. sd

    From experience, there has to be buy in, readily available free testing, and provide pay for anyone who tests positive. The US doesn’t even want to pay employees a minimum wage anywhere close to a living wage.

    My workplace has strict protocols. Since June, there were 2 positive cases. Both times, the immediate colleagues of the individuals were sent home for 2 weeks with pay and additional testing, both times identifying only 1 other positive.

    The manager then contacted everyone who was in their second ring, had spent time in close proximity, then working out. Anyone who spent a cumulative 15 minutes with someone who tested positive shifted to PCR testing x3 a week.

    So far, it’s been successful.

    But now I’m going to throw a wrench in the works. Someone I know got the virus early in March. They can test undetected on Monday, detected on Tuesday and Wednesday, and undetected on Thursday. There’s nothing they can do about it and they are approaching the one year mark. We already know reinfection is possible.

    At what point does testing just become ineffective? If testing isn’t effective, then there’s no reliable way to really keep track of the virus.

    At work we say wear your mask, wash your hands, stay in the bubble (don’t socialize), it’s really about the only thing you can do to protect yourself.

  7. Henry

    It seems that since the antigen test can be cheaply (a few dollars each) manufactured on a large scale and even though it will only tell you that you are currently spreading the virus not whether you will in the future or did in the past, as the PCR test does, it would be worth the government spending ~ $100/person to send everyone a months worth of test strips so they could test themselves before going into public. The results only take a few minutes. For another ~$20/person they could provide everyone with a months worth of Vit D (~ 3000 iu/day) so any virus that slipped through would have a minimal impact on all but the most at risk. If you test positive then you isolate for the week while taking Ivermectin and let everyone you’ve been in close contact with since your last test know. That is likely not many since you are testing regularly so hiring contact tracers is not necessary except with very large gatherings of unrelated people. Since everyone is monitoring themselves we can focus on isolating the most at risk and the actively contagious and the rest can get back to our “normal” lives.
    MedCram on antigen testing:
    Dr Campbell Vitamin D:
    FLCCC Efficacy of Ivermectin:

  8. VietnamVet

    When Dr. Anthony Fauci became Joe Biden’s Medical Advisor, this was a clear signal there would be no substantial change in government policy; profits over lives. NIH, CDC and FDA are just as regulatory captured by corporations as is the Pentagon. Joe Biden has already reinforced more American troops and contractors back into the Syrian occupation.

    Public Health is not rocket science. It is over a century old, and like lots of things, the USA no longer is a pioneer in treating, isolating and controlling disease, like it once was;

    If you argue that America, is not Taiwan, Vietnam, South Korea or Thailand; then, just copy and do what fellow settler colonies, Australia and New Zealand, are doing. North America is as isolated as Australia from the rest of the world.

    Yes, the virus is endemic and vaccines will help. But the virus is mutating and deaths have not started to decline. 486,922 Americans are dead to date. This is war. Fix, flank, encircle, then mop up the enemy; one community at a time. Either coronavirus is eradicated or the incompetent top 10% overseers will find themselves in a civil war with the bottom out-of-work 90% of Americans. “A majority of the people arrested for Capitol riot had a history of financial trouble.”

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