A robust network of “contact tracers” is needed to control the spread of the coronavirus and eventually reopen the country, experts say, a massive undertaking for a public health system that has been understaffed and underfunded for decades.
State and local health departments are lobbying Congress for billions of dollars to hire at least 100,000 contact tracers — workers responsible for tracking down people who have been exposed to confirmed coronavirus cases and asking them to self-quarantine.
The goal is to break the chains of transmission within communities and prevent outbreaks before they happen, especially when a second wave of the virus hits in the fall.
Public health groups say at least $3.6 billion is needed from Congress hire contract tracers, of which there are only about 2,200 in the U.S.
“I think there is a real recognition that while this is a lot of people and a lot of money, the other side of the coin is a country where we continue to be in lockdown, where our commerce is forced to a fault, people are scared, and kids are not in school,” said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials (NACCHO).
“This is a big investment and is a big risk but it gets us out of the current situation we have,” Casalotti added.
Contact tracing is one of the oldest infectious disease interventions in the book.
Public health departments around the country employ more than 2,000 of these tracers to stop the spread of sexually transmitted diseases, HIV and tuberculosis. While most of these workers have been redeployed to the coronavirus response, hundreds of thousands more are needed to track a disease that is this infectious and fast-spreading, experts say.
“There’s been a lot of attention, rightfully so, paid to the need for more testing. But without contact tracing and being able to go to potential cases early and have them quarantined safely, we won’t be able to stop community spread of COVID,” said Anita Cicero, deputy director of Johns Hopkins Center for Health Security, and co-author of a national plan to use contact tracing for COVID-19.
“I really do think that is the key, and a very important key, to helping us get back to some semblance of normalcy,” she added.
The method has been used in New Zealand and Iceland with success. Contact tracing is also a large part of the response in Asian countries but primarily relies on technology, which would likely run afoul of U.S. privacy laws.
The national contact tracing plan developed by Johns Hopkins Bloomberg School of Public Health and the Association of State and Territorial Health Officials (ASTHO) recommends starting with an additional 100,000 contract tracers for a 12-month deployment, with Congress needing to appropriate about $3.6 billion in emergency funding for state and local public health departments.
NACCHO, which represents local health departments, has made a similar recommendation.
But the number of contact tracers could grow as more cases are identified through testing. Former Centers for Disease Control and Prevention Director Tom Frieden has said at least 300,000 tracers are needed.
Contact tracing alone isn’t a cure for the nation’s testing woes.
“Testing is one of the critical components. If you can’t find the cases, there’s no way to successfully do the contact tracing that’s really going to stop the spread of the disease in its tracks,” Casalotti said.
Ideally, once a person tests positive for COVID-19, a contact tracer would connect with them and ask for information about whom they have been in contact with.
Most of the work could be done over the phone, so workers aren’t put at risk of catching the virus, though they might need to visit people’s houses occasionally.
Ideally, contacts of a COVID-19 case would be asked to quarantine for 14 days and would be connected with services, including paid time off, safe housing, access to food, medical care and other materials.
While it’s likely to be three to six months before there is widespread COVID-19 testing in the U.S., departments are looking to scale up their contract tracing forces now since it takes time to hire and train people, Casalotti said.
Departments are starting to look at who they have on staff who can be moved into contact tracing roles. Volunteers might also become a key part of the network, through the Peace Corps or the U.S Medical Reserve Corps, a national network of volunteers.
Massachusetts is working with a global health nonprofit to recruit an extra 1,000 workers for contact tracing.
Vermont hopes to have 48 people by the end of the week solely focused on contact tracing, up from the two people they had on the project, according to VTDigger.
San Francisco is also building up a similar program.
But the public health workforce has shrunk by a quarter since the 2008 recession, and funding has been reduced by 30 percent in the last 15 years. About 100,000 people work at public health departments now.
While health departments got an infusion of coronavirus response money through emergency funding bills passed by Congress, it’s not enough to support a massive contact tracing program, experts say.
“We’re talking about doubling the public health workforce,” said Michael Fraser, CEO of ASTHO.
“But there’s no other way to do it and reopen [the country],” he added. “You have to have the capacity to contain individuals that have the virus. And then follow up with folks who might have been exposed and monitor them and in most cases, probably ask them isolate them as well.”