Ben Lonergan / AP
The United States has more than 50,000 follow-up contacts for the first time since the coronavirus pandemic struck, according to a U.S. study conducted by the John Hopkins Center for Health Security in collaboration with NPR.
The total number of contact tracking messages in all US states and territories is 53,116. This is four times the number of contact tracking countries reported to the NPR in the original survey at the end of April, but it is still far more just over the more than 100,000 public health experts called for since the start of the pandemic seven months ago.
“I see how we are increasing in terms of increasing contact tracking staff, [though] still only halfway to where we need to be, “said Daniel Allen, director of the Edmund J. Ethics Center. Safra “at Harvard University and co-author of the COVID-19 Policy Handbook. This latest study shows an almost 30% increase over the last NPR study in early August, which found 41,122 follow-up contacts across the country, but part of it increase due to the fact that more countries are now included.
Contact tracking staff “feels stagnant,” said Crystal Watson, a senior scientist at the Johns Hopkins Health Security Center. She led the study in collaboration with NPR. “I don’t see much evidence that we have a new impetus or renewed interest in trying to prepare for what we can see this winter,” she said, “and we’re already seeing cases in the United States and Europe. “
Here are six draws from this latest study
1. The contact tracking workforce in most countries does not meet the needs
Currently, only a handful of countries have enough public health officials to investigate their coronavirus cases, according to an NPR analysis. This is the case every time the NPR surveys countries. This time, only Oregon and Vermont and Washington have enough. Four more states – Maine, Montana, New York and Hawaii – have enough when reserve workers are involved. And 44 countries do not need.
The analysis, based on the number of cases in the country over the past 14 days, was made using an assessment tool developed by the Fitzhugh Mullan Institute of Health Workforce at George Washington University. As in June and August, the NPR assumes that workers call 10 contacts per case and that followers reach up to 45% of contacts and monitor them during the day – a conservative estimate to reflect the real challenges facing health workers.
2. Against the background of surges, contact tracking cannot solve everything
Watson says states must continue to increase staffing to help curb transmission, but that contact tracking cannot stop the pandemic on its own – especially when cases increase in many places.
She and her team have landed on a new threshold that contact tracking cannot handle: 10 cases of coronavirus a day per 100,000 people. This threshold is “based on both the data we see and the discussions we have had with public health officials at local and national level.”
“It’s easy to overload these systems,” explains Watson. When cases increase, they can increase rapidly – much faster than the public health team can hire more tracers. The threshold emphasizes that tracking contacts is “not the silver bullet – it is a necessary component of a successful response, but we cannot rely on it once we have out-of-control epidemics in communities,” she said. Instead, communities need to turn to more aggressive interventions, such as closing businesses and masking mandates.
Jane Yakley, an epidemiologist with the Tennessee Department of Health, agrees that contact tracking can only be successful when combined with other measures. She emphasizes the need to “stay at home an easy choice” for people who are infected or exposed.
“Contact tracking continues to be part of the puzzle – it will not destroy COVID-19 and cannot work if people cannot (or will not) comply,” Yakli wrote in response to the study. “The perceived ‘failure’ of contact tracking is a failure of expectations. Contact tracking alone cannot control this level of disease. “
3. States are adapting to the growing cases and plan to hire more staff
Asked if they should have changed their contact tracking process during the wave, six countries said they did, 21 said they did not, while others said the question was not applicable or the answer was unknown.
“I think a lot of programs will be overloaded at some point during this pandemic,” Watson said. “So it’s worth thinking about what that means for tracking contacts – whether that means more federal support, more backup staff or different approaches to tracking contacts when the transmission gets really high.”
More than half of the countries that responded to the survey said they plan to hire even more contact markers, even seven months after the response. In total, the states have announced plans to recruit more than 3,500 workers.
“I think that means they can now see its value both in making a real contribution to suppressing the disease and in providing really valuable data, intelligence and knowledge,” Allen said. “They realize they have to catch up.”
One state that said the increase in cases is slowing down efforts to track contacts is Wisconsin. “We are maximizing limited resources to cope with the increasing number – as well as the increased complexity – of cases,” wrote Elizabeth Guzit, communications specialist in response to the study.
She noted that “workload fluctuations make staff retention challenging” and funding problems could prevent local health departments from hiring and training new staff quickly.
Michigan, which relied heavily on volunteers to handle contact tracking, also had to adjust. “This worked really well, while colleges and schools led to big increases, so we’re looking for better paid staff,” wrote Katie Macomber of the Michigan Department of Health and Human Services in response to the survey.
4. More countries share tracking data with the public
Contact tracking is also a tool for understanding where the transmission is taking place in the community.
“The thing that’s extremely valuable about tracking contacts at this point is the literal intelligence – the knowledge and understanding – that it gives to decision makers,” says Allen. “If you can understand that you have a whole cluster coming from a specific type of activity, then that’s what you’re excluding – you need to exclude everything.”
In this survey, almost every country reports that it collects transmission information and other indicators from contact tracking. 22 countries said they shared this information publicly on a government website – up from 14 last time.
Watson points out that public information on the number of contact tracking staff is surprisingly less likely to be public than details of the broadcast.
5. Many countries have launched applications but are concerned about public acceptance
The traditional method of tracking contacts is intensive for people and resources – trained public health officials call and interview any person who takes a positive test, and monitor that person’s close contacts for days to ensure that they are quarantined.
Since the spring there has been great interest in the technological shortcut. North and South Dakota were previously used contact tracking applications. Since Google and Apple joined forces to make it easier to create contact-tracking apps, Virginia has released one, along with New York and New Jersey.
Overall, the new study found that 20 countries currently report using a contact tracking application or related technology, with nine more planning to implement one in the future. The main concerns that countries cite about these applications are related to involving the public in the adoption and acceptance of this technology, and privacy concerns are close.
“I’m curious to see how many people download these apps, how much the public health services put in the people who take them – I think it really remains to be seen,” Watson said.
And it can be difficult to measure the extent to which these applications help limit the spread of the virus, says Allen. “Precisely because they protect confidentiality, it’s actually very difficult to understand what kind of impact they’ve had,” she explains.
Looking at countries like Switzerland that have used applications, she says that “they definitely catch some cases, but it’s on the borders, it’s not like something transformative. It is definitely not one of the things that will provoke or disrupt our response. “
In other words, there is no way around the need for many trained public health workers who can do the labor-intensive and labor-intensive work of making many phone calls.
6. There are still no significant federal resources
States have tried to respond to the need for follow-up contacts without much help or resources from the federal government. Some rely on volunteers, others raise money from private philanthropists.
The need is significant. In April, a group of former federal officials who wrote a letter to Congress calling for more support to track contacts estimated that $ 12 billion in federal funding would be needed to pay for new rents. There has been some effort in Congress to better fund and coordinate contact tracking, but the prospects for a coronavirus relief bill have diminished with the election in weeks.
Watson says that as the number of cases increases, members of the public and policymakers may be tempted to “blame contact tracking for failure if the show starts to avoid again, and I don’t think it’s fair to put that on tracking. contacts, especially when it is not properly secured. “
Without that financial support, Allen says the country’s tracking workforce is likely to “just keep growing,” even if coronavirus cases jump.