Whenever a new infectious disease emerges, contact tracing is public health’s most powerful weapon for tracking transmission and figuring out how best to protect the population.
But now, as coronavirus cases are surging in hot spots across the United States, the proven strategy’s effectiveness is in doubt: Contact tracing failed to stanch the first wave of coronavirus infections, and today’s far more extensive undertaking will require 100,000 or more trained tracers to delve into strangers’ personal lives and persuade even some without symptoms to stay home.
“We don’t have a great track record in the United States of trust in the public health system,” said David C. Harvey, executive director of the National Coalition of STD Directors. Ever since the 40-year Tuskegee experiment, which withheld treatment for syphilis from poor black men, officials have had to make special efforts, he said, to reach those now “disproportionately impacted by covid who are African Americans and Latinos.”
Still, as states relax restrictions, public health experts say wide-scale contact tracing is the price that must be paid to reopen safely without reverting to the blanket shutdowns that put nearly 40 million Americans out of work. Time is of the essence, they say, taking advantage of the drop in cases resulting from the shutdowns.
“Contact tracing is finding the next generation before they happen, getting ahead of that transmission cycle to stop it,” said Emily Gurley, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health and the instructor of the school’s new six-hour online contact-tracing course. Gurley doesn’t believe the strategy will stop transmission but that, in concert with testing and other measures, it can prevent the disease from spreading exponentially.
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Right now, though, the virus is showing signs of taking the lead again, as states relax restrictions on large gatherings and welcome customers back into bars, restaurants and movie theaters. Cases are on the rise in more than 20 states across the country, with new highs in Arizona, Texas and Florida.
In Arizona, Gov. Doug Ducey reopened the state before local health departments had trained its new army of contact tracers, said Will Humble, former director of the state’s health department.
Humble described case investigation and contact tracing as key elements of a multipronged response, including mask-wearing and social distancing.
Texas, also seeing a dramatic surge, has relaxed restrictions after hiring about 3,000 of the 4,000 contact tracers Gov. Greg Abbott said in April he planned to have in place as part of his reopening strategy.
Michael Sweat, director of the Center for Global Health at the Medical University of South Carolina, said that state’s health department, which has suffered from long-term underfunding, was trying hard to ramp up contact tracing as parts of the state suffer “worrisome micro-epidemics.”
The University of California at San Francisco has been tapped by the state to create a Pandemic Workforce Training Academy that will train as many as 3,000 people for the state’s 58 county health departments, many of them focusing on low-income communities where requests to self-isolate can be financially devastating.
In San Francisco, librarian Ramses Escobedo, who became a contact tracer after two weeks of training, said the health department gave out a 60-page instruction document. “It has information from the scripts you’re supposed to follow, the questions you’re supposed to ask.”
Of the 30 people Escobedo spoke to in his first three weeks as a contact tracer, only one refused to answer his questions.