Contact tracing, essential to fight against coronavirus, hits roadblocks

One of the most crucial parts of the fight against the spread of COVID-19 relies on significant cooperation from the public, and so far, the results are mixed.

Public health workers are trying to break the chains of COVID-19 transmission by reaching out to people who have tested positive for the disease and asking them to both self-isolate for two weeks and provide a list of people they had contact with 48 hours before becoming sick, who will, in turn, also get a call.

But in the age of robocalls and scams, so-called contact tracers are having a difficult time getting people to answer their phones or return missed calls.

Governors and public health officials in recent days have pleaded with the public to answer their phones if they get a call from the health department.

“If it comes up on your phone, please answer,” Louisiana Gov. John Bel Edwards (D) said Friday during a news conference, after reminding everyone of the phone number to look for. “In many cases, people are simply missing the call, or I suspect they don’t recognize the number and they just choose not to answer.”

States and localities have for several weeks been hiring and training thousands of new contact tracers using money appropriated by Congress to slow the spread of the coronavirus across the U.S. and prepare for a potential second wave in the fall.

Health experts say contact tracing, combined with increased testing and isolation of confirmed or suspected COVID-19 cases, can slow the rate of infection enough to safely reopen society and prevent explosive spread that can overwhelm hospitals and damage the economy.

As states get their expanded contact tracing networks off the ground, data is starting to trickle out on the effectiveness of those programs.

In Michigan, contact tracers are only getting ahold of positive COVID-19 cases 60 percent of the time, far short of its 98 percent goal. Louisiana contact tracers are faring worse, with positive cases being reached successfully 48 percent of the time.

“The goal is always to reach 100 percent of COVID-positive patients but in the real world, it’s not going to be possible to reach everybody,” said David Harvey, executive director of the National Coalition of STD Directors, which works with contact tracers.

“But we know that any person reached is going to make a difference,” he said, adding that reaching 50-75 percent of infected patients can still significantly reduce infections if those people quarantine.

In Colorado, contact tracers have successfully reached 78 percent of positive cases through May 15. 

The Centers for Disease Control and Prevention (CDC) hasn’t released a national contact tracing strategy that establishes metrics to help localities evaluate their efforts. 

But Resolve to Save Lives, a nonprofit led by former CDC Director Tom Frieden, recommends contact tracers interview at least 90 percent of newly confirmed COVID-19 cases within 24 hours of receiving the test results. He also recommends that at least 80 percent of those who have been in contact with someone who has tested positive for COVID-19 be notified within 24 hours.

“For it to be as successful as it can be, we need to see high rates of success,” said Joshua Sharfstein, vice dean for public health practice and community engagement at Johns Hopkins Bloomberg School of Public Health, adding that some programs may be seeing lower rates because they’ve only recently started. 

Contact tracing isn’t a new tool and is typically used to control the spread of STDs, tuberculosis and other illnesses that are less contagious or spread differently than COVID-19. 

Traditionally, contact tracers have gone to people’s homes, especially if they can’t be reached by other means. That option is now off the table to prevent workers from getting sick themselves.

Most of the work is now done by phone, text, email, letters or private messages on social media, said Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials.

He said some states have had calls from contact tracers show as such on caller IDs. For example, calls from the Michigan Department of Health and Human Services appear as “MI COVID HELP” on caller IDs. 

“A lot of contact tracers went into communities, going door to door and finding people that way. With COVID, it’s more challenging,” Plescia said.

But most people have probably never had an interaction with a contact tracer before, and public health officials have been working to demystify the process. 

“Contact tracing is a new idea for a lot of people, and it happens at a time when a lot of people don’t answer their phones if they don’t know the number that is calling them,” Sharfstein said.

Sharfstein said it’s important for people to be informed about contact tracing when they get the COVID-19 test, to let people know they may be getting a call if they are positive, and to highlight that participating is “really important so you can protect your own friends.”

If someone tests positive for COVID-19, they will likely be contacted by a contact tracer, who will provide information about support systems that are available and ask for a list of people the person had contact with in the two days before they developed symptoms. The names of people who test positive are confidential and aren’t provided to the contacts they identify.

Some populations, such as immigrants or communities of color, might feel uneasy about giving personal information to government workers, although they stress that the process is entirely confidential and won’t be used against them. Experts say that is why it is important to hire contact tracers who live in the communities they are working in, while spreading the message through community leaders. 

Other people, particularly those working low-wage jobs, may avoid calls from contact tracers fearing they will be told to stay home for 14 days and have to skip shifts they can’t afford to miss. Financial support is sometimes available for people who must miss work due to COVID-19.

For example, New York City has instituted a range of benefits to help people who need to stay home because of COVID-19, but those resources are less likely to be available in poorer states, said Harvey. 

Congress passed a COVID-19 relief bill earlier this year that gives many workers paid time off if they need it for the virus, but it doesn’t apply to the 48 percent of workers who are employed at companies with more than 500 workers. 

“It very uneven as you move across the country, which is why we argue that the federal government has to provide a lot more resources for this function, and the social supports that are needed to help people as they navigate this COVID world, and have a need to isolate themselves to prevent further infections,” Harvey said.