The country’s health department scaled back contact tracing in late spring or early summer when Covid-19 cases began to decline as vaccination efforts took center stage.
Then delta hit.
Now, state and local health departments are trying to rebuild operations with depleted resources as Covid fatigue among their employees and the public complicates those efforts.
“Contact tracing since the start of this pandemic has given us really valuable information,” said Dr. Amanda Castel, professor of epidemiology at George Washington University. Castel said it was still “a fundamental part of our response.”
So does Covid testing, especially for vulnerable or unvaccinated people, such as children under 12. Yet many departments now find themselves with fewer contact tracers and less robust programs. Like testing, contact tracing appears to have been abandoned.
Contact tracing is a resource-intensive operation, requiring workers to quickly call people who test positive for a disease and offer medical advice, then identify and contact anyone with whom the infected people have come into close contact. The hope during the pandemic is to prevent the spread of the coronavirus and to observe its evolution. Public health officials have used the process for decades to stop disease transmission.
But many public health departments have been overwhelmed by the onslaught of Covid. Last winter – before vaccines brought relief – they couldn’t stay ahead of the virus through contact tracing. And as the number of cases fell due to increased vaccination rates in the spring and early summer, more than a dozen state health departments downsized, Crystal Watson said. , principal investigator and assistant professor at the Johns Hopkins Center for Health Security. Resources were needed for immunization initiatives and to reinvigorate other public health programs.
The situation has become critical in a number of states over the past month or so, as local health officials once again find themselves behind the curve as the delta variant pushes up the number of cases. Resources are already stretched and the politicization of Covid has left local officials making tough calls about who to look for in places like Missouri and Texas. And some states just don’t have enough staff to do the job. The army of disease detectives most often included temporary agents or civil servants from outside the health services. In Kentucky, the former director of contact tracing is now the commissioner of the Department of Aviation. The state public health department said he had a successor, but declined to name who.
The highly contagious delta variant makes labor more difficult. Cases can pile up quickly. Public health departments, chronically understaffed and underfunded, must choose the tools that will serve them best.
“Some places have managed to retain a kind of reserve workforce that they could call back. And I’m sure it’s handy right now. Other places didn’t. And they’re probably going to be overwhelmed quickly,” Watson said. “It’s also hard to say because there aren’t a lot of public reports.”
Arkansas, where Republican Gov. Asa Hutchinson now says it was a mistake to sign legislation in April banning mask mandates, is averaging about 2,000 new cases a day, one of the biggest increases important among states. But the state health department now has far fewer contact tracers — 192, down from 840 in December, when case numbers were at the same level, according to the department and data collected by Johns Hopkins.
Danyelle McNeill, spokeswoman for the Arkansas Department of Health, said contractors doing the work have been allowed to increase their staff size. She also said the agency is triaging cases, prioritizing people who test positive or are diagnosed with Covid within six days of sample collection or symptom onset, which the Centers for Disease Control and Prevention recommended when capacity is limited. She said vendors don’t call all positive cases the same day they receive listings when infections approach 2,000.
You have an audience that is really not supportive of contact tracing and quarantine.
In states that have chosen to minimize contact tracing, county and city health officials are left to their own devices. In the hard-hit southwest region of Missouri, the flood of cases overwhelmed an already exhausted staff, said Katie Towns, director of the Springfield-Greene County Health Department, so the department pivoted to perform contact tracing only in cases involving children under the age of 12. , who don’t have access to vaccines, Towns said.
Lisa Cox, spokeswoman for the state Department of Health and Senior Services, said “local health departments will work to triage and prioritize case investigations and work with them if assistance is needed.” . His department expects financial support through the US federal bailout, but the funds have not yet been allocated. Ultimately, local strategies will come down to priorities. “We have made it clear that local jurisdictions must make decisions locally based on their unique circumstances.”
The Springfield-Greene County Health Department’s surge capacity declined as team members were redeployed to other health programs, which had been neglected during the pandemic. But Towns said that even if she had unlimited resources, she wonders how effective it would be to invest all that in contact tracing: Covid is rampant and compliance with public health measures has declined. She would be more likely to deploy more people for outreach and vaccine distribution.
Kelley Vollmar, executive director of the Jefferson County Health Department in eastern Missouri, said the delta surge hits a community polarized against public health efforts. “You’ve got an audience that’s really not supportive of contact tracing and quarantine, and the funding for contact tracing and the infrastructure isn’t there like it was last year. last,” she said.
Contact tracing controversy
The Texas Department of State Health Services is “closing” its contact tracing program to meet budget requirements. In the new budget, which takes effect on September 1, the health services are expressly prohibited from using taxpayers’ money for Covid contact tracing.
“We will continue to conduct case investigations and other public health follow-up,” Chris Van Deusen, director of media relations for the state health department, said via email, “but we will not We will not provide contact tracing for local health services”.
The Texas Education Agency, which oversees elementary and secondary education, also said this month that schools are not required to conduct contact tracing.
Contact tracing has been clouded by controversy in Texas. Five lawmakers sued Republican Gov. Greg Abbott and the health department last August for awarding a contract to run the program.
“The contract-seeking policy was never established as a policy accepted or supported by the Texas Legislature,” the lawsuit said. Another lawsuit filed the same month by dozens of Texans alleges that adopting contact tracing violates their constitutional right to privacy.
In Williamson and Bexar counties in Texas, where community transmission of Covid is high, local health officials are troubled by the lack of statewide tracing.
Williamson County turned to the state health department for help in contact tracing and case investigation as 50 to 100 new cases a day were being reported.
The county’s health department, which is separate from the county government, has also trained more than half of its staff in contact tracing, from clinical staff to media officers, said epidemiologist Allison Stewart. chief of the Williamson County and Cities Health District, but the 65 people, including outside staff and volunteers, couldn’t keep up with the pace of cases. Some used to work seven days a week or 12 hours a day, but now the county is dependent on the state for labor.
“We can’t go back to that time now because all the people we used are actually doing their real jobs,” she said. “We are trying to figure out right now what the plan is for September 1. And that may mean the plan is that we don’t do case investigation or contact tracing.
“Honestly, we don’t know,” she said.
San Antonio in Bexar County, one of the nation’s largest cities, has its own contact tracers, but it relies on the state whenever there’s a surge, Rita Espinoza said, chief of city epidemiology. San Antonio relies on the state and therefore is able to handle the load without arrears, Espinoza said. She is worried about what will happen in the fall, after school starts and there are more possibilities for transmission. The staff is already operating at a reduced capacity of 80 people.
“The specific impacts are unknown, but it could impact efforts to improve other infectious disease investigations,” Espinoza said.
Florida, where Covid has become a political buzzword, is another state where tension is playing out. Broward County Mayor Steve Geller said he asked about contact tracing capabilities, including how many investigators the state health department has, but said that he had only been told: ‘We are working on it. It’s under control. » Contact tracing data is not publicly available; Republican Gov. Ron DeSantis once told local reporters that contact tracing “just didn’t work.”
Geller did not push health officials for information given that “contact tracing doesn’t work well when everyone has Covid” and Covid data has become controversial in Florida.
“I’m not looking to create new martyrs,” he said.
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