Even though Connecticut’s COVID hospitalizations fell by more than 200 patients over the weekend and case rates return to a more manageable level, some officials say contact tracing may never be as robust as it was. at the start of the pandemic.
“Contact tracing is very intensive, not only is it very time consuming, but it’s very staff intensive,” said Dr. Ulysses Wu, chief epidemiologist at Hartford HealthCare. “I don’t mean that the state slowed down contact tracing in the middle of the omicron wave, it was more that they were really unable to necessarily have the staff to do it. So I think contact tracing is still ongoing, but it’s targeted. »
There are signs that the COVID surge, driven by the omicron variant, is loosening its grip on Connecticut. On Monday, the state announced there had been 218 fewer COVID hospitalizations since Friday, with the total now standing at 1,477. The positivity rate also dropped to 11.36% with 12,057 new cases confirmed at the weekend course in 106,153 tests.
But as the pandemic has evolved, so has contact tracing. On the last day of 2021, the state Department of Public Health sent a message to schools: You are not required to continue contacting the trace for COVID-19.
“Because contact tracing at the individual level is a tool that becomes less effective when levels of community transmission are high, DPH recommends that schools begin to refocus the activities of healthcare personnel away from investigating risky exposures. relatively low in school settings and towards the identification, early isolation and clinical management of students and staff with active symptoms that may be related to COVID-19,” the agency wrote in the guidance to schools.
Fran Rabinowitz, executive director of the Connecticut Association of Public School Superintendents, said contact tracing hasn’t proven to be very helpful in school settings.
“There’s been a lot of community spread and we haven’t found a lot of positive cases through contact tracing either,” she said. “It seemed like a tremendous amount of work without much reward.”
It’s not just the schools. The state changed its contact tracing strategy, relying instead on text alerts to residents.
“We are still doing contact tracing,” DPH Commissioner Manisha Juthani said. “So the local health department and departments are still involved in contact tracing. We simply recommend that this not happen in schools.
Juthani, however, said the strategy would have to change as the disease is “no longer an endemic virus”.
“People can take personal responsibility to let people know if they’ve been infected, and they’ve been around someone else who’s a friend, a loved one, anyone they know, and just kind of let it be known,” she said. . “I think it’s something people can take responsibility for, regardless of whether the contact tracer is looking for someone who has had the disease and then exposing others.”
Wu used Hartford HealthCare as an analogy for the state as a whole. He said they were still doing contact tracing in some circumstances, but not following up on all cases.
“We didn’t do contact tracing for every exposure,” he said. “We really looked at the things we needed to target – whether or not there was an outbreak, whether a lot of patients or a lot of staff got sick, we would definitely contact research in those situations, but we weren’t in touch. every positive point.
Scott Roberts, associate director of infection prevention at Yale New Haven Hospital, said a similar shift has taken place in his healthcare system.
“We were doing omicron contact tracing maybe in mid-December when things were still manageable,” he said. “And then, very quickly, within a week, it just became unsustainable.”
“We even had our contact tracers who contracted COVID and got sick,” he added.
When asked if, as the latest COVID surge continues to wane, she thinks contact tracing in schools will ever resume, Rabinowitz replied, “I don’t think so,” however, “we’re definitely taking our recommendations from the Department of Health.”
“Even before omicron, transmission was negligible in schools,” she said. “There was not a lot of transmission at school. Contact tracing did not yield a large number of positive cases. It’s new for everyone. We had to go through it and find the data to figure out that it didn’t work.
At its peak, Connecticut’s contact tracing system, known as ContaCT, employed 242 tracers, 21 supervisors and 19 community outreach specialists, as well as 132 volunteers.
The state originally budgeted $23.8 million for the ContaCT system, operated by AMN Healthcare and designed by Microsoft.
But when cases got too high, Juthani said contact tracing became less efficient and they shifted gears.
“Particularly through this omicron wave, because there were so many cases, we started implementing a text option for the first response when someone tests positive to be able to help quickly connect people to information that can help them navigate being positive with COVID,” she says.
Between the start of this text option on Jan. 1 and Jan. 21, 118,221 residents “received health education materials via text message,” according to DPH spokesperson Chris Boyle.
Boyle said Monday that between Dec. 26 and Jan. 15, 144,868 “actionable cases” were reported to ContaCT, 43,148 of them “had a call attempt by a contact tracer from the state or local health department and 12,062 were successfully interviewed – about as many COVID cases identified in Connecticut in the three days ending Monday.
Contact tracing, according to Roberts, is a “bread and butter epidemiology,” dating back to the days of widespread bubonic plague.
“Contact tracing is fundamental to preventing the spread of communicable diseases in the community,” he said. “From medieval times, I know they were focused on isolating exposed people and tracing.”
COVID is not the only disease currently being detected.
“We do contact tracing, depending on the pathogen,” Roberts said. “TB and measles, for example, we definitely try to contact the trace, even if someone is sent back to the community, just contacting their family.”
But not all diseases are managed this way, even if they have reached what Roberts called a “state of endemicity.”
“The big thing against that is that the flu is kind of still endemic, but we don’t contact the trace of the flu, even when the levels are low,” he said. “If we have a case of the flu in the community, I don’t know if the state contact is tracing a single case, like when it starts happening in September.”
Roberts said he expects YNHH to reinvigorate broader contact tracing efforts when it becomes possible again, though he’s not sure the state and schools will follow.
“I think if we see this continuing trend, where the next variant is even milder, and we don’t see hospitalizations increasing to about the same degree and we have this endemicity established, my suspicion and my assumption is that we will reduce our contact tracing efforts at this point,” he said.
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