In the days after it became clear that the White House had suffered a COVID-19 outbreak, many who had been in the building or interacted with the President wondered aloud: why hadn’t they heard from contact tracers?
But though the idea of a legion of agents armed with the know-how to trace and detect an outbreak may be comforting, it’s one of a series of misconceptions that surround the idea of contact tracing in the U.S.
Though the concept has been successfully implemented in countries around the world and in a few locations here, the U.S. as a whole lags far behind where it needs to be in order to have contact tracing function as an effective tool to mitigate and control the pandemic.
Beyond the lack of infrastructure, personnel, and funding for the local public health departments that conduct contact tracing, the approach also faces a conceptual problem due to the massive amount of virus that continue to spread across the country.
“There’s just too much viral load for contact tracing to be effective right now,” Gary Slutkin, a former WHO epidemiologist who fought disease in Africa, told TPM.
What’s left is a bleak but revealing picture: a key tool needed to bring the pandemic to an end is missing.
Contact tracing operates on a simple principle: if you can identify who an infected person has been in close contact with, you can get ahead of COVID-19 by quarantining those exposed to the virus.
The approach is an essential component of any pandemic mitigation and prevention strategy, allowing public health officials to catch and halt transmission chains as they occur.
But it’s a huge ask. A report from the Association of State and Territorial Health Officials estimated that nearly 330,000 contact tracers would be needed nationwide, assuming a ratio of one contact tracer per one thousand citizens.
And contact tracing is most suited for the beginning and ends of the epidemic curve, Josh Michaud, associate director for global health policy at the Kaiser Family Foundation, told TPM — times when cases are few enough that individual outbreaks can be tracked down and potential cases contained. That’s not the situation the U.S. finds itself in today, with only somewhat-mitigated spread.
“In places where you have a city or a county or something where there’s just widespread transmission, too many cases to count, in that kind of situation you don’t see contact tracing having much of an impact,” Michaud said.
Coupled with the overwhelming rate of new cases in the U.S., slow testing turnaround times and lack of resources for the local public health departments that actually trace contacts drastically reduce the effectiveness of an already sparsely used program.
“If results are being delayed 7-10 days, contact tracing almost is worthless because you can’t identify people quickly before they’ve already spread the virus,” Michaud noted.
Public health departments around the country are already equipped to handle the function in limited ways due to past experience with tuberculosis and HIV/AIDS, Dr. William Schaffner, a professor of preventative medicine at Vanderbilt University Medical School, told TPM.
“It’s traditionally done at the local level, by the city or county health departments, and it takes some training,” he added. “It depends on gaining the trust of the person whom you’re interviewing for the case.”
“We haven’t had a lot of resources,” Schaffner added.
Congress appropriated $25 billion for COVID-19 testing and contact tracing in March as part of the CARES Act.
But since then, no new federal dollars have been earmarked for the task.
Experts told TPM that in an ideal scenario, COVID-19 transmission would be reduced to a level where contact tracing would be effective: individual outbreaks could be caught and stopped by local public health departments.
“If you think of the population as being infected in a more circumscribed way — the White House, for example — contact tracing there can be very, very helpful,” Schaffner added. “You can button things up in that particular population. But if you think of our population at large, regardless of what we’re doing with contact tracing, it has a much less notable effect.”
And though some areas like New York City have managed to stand up groups of contact tracers to try to identify and halt new outbreaks as they occur, many areas with underfunded health departments have had trouble finding the money and time to track down the contacts of people infected with COVID-19.
Several proposals would see billions of dollars go towards local public health departments, allowing them to hire scores of contact tracers that would be able to meet the level the country needs to keep virus transmission at a level far lower than it is today.
ASTHO and Johns Hopkins released an estimate saying that 100,000 contact tracers was the minimum needed nationally “to rapidly identify, contain, support, and re-test
individuals who are infected and have been exposed.”
The Biden campaign has latched onto that number, committing to establishing a “U.S. Public Health Job Corps” that would be composed of at least 100,000 people to work on public health issues around COVID-19, including contact tracing. Biden has also said that he would establish a “U.S. Public Health Service Reserve Corps” that would deploy around the country to train local health departments to detect and respond to COVID-19 outbreaks.
Other questions around massive budgetary losses in local government linger. Public health departments are already constrained by a steep drop in tax revenue, making it difficult to add more services.
The HEROES Act, House Democrats’ bill aimed at addressing the pandemic, includes a $75 billion appropriation for testing and contact tracing which would go part of the way towards addressing this.
But, Michaud argued, to have avoided outbreaks in the fall and coming winter, the country should have made these investments months ago.
“The time to invest was yesterday,” he said. “We needed to make sure to have those in place for what could be a surge in cases going forward as the weather gets colder.”