As Covid Numbers Decline, Covid Contact Tracers Have More Success

The massive scale of infection at the height of the multiple Covid surges during the pandemic made traditional contact tracing virtually impossible. It was simply moving too fast for public health to keep up. 

Now that infection rates are lower, contact tracers are actually having an impact, even in the face of the Delta variant. JL 

Betsy McKay reports in the Wall Street Journal:

As the pandemic slows in the U.S., public-health departments say they are finally able to reach for the traditional goal of contact tracing: stopping new outbreaks. During surges over the past year, rapid transmission of the virus in much of the U.S. made it nearly impossible to identify or contact every patient. Now, with new cases dropping, they hope to identify all diagnosed or exposed people and coax them to stay away from others. Contact tracing is particularly critical because the highly transmissible Delta variant is expected to become the dominant strain

Andrea Valencia worked the phone furiously day after long, dark day this past January, racing to reach people around Richmond, Va., who had tested positive for Covid-19.

As many as 500 new cases were being reported daily in the area. She and colleagues at the local public-health department had only a few minutes to spend on each one—if they could reach the person at all. They didn’t have time to help people to isolate or quarantine, or make sure that they did.

Now, with just 10 or so new Covid-19 cases coming in each day, the team is aiming to stop the virus in its tracks, the 35-year-old public-health investigator said. She calls every person who is reported as a positive case, as well as their close contacts, and urges them to isolate or quarantine. She also offers help.

“It’s huge, honestly, that we’re able to sometimes have multiple phone calls in a week with one person,” Ms. Valencia said. “We’re able to walk through it with them.”

As the pandemic slows in the U.S., public-health departments say they are finally able to reach for the traditional goal of contact tracing: stopping new outbreaks.

“We want to contain it completely,” said Michael Mendoza, commissioner of the Monroe County Health Department in Rochester, N.Y.

During surges over the past year, rapid transmission of the virus in much of the U.S. made it nearly impossible to identify or contact every patient. Public-health workers such as Ms. Valencia struggled to do their part to slow the spread.

Now, with new cases dropping, public-health officials say they hope to identify all diagnosed or exposed people and coax them to stay away from others. Public-health departments typically use that approach to stop transmission of communicable diseases such as syphilis or measles.

Contact tracing is particularly critical because the highly transmissible Delta variant is expected to become the dominant strain in the U.S. soon, said Crystal Watson, senior scholar at the Johns Hopkins Center for Health Security, who has tracked contact tracing in the U.S. “We can drive down the incidence even further and be more protective of those who haven’t been vaccinated in particular,” she said.

In spring 2020, public-health leaders and academics including Dr. Watson projected that the U.S. would need between 100,000 and 300,000 workers tracking Covid-19 cases and their contacts to keep the virus from spreading. It isn’t known how many were ultimately hired because state and local health departments acted on their own, often reassigning staff from other jobs or contracting with outside firms, said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials.

“We never quite got to the level of contact tracers we needed across the country,” she said.

A survey led by Centers for Disease Control and Prevention researchers found that contact tracing wasn’t sufficient to reduce transmission of the virus in most communities between June and October 2020, because two out of every three Covid-19 patients weren’t reached for an interview, or didn’t name any contacts when interviewed.

New Covid-19 cases have dropped so precipitously that far fewer people are required to track them, officials said. Public-health departments, including those in Richmond and Rochester, are cutting back on contact-tracing staff as people leave or go back to their regular public-health jobs. New federal funds, including $7.4 billion from the Biden administration, are helping them train in-house experts to respond quickly to clusters of Covid-19 and other diseases.

The San Francisco Department of Public Health said it had 216 employees dedicated to case investigation and contact tracing during the height of the winter surge, when it was monitoring an average of 240 new cases and 156 new contacts a day. From April to June, it had an average of 17 new cases and 19 new contacts a day. The department has 35 staffers following up with Covid-19 cases and will maintain a core team for that work, said Stephanie Cohen, acting director of the disease prevention and control branch of the public-health department’s population health division.

They are paying particular attention to people who are vaccinated, because they may have been infected with a variant of concern, Dr. Cohen said. The department has a five-year federal grant to hire more disease-intervention specialists and improve data systems to detect and respond to infectious-disease clusters, she said.

Virginia has adapted its contact-tracing approach to use smaller teams with more public-health training that will build relationships in schools, businesses, jails and other settings where outbreaks could occur, said Elena Diskin, epidemiology program manager for the state’s contact-tracing program.

“They’re pretty much serving as junior epidemiologists,” she said.

Virginia has a contact-tracing app that lets users know if they have been exposed to Covid-19 or upload positive test results, but it doesn’t replace outreach from public-health workers, Ms. Diskin said. “It’s a really great supplement to manual contact tracing,” she said.

Ms. Valencia, who came to the U.S. from Colombia as a teenager, focuses on Spanish-speaking communities around Richmond. Working from a desk in her walk-in closet during the winter surge, she called people to tell them they had tested positive, offered information and services, and then moved on to the next call.

Sometimes it was hard to get people to pick up the phone. Many who did answer needed help; her team arranged food deliveries for some and laundry service for a family quarantined without a washer and dryer at home.

Now, more people are answering the phone. She talks with some repeatedly. “My hope is that we have gotten some trust from our community to where they know we aim to support them,” she said.