Experts warn ’time is of the essence’ to put contact tracers in place

It will take an army of disease detectives to win the next stage of the battle against Covid-19, the sometimes-deadly disease caused by the novel coronavirus SARS-CoV-2, public health experts said.

The first phase of the battle — slowing the spread of the disease by social distancing — may be nearing its end, according to Crystal Watson, DrPH, of Johns Hopkins Bloomberg School of Public Health, and the next phase will see a gradual lifting of those social restrictions.

But a key to success in that will be a dramatic increase in the number of people involved in tracing the contacts of every new Covid-19 patient in order to find new cases, interrupt chains of transmission, and stop surges of disease, Watson told reporters in an online briefing.

The U.S. will need “at least 100,000 contact tracers across the country,” Watson said — an “unprecedented” number in a nation that usually has less than a fiftieth of that. An estimate generated before the pandemic suggested there were about 2,200 people engaged in contact tracing in public health departments across the U.S.

However, a recent survey by National Public Radio, including data from 41 states and the District of Columbia, found they have about 7,600 contact tracers on staff with plans that would see the number rise to more than 36,500.

“That’s a great start,” Watson said, adding that reaching 100,000 is “achievable.”

She and colleagues are working with New York state and Bloomberg Philanthropies to develop a curriculum and training program to get new contact tracers up to speed on the basics of the disease, the goals and mechanisms of contact tracing, and the legal and privacy ramifications of the work.

But they don’t have to reinvent anything, she said: Contact tracing “is not new — we just don’t have enough capacity.”

Indeed, “we’re playing catch-up,” said Emily Gurley, PhD, also of Johns Hopkins Bloomberg, adding the national goals at this stage of the pandemic should be to bring the case numbers down and the workforce numbers up.

In most diseases, contact tracing can be done in a rather leisurely fashion, she told reporters, but Covid-19 is different — it is more contagious than many illnesses and can be spread by people who have no symptoms.

So, for pandemic contact-tracers, “time is of the essence” if they are to interrupt transmission chains and slow the spread of the disease, Gurley said.

Contact tracers, she said, need “good people skills” so they can win the trust of people they reach out to, but they also need to know how to get those people the resources they need, including disease testing, medical care if needed, and assistance with isolation where warranted.

Gurley said training on the basics of the disease should take four to five hours but learning about the other aspects of the job will vary from place to place and could take up to a couple of days.

Watson added said she fears that, in the rush to re-open, some governments are losing sight of key markers, including a consistent downturn in new case numbers, wide access to diagnostic tests, and increasing contact tracing.

“I worry that transmission will start to get out of control again,” she said.

Enrolling new workers might well be the easiest part of the plan; Watson noted that owing to the pandemic, many people are out of work.

But who pays is an open question — at the average pay of $17 an hour for public health workers, a year’s worth of full time work by 100,000 people is about $3.6 billion, she and colleagues noted in a report.

Money could come from state and federal governments, as well as philanthropic organizations, she said.

In a letter released April 27, a former federal health official called on Congress to find $12 billion to help expand the contact tracing workforce, estimating that the U.S. will need up to 180,000 before a SARS-CoV-2 vaccine is available.

Michael Smith, Contributing Writer, BreakingMED™

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