Contact trackers encounter resistance, indifference as they run to contain the spread of the coronavirus in the U.S.

HOUSTON – Health departments in the US that are using contact trackers to contain coronavirus outbreaks are struggling to strengthen their ranks amid a surge of cases and resistance to cooperation from those infected or exposed.

With very few contact trackers trained to handle the growing number of cases, a heavily affected Arizona county relies on National Guard members to participate. In Louisiana, people who have tested positive often wait more than two days to respond to health officials, leading to illness. crucial moment to spread. Many trackers find it difficult to break suspicions and apathy to convince people that compliance is crucial.

Tracking contacts (tracking people who tested positive and anyone they came in contact with) was challenging even when orders to stay home were in place. The trackers say it’s exponentially more difficult now that many restaurants, bars, and gyms are full, and people are gathering with family and friends.

“People are probably letting their guard down a bit … they think there is no longer a threat,” said Wendy Hirschenberger, health officer for Grand Traverse County, Michigan, who was alerted by health officials in another part of the state that they infected tourists. She had visited vineyards and bars in her area.

His health department was then able to urge local residents who had visited those businesses to be quarantined.

Hirschenberger was lucky to receive that information, it was only possible because the tourists had cooperated with the contact trackers. But often that is not the case.

Dr. Anthony Fauci, the country’s leading infectious disease expert, said Friday that contact tracing is simply not working in the U.S.

Some who test positive do not cooperate because they do not feel sick. Others reject the test even after being exposed. Some never call back to contact trackers. Still others simply object to sharing any information.

Another new challenge: More and more young people become infected and less likely to feel sick or believe they are a danger to others.

While older adults were more likely to be diagnosed with the virus early in the pandemic, figures from the Centers for Disease Control and Prevention show that the image changed almost as soon as states began to reopen. People ages 18 to 49 are now more likely to be diagnosed.

On Monday, the United States reported 38,800 recently confirmed infections, with a total exceeding 2.5 million, according to a count by Johns Hopkins University. For a few days, the cases reported daily in the United States have broken the record set in April. That partially reflects the increase in evidence.

Some states were caught off guard by the increase and are trying to rapidly increase the number of contact trackers.

“Right now we have insufficient capacity to do the job we need,” Arkansas Governor Asa Hutchinson recently said, announcing that he wanted to use federal coronavirus relief funds to increase the number of contact trackers to 900.

Arkansas already has 200 doing the job, but infections have increased more than 230% and hospitalizations nearly 170% since Memorial Day. Businesses that had closed due to the virus were allowed to reopen in early May, and the state further eased its restrictions this month.

In addition to needing more staff to handle the growing number of cases, contact search teams must also build trust with people who might be restless or scared, said Dr. Umair Shah, executive director of Harris County Public Health in Houston, where an outbreak threatens to overwhelm hospitals.

That’s difficult to do if infected people don’t return calls.

In Louisiana, only 59% of those who tested positive since mid-May responded to phone calls from contact trackers, according to the latest data from the state health department. Only a third responded within the crucial first 24 hours after the test results. Trackers receive an answered phone call, on average, more than two days after receiving information about the positive test.

Perry N. Halkitis, dean of the Rutgers School of Public Health, said that COVID-19 spreads so fast that contact trackers must contact 75% of potentially exposed people within 24 hours of their exposure to successfully combat the spread.

“Is it as good as we would like? Well, obviously not,” said Dr. Jimmy Guidry, Louisiana state health officer. “It’s better than not having it.”

Contact trackers in Salt Lake City, the Utah capital, have seen the number of cases double and cooperation has declined since the economy reopened, health researcher Mackenzie Bray said. A person who was not answering calls told Bray that she did not want to waste her time because they and their contacts were not high risk, a dangerous assessment because the person may not know the health history of their contacts, Bray said.

Getting people to act on the advice of tracers is also a challenge. In the Seattle area, only 21% of infected people say they isolated themselves the day they developed symptoms. People, on average, spend three days from the time they develop symptoms until they’re tested, said Dr. Matt Golden, a University of Washington physician who leads case investigations of the County Department of Public Health. from King.

Since people are infectious for two days before symptoms, that means that many people transmit the virus for five days, he said.

In Maricopa County, Arizona, officials hired 82 people to reinforce contact tracking, allowing them to reach 600 people per day, said Marcy Flanagan, executive director of the Maricopa County Department of Public Health.

But the daily average for confirmed infections has soared, to 1,800 per day from 200 in May, county figures show. That means the county must let the rest of the cases be handled by universities, health agencies and the Arizona National Guard, Flanagan said.

Everyone should rank: Each infected person is asked in an automated text to complete a survey to assess their level of risk, and trackers only contact those by phone who appear to be high risk or work in settings that could trigger an outbreak. dangerous, like an assisted living facility.

Tracking contacts is key to avoiding the worst outcomes, said Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention and current president and CEO of Resolve to Save Lives, a nonprofit organization that works to prevent epidemics. But the explosion of cases in the United States has made it nearly impossible for even the best-staffed health departments to keep up, he said.

Tracking contacts is “a proven and true public health function,” Frieden said. “If the health department calls, pick up the phone.”


Webber reported from Fenton, Michigan, and McCombs from Salt Lake City. Associated Press journalists Andrew DeMillo in Little Rock, Arkansas; Carla K. Johnson in Seattle; Melinda Deslatte in Baton Rouge, Louisiana; and Terry Chea in San Francisco contributed.