Tracking contacts, a key part of the public health strategy to control the coronavirus pandemic, strives to keep up with California’s summer spike in COVID-19 cases.
The time-tested tactic of asking newly infected people about family, friends, and acquaintances they might have been exposed to so that they can be quarantined and tested, is hampered by the increase in cases in which urban areas of the state and related delays for timely testing and results.
Although California has achieved its overall personnel goals, a statewide force of 10,000 contact trackers, and some counties like Santa Clara have far exceeded the state personnel benchmark, Dr. Mark Ghaly, Secretary of Health and Human Services He said this week that those goals did not meet today’s increase.
“Tracking contacts with this level of transmission is much, much more difficult,” Ghaly said Tuesday. “We did not build the current contact tracking program at this level of transmission.”
The limited availability of tests and delays in obtaining results are causing crucial delays in reaching newly infected people and their close contacts, increasing the number of people who may have been exposed.
Even in Santa Clara County, which has amassed a contact tracking force of more than 700, roughly three times the state recommended minimum of 15 per 100,000 people, health officials cannot confidently say how well tracking is working.
“I don’t have an answer,” Dr. Sarah Rudman, Assistant Santa Clara County Health Officer, who oversees the county’s contact locating effort, flatly acknowledged when asked recently if the system is proving effective against the stealthy coronavirus, which people can spread for days before they show symptoms.
“I think it is definitely effective under the best of circumstances,” said Rudman. “But there are many moving parts for us to achieve those circumstances here in Santa Clara County.”
Other counties such as Alameda remain far from the state’s minimum contact tracking staff target. Alameda County has 93 tracers, less than half of the approximately 250 that the state has suggested are needed to have 15 for every 100,000 residents. Another 40 have completed the training.
“The recent increase in cases has made this work an additional challenge,” said Alameda County spokeswoman Neetu Balram. “But we are expanding our efforts through internal recruiting to attract more county staff to do this job.”
Contra Costa County did not respond to Wednesday’s questions about its current staff.
State Senator Steve Glazer, D-Orinda, said the lack of performance data on the statewide contact localization effort is troubling as cases increase.
“Beyond the goal that Governor Newsom had set to train 10,000 new contact trackers, I am not aware of any other data or other fact that shows we are doing it successfully,” Glazer said Wednesday.
Glazer said the state and most counties have not indicated how many people reach contact trackers within 24 hours, the amount of time that the U.S. Centers for Disease Control and Prevention recommends. To effectively isolate new infections and contain the spread. Nor have they indicated how successful they are in reaching close contacts of new cases.
And he said they have not provided collected case data on the infected that could be useful in assessing public risk: Were medical personnel or other workers considered essential during the outbreak, such as food and grocery production employees? Were they avoiding going out in public or going to parties? Did they wear masks regularly?
“We don’t have any data to understand our circumstances,” Glazer said. However, without it, we cannot expect to contain the virus. “
In the Bay Area, doctors in Alameda and Santa Clara County have expressed concern about cases and contacts that public health contact trackers have not reached and the lack of disclosure about how well tracking is working. and what it reveals about the outbreaks.
In Alameda County, Dr. Nicholas Moss, acting director of the public health department, said in a recent interview that while contact tracing has been used for years to control infectious diseases ranging from measles to HIV, the sheer number of COVID-19 cases has made it more of a challenge.
“They are orders of magnitude more cases than we are used to, so it has really strained our legacy systems,” Moss said.
Santa Clara County’s rapid expansion of its contact search force through reassigned county employees, volunteers and a contractor has been a local success story.
But little has been made public about the effectiveness of the program. A Santa Clara County tracking volunteer responded to Glazer on Twitter on Wednesday and described the effort as a “show (expletive).”
Rudman said last week that Santa Clara County trackers were reaching “approximately 70-75% of all cases and 65% of contacts” and that “the vast majority are reached in 48 hours.” But exact figures were not available.
Perry N. Halkitis, dean of the Rutgers School of Public Health who is advising New Jersey on its follow-up contact program, said the goals vary by disease, but for COVID-19, which spreads easily and stealthily, tracers should ideally reach three out of four cases and exposed contacts within 24 hours. Reaching them within 48 hours, he said, “is not great,” and beyond that, effectiveness is limited.
Gonzalo Riccombeni, a Santa Clara County public health contact tracker, said he has found that the people he has reached are cooperative and helpful, but that the availability of tests and response times for results have been a concern.
Balram said that while Alameda County is meeting its goal of screening 3,100 people per day, “we, too, are experiencing a longer lag time for test results.”
Labs across the country have reported that test response times have doubled with delays of several days and, in some cases, delays of more than a week. Ghaly announced Tuesday that, given the limitations, the state will prioritize testing for those with symptoms.
“We wish we could refer everyone to a test,” said Riccombeni. “The test is definitely my biggest obstacle for me.”
Despite the obstacles, health experts argue that contact tracing remains the most effective tool to contain outbreaks and allow reopening of businesses and schools, and that the increase in summer COVID-19 in the nation is not the result of tracing failures.
“It is spreading not because contact tracking is failing,” Halkitis said, “but because people are acting as if the pandemic has ended.”
