Tracking contacts for the coronavirus pandemic does not work

Government virus expert Anthony Fauci told reporters at a press conference on Friday that contact search efforts to contain the coronavirus “are not working.”

Because it is important: Without a vaccine, contact case tracking is the best tool available to stop the spread of an outbreak. But understaffed public health agencies, privacy concerns, disappointing technology, and the sheer size of the pandemic are limiting the technique’s effectiveness.

By the numbers: The public health standard is that a state must have at least 30 contract tracers (public health employees dedicated to investigating positive case contacts) for every 100,000 people during a pandemic. However, according to a June 25 report from Nephron Research, only seven states have met that standard.

  • Seven others have short-term plans to sufficiently increase contact tracking capacity.
  • Many of the states experiencing the largest increases in cases are well below the recommended number of tracers and have no short-term plans to reach that level. That includes states like Texas, where hospital executives in Houston warned that the ICU use of COVID-19 could soon exceed capacity, and Arizona, where hospitalization numbers are increasing.
  • CDC Director Robert Redfield stated that there are between 27,000 and 28,000 people doing contact tracking work. That’s more than 11,000 at the start of the pandemic, but it is well below the 99,000 minimum tracers that the Association of State and Territorial Health Officials estimated are necessary for the United States to reopen safely.
  • Other public health experts believe the real need is closer to 300,000 tracers.

Even those states that have enough Strengthening their contact tracking systems, they are fighting to get positive people to report who they were in contact with or, in some cases, even pick up the phone.

  • New York State currently has nearly 50 trackers per 100,000 people, most in the US But in New York City, long the epicenter of the pandemic, contact trackers were only able to successfully complete one interview with about half of all positive cases between June 1 and June 20.
  • That is well below the 75% rate that public health experts say is necessary to maintain a contained outbreak.
  • The situation is worse in other affected cities such as San Antonio, which has only received responses from around 300 of the 2,500 cases currently under review.

Context: The United States has had great success in the past controlling diseases like HIV and tuberculosis through contact tracking. But COVID-19 would present enormous challenges even for a well-funded and well-staffed national contact search effort that the United States surely does not have.

  • Unlike tracking the spread of sexually transmitted diseases, where contacts can be reduced to sexual partners, COVID-19 requires trackers to question a positive case for everyone they may have been in contact with, even over a period of time. relatively short.

Early expects that app-based smartphone tracing contacts could go a long way in not fulfilling it.

  • At least 60% of the population would need to download such apps to be effective, but according to a recent study, only 29% of Americans would consider downloading one.
  • Privacy concerns are a major obstacle to successful contact tracking. South Korea’s success in outbreak control was due in part to the use of phone GPS logs, credit card transactions, and even security camera images to increase its contact tracking – methods that would likely not fly in the US USA
  • African Americans are getting infected and dying from COVID-19 at higher rates, but a long history of discrimination, even by doctors, has made them “less willing to align and trust a public agency right now, including healthcare public, “writes Katelyn. Esmonde, postdoctoral fellow at the Johns Hopkins Berman Institute for Bioethics.

The bottom line: More than four months after the first recorded cases of COVID-19 in the U.S., the virus is still outstripping our ability and willingness to track it.