WASHINGTON – In mid-March, boss Jenine Clements asked her to set aside at least 24 hours from her work week to call people who tested positive for COVID-19. The aim is to find people who have been in close contact with infected patients and make sure they are quarantined for two weeks to stop the spread.
Clements, 41, is a disease investigation specialist for the Washtenaw District Health Department in Michigan and, for more than 17 years, has made similar calls to people who test positive for other diseases, including HIV, syphilis and hepatitis C.
Making additional calls to COVID-19 patients means that Clements has to work nights and weekends. But he said he was happy doing it. If people don’t answer at first, they call back up to three times. He said it was helpful that the state issued a public notice last week asking everyone to answer calls from the health department.
“The level of fear is quite high now,” Clements said. “With so many people in quarantine far from their families, many people just want to talk to someone.”
Nationwide contact tracing – conducted by Clements and more than 2,000 other public health workers across the country – is key to reopening businesses and restarting some normal life forms when the coronavirus pandemic begins to subside, epidemiologists say.
But without a national plan and a little federal money on the horizon, countries are funding their own initiative for what experts predict will be a huge undertaking that lasts 18 months to two years, until the vaccine is developed.
The result will be patches on the national contact tracking team, with some more effective than others.
The big challenge will be to coordinate the flow of information from different databases about who tested positive, who was called and who was quarantined among separate local, state and contract workers, said Josh Sharfstein, deputy dean at Johns Hopkins Bloomberg Public Health School. in Baltimore. “We don’t want some people not to get a call and others get 10,” he said.
Several large countries, including California, Massachusetts and New York, have announced major projects involving millions of state dollars and philanthropy, thousands of new workers and partnerships with various organizations.
But so far, most states have mobilized existing public health employees, along with volunteers, school nurses who are not working, to reassign civil servants and the National Guard, to contact residents who have tested positive for COVID-19 and those they know. has been related to.
Several states, including Colorado, Kansas, North Dakota, and Rhode Island, rely heavily on mobile data, online applications, and other technologies to improve their contact search efforts.
“There are many different models out there,” said Marcus Plescia, chief medical officer at the Association of State and Regional Health Officers.
“Some countries might say,” We’re not Massachusetts; we are not able to launch such an effort, ” he said. “But there is something that every state can do that suits their unique circumstances and budget. They have to do something if they want to get out of ‘staying at home’ this summer. “
A new report by researchers at Johns Hopkins Bloomberg Public School and the Association of State and Regional Health Officers estimates that at least 100,000 additional trained workers and more than $ 3.6 billion will be needed to manage the spread of the virus safely once businesses start reopening. .
Tom Frieden, former director of the Centers for Disease Control and Prevention and New York City health commissioner, estimates the number of contact tracers needed to be close to 300,000 – approximately one contact tracker for every thousand people.
David Harvey, executive director of the STD’s National Coalition Director, representing workers such as Clements, called on the federal government to increase the country’s disease intervention specialist, which has helped nearly every public health outbreak for more than half a century, including HIV and STDs, Ebola and Zika.
“We need a federal plan that provides money and training for the states and employs the expertise we already have,” he said. “We can’t just hire an army of young people and get them into the public health system.”
This week, a group of bipartisan health experts, including former head of the Food and Drug Administration Scott Gottlieb and former temporary administrator of the Medicare & Medicaid Service Center, Andy Slavitt, sent a letter to Congress asking for $ 46 billion to increase state contact. track capacity, including timely testing of all those who need it.
Contact tracers know they have to track everyone who lives in the patient’s household or shares the same workspace. In other cases, more magic practice is needed. That could include an infected person sitting near a bus or standing in front of a long line of grocery stores.
In developing a contact tracing program, public health authorities devise criteria to determine who needs to be tracked, starting with standards for physical proximity to an infected person and duration of contact – for example, within 6 feet of an infected person for 10 minutes. or longer.
Depending on the extent of social distance practiced in certain states or regions, the number of people who may be infected by one corona virus patient can range from two or three to more than a dozen. So for every 1,000 people who test positive for COVID-19, there may be 10,000 or more contacts who are potentially infected. The number is increasing rapidly.
To be effective, contact tracers must contact as soon as possible with people who are tested positive for COVID-19. Often, they are the first to give patients their test results.
Here’s how it works: When someone is tested positive for COVID-19, the lab sends a report to the doctor and to the health department, as do other infectious diseases. The health department then makes a list that is shared among contact tracers, who immediately start making calls.
After an infected person is contacted, the names of the people they have contacted are contacted by talking to them, and in some cases, asking them to check their cell phone call records, calendars, credit card receipts, and photographs to hold their memories together. . Then people who are potentially infected are called and asked to do quarantine on their own voluntarily for two weeks. If available, contact tracers offer people housing, food delivery, and cash to replace wages lost during quarantine.
Most public health institutions have extensive experience in disease control. State and local health departments are often asked to track foodborne outbreaks and other poisons, and infectious diseases such as Ebola and H1N1 flu.
One of the biggest efforts took place around HIV / AIDS in the 1980s and 90s. Although the disease was very stigmatized at the time, it had a clearer pattern of spread, through sexual contact or sharing needles. That way, identifying contacts might prove easier than the COVID-19 virus, where an infected person might not even know the person from whom he has contracted the virus.
And of course, no contact tracking program has ever come close to the scale needed now, according to Jonathan Zenilman, a professor of epidemiology at Johns Hopkins University.
This virus emerged after a period in which investment in public health had declined dramatically. Federal funding for public health has fallen 10% over the past decade, according to the nonprofit Trust for American Health, leaving the country with a large deficit in the number of public health workers.
Earlier in April, Massachusetts Republican Governor Charlie Baker was the first to announce a large-scale contact tracing project. Budgeting $ 44 million and working with the public health organization Partners in Health, Baker promised to initially recruit and train 1,000 new workers. The state’s local health department has been tracking contacts, assisted by 1,700 volunteers from state universities.
Last week, New York Governor Andrew Cuomo, a Democrat, announced that his country, together with Connecticut and New Jersey, would join in a partnership with Bloomberg Philanthropies Michael Bloomberg to create a regional contact tracking program. The states have coordinated some of their COVID-19 policies.
As part of the project, Johns Hopkins University will build an online curriculum and training program for contact tracers. Bloomberg Philanthropies, which has pledged $ 10.5 million for this effort, will work with the New York State Department of Health to identify and recruit contact tracers.
The state said it hoped to attract trackers from the department of public health, other state institutions and a collection of 35,000 students in the medical field at state universities. Connecticut and New Jersey have not released details of the plan in their state.
Earlier this week, New York City Democratic Mayor Bill de Blasio said the city wanted to immediately hire 1,000 contact tracers.
California Democratic Governor Gavin Newsom announced last week that the state would develop an academy to train 10,000 public health workers to become contact tracers.
The state of Washington plans to recruit and train 1,900 contact tracers in mid-May to map and control the spread of the virus when the country begins to reopen the economy.
At a press conference, state health officer Dr. Kathy Lofy warned that countries need to do at least two to three times the tests they are doing now for contact tracing to be effective. He said 600 people in the state government had been trained in contact tracing and another 800 volunteers were being trained. Democratic Governor Jay Inslee also asked the National Guard to deploy 500 troops as contact tracers.
Maryland Republican Governor Larry Hogan authorized a contract with the National Opinion Research Center based at the University of Chicago to double the current number of contact tracers to 1,000.
The Michigan Department of Health and Human Services announced last week that more than 2,200 volunteers had completed training and were ready to begin assisting around 130 state health department workers and hundreds of regional contact trackers such as Clements.
According to state agents, contact tracers have reached around 12,000 residents who tested positive for COVID-19. The state is expected to announce this weekend the names of companies that will work with it to oversee operations.
On a smaller scale, the Utah health department in April mobilized 200 health department staff to work with the local public health department in contact tracing, and 500 other state employees from other agencies will also be provided, according to Tom Hudachko, a department spokesman.
In Alaska, 80 registered nurses stationed across the state and some traveling nurses who travel to remote villages have worked full time on COVID-19 contact tracing since the first case was diagnosed in Anchorage in early March.
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Before the virus attacks, they track contacts for sexually transmitted diseases and tuberculosis and work with the community to combat homelessness, addiction, domestic violence, hunger and other public health problems.
Alaska, which lost an entire village to the Spanish flu pandemic of 1918, employed another 20 to 30 nurses, according to Sarah Hargrave, manager of public health nurses for southeastern Alaska.
“We will continue to grow as much as needed,” he said. “We really want to stay on top of the spread of this COVID.”
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