Short Wave - Contact Tracing Is Key To Reopening. We're Not There Yet

Episode Date: April 24, 2020

The U.S. may need 100,000 people trained in the public health practice of contact tracing — tracking and isolating people who've been in contact with someone who tests positive for the coronavirus. NPR health policy reporter Selena Simmons-Duffin explains how it works, and why it's a key part of the fight against the pandemic. Email the show at [e-mail]. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Maddie Safaya here with longtime listener, first-time short-waver, NPR reporter Selena Simmons-Duffin. Hey, Slena. Hey, Maddie. Where are we starting today? We are starting in a small town in northeast Nebraska with a woman named Katie Berger. I live in Nebraska and I work at a college. Katie was at her usual hair salon a few weeks back.

Her state did not have a shelter at home, ordering. at the time. And it turns out one of the stylists there was infected with the coronavirus. My stylist started making a cup of coffee for me and she went off into the back room and the

stylist who was infected picked up the coffee cup and handed it to me and I drank out of it. Now that she knows this Katie in her head has been replaying every moment of her time at the salon that day. How close I was to her and when we brief

talk to each other. I'm trying to remember every little detail just because it was, I was pretty panicked for a while. So obviously, while she was at the salon, she didn't know that the stylist was sick. Right. She found out later, first, because to their credit, the salon texted her and gave her a heads up. But then a couple of hours later, the local public health office gave her a call. They said, we're calling to inform you that you were exposed to a COVID-19 patient. And I said, oh, this is from this place because they had contacts in me. Katie was told to monitor her symptoms for 14 days from that contact. And she was extra careful about social distancing after she got this news.

That was more than two weeks ago now and she never did feel sick. So this is an example of a thing we're hearing more and more about when it comes to the coronavirus, contact tracing. It's a really simple concept. Someone tests positive. A public health worker calls them and gets them. them to run through everyone they had contact with, starting two days before they felt sick. Then the worker calls those contacts and usually asks them to quarantine for 14 days. The patient might go through calendars or social media to jog their memory.

Maybe they haven't been out too much, but if they have been out, the process can take a while. And it can sometimes add up to hundreds of people. Yeah, like I'm just imagining trying to remember everybody pre-coronavirus, of course, that I might have handed a cup of coffee to over a week or more. Right, exactly. But then once you know you're a contact for someone with COVID-19, you can keep yourself at home and you can theoretically protect other people in your life. I was calling my parents and my friends and telling them, like, look, I got exposed.

So knowing is the key. Once people know they've been exposed, it's an opportunity to cut off disease transmission right there. It's really an important tool in the public health fight against the coronavirus. So today on the show, contact tracing, how it could help contain the pandemic, and does the U.S. really have the capacity to do it? You're listening to Shortwave, the Daily Science Podcast from NPR. Okay, Selena, the story of contact tracing we just heard came from northeast Nebraska. That is an important detail to hone in on. Yeah, it's no coincidence that this example comes from a small town in Nebraska with like 16 cases of coronavirus in the whole county.

Right now, the places that are able to do this effectively are those that are not in the hot zones like New York City. Contact tracing takes a lot of work. And in those places, there are just too many cases to do it right now. At its peak, there were more than 7,000 new cases in New York City every day. Can you imagine tracking down all the content? for 7,000 people a day, it's just not feasible. There aren't enough contact tracers or hours in the day even to do that. Though there are lots of efforts underway, including some just announced in New York, to ramp up the contact tracing workforce.

So we can talk in a bit about where those workers might come from. But before we do that, let's talk about how contact tracing, if we are able to do it widely here in the States, will help people go back to work. So one way to think about social distancing where we're all in our houses pretty much, not going anywhere, is that it's kind of like mass quarantine. With a robust test, trace, and isolate system in place, you don't need everyone to be at home, just those who have the virus or who might have it. So theoretically, then the rest of us can go about our lives, knowing that public health officials are on top of making sure that those who are sick are staying home. And these quarantines are not perfect. An epidemiologist I spoke to said they're leaky. But even if you're able to reach 85% of contacts and they cooperate, that can still have a big impact.

So who technically qualifies as a contact? Like, if I tested positive, would a contact tracer need to track down the grocery store clerk who checked me out? Well, it kind of depends on whether there was a barrier, how long you were at the checkout. And part of this is that the science of how the coronavirus spreads is still emerging. So the CDC has made guidelines based on what we know. And right now, a contact is defined as someone you were within six feet of for around 10 to 30 minutes. I mean, that's really interesting to me because they're basing this entire criteria on kind of an educated guess. Like, we don't actually know enough about this virus to say, yeah, 30 minutes, six feet apart, that'll do it.

Right. Plus, there are lots of factors that affect the risk of a contact. whether the sick person was coughing or wearing a mask, how close you were to them for how long. But those are the basic guidelines, six feet, 10 to 30 minutes. Okay, so how close are we to having that test trace and isolate system for coronavirus? Honestly, not that close. You've been following all the issues around testing. There have been improvements, but the kind of widespread testing with fast results you would need is not there yet.

And speed is important. You need to diagnose people. and get a hold of their contacts so they're aware and can stop going in public as soon as possible. Okay, so if we're good about social distancing, let's say we get the number of cases kind of under control, and we have enough tests to try this. Where would all the new contact tracers come from? Like, who would actually do the contact tracing? Well, here's our starting point.

There are about 2,200 people able to do contact tracing nationally, and several analyses that have been looking at this put the number we need to add at, at 100,000. So this week, in an interview with NPR, CDC director Robert Redfield wouldn't get specific about the number needed, but he said the government is in discussions with other government agencies with big boots on the ground workforces. Discussions, for example, with the Census Bureau, the Peace Corps, AmeriCorps, or some of the states actually have already started to reach out to students that are, you know, medical

students, nursing school, public health students, college students. So we are in the process. So I reached out to the Peace Corps, which has about 7,000 volunteers at home right now, and they didn't respond to NPR's request. But we did hear from AmeriCorps, which confirmed discussions with the CDC and said many of their volunteers are helping with COVID relief efforts already, although contact tracing would be new for them. As for the Census Bureau, our colleague Hansila Wong, who's reported a lot on the census, says the Census Bureau doesn't really have a field staff until at least June 1st, and it's unclear how the hiring and background check process might be disrupted by the coronavirus. In other words, still have a lot of questions and certainly not easy shortcuts here.

So if there's no federal workforce ready to deploy, what are states going to do? So I had the same question. So I reached out to all 50 state health departments this week to try to find out what they're doing and what they're planning. They're very busy right now. I did not hear back. How did that go for you, Selena? I didn't hear back from all of them. I did find out some really interesting things. The short answer is that there's a really big range. Massachusetts and Maryland are both planning to add 1,000 workers. Louisiana is adding 700.

But other efforts are on a much smaller scale. Mississippi told us they have 180 tracers and are looking to add 20. Utah has reassigned 30 workers from its Medicaid program to help. So you don't need to be an epidemiologist to do this work. It's often done by public health nurses or even, people who aren't health workers and are trained to do it empathetically. So listen to Harvey Schwartz, a contact researcher in Massachusetts, describe the kind of calls he's had to make to people who are infected. I think some of the most scared people are parents who are infected with children who aren't.

They ask, is there someplace else I could live? They're worried about affecting their children. Who wouldn't be? Right. So you have to be empathetic and questions about how people should quarantine safely. is the subject of the whole other episode. But in terms of contact tracing and timing, it is going to take a while to recruit folks and get them trained.

So Redfield at the CDC is really talking about shoring up the system across the country so that if the virus flares up again in the fall, as many experts expect, we are ready. Clearly, as we get closer to next October, November, December, we're going to have, our nation's going to have to have a substantially enhanced public health workforce so that during what I call the second wave of the coronavirus infection, we have the public health resources to stay in the containment mode. Wow. Okay.

So we have a lot to do fairly quickly. Right. And our starting point here is a public health system that has been underfunded for decades. Howard Markell, who's a physician and medical historian at the University of Michigan, says that in the 20th century, local public health departments were bigger. They had many workers all the way from doctors who ran things and public health nurses and social workers, but also contact trace workers. Contact tracing has been a big tool for sexually transmitted diseases. With HIV and syphilis, it's also been used for measles outbreaks and tuberculosis.

And as public health budgets were cut beginning in the 1980s and almost every year since, That has fallen by the wayside. Markell says that public health was kind of a victim of its own success. These pathogens were thought of as controlled or vanquished, and lawmakers started putting money elsewhere. Yeah. So, hey, can we talk about smartphones real quick? Because I've seen some news about big tech companies giving us a way to kind of do this on our phones, which might bring some relief for, like, the amount of people we need. Yes, there are some promising apps.

Google and Apple have been talking about rolling out a system in. mid-May, and those would be similar to an app used in Germany that uses Bluetooth to notify you if you've been close to someone who tests positive. Other apps out there might help contact tracers just work more efficiently, for instance, by automating follow-up for contacts who are in quarantine, asking them if they have any symptoms or if they've gotten a fever. What about privacy concerns, though? Because this would be the government tracking our movements, right? Yeah, there are definitely privacy concerns. you don't necessarily want to share who you know or who you close to or anything like that.

And these apps are still really in development, so there are a lot of unknowns. Many of the states I touched base with this week said they were looking into apps but hadn't decided on anything yet. And like we said, the U.S. is still just not staffed up for widespread contact tracing done by real people just making phone calls. It depends on how many cases and availability of tests. If you think of the pandemic like a bell curve, Howard Markell said, contact tracing is really an important tool for the very beginning of that curve and for the very end. Selena Simmons-Duffin, thanks for the info. We appreciate you. Thanks, Maddie.

This episode was produced by Brent Bachman, edited by Viet Le, and fact-checked by Emily Vaughn. I'm Maddie Safaya. Thanks for listening to Shortwave from NPR.