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With a new wave of coronavirus cases raging across the country, the Centers for Disease Control and Prevention this week urged local health officials to prioritize the use of contact tracing for new cases that could possibly stop the spread of COVID-19. But the worst-hit counties in the Bay Area say they have no plans to sort out just yet.
CDC guidelines recommend that health services hit by an outbreak of cases focus contact tracers on people diagnosed in the past six days, on members of their households, and those who live, work or visit living quarters collective, high density workplaces for explosive propagation.
The review recognizes that the strategy of health officials interviewing patients to find out who they may have exposed, then asking those people to quarantine them and reveal who they may have exposed, has struggled to keep up with successive waves. of COVID-19 cases in the United States.
In the Bay Area, however, health officials in some of the larger counties have said that despite the increase in the number of cases, they have not yet reached the point where they need to reduce research. contacts.
“We are already anticipating an influx of cases,” said Will Harper, spokesperson for the Contra Costa County Public Health Department, which is reviewing the CDC’s guidelines and plans to discuss it next week. “Even with a large influx of cases, we expect that we will reach all cases within 24 hours of entering the state’s CalConnect system,” which matches the coronavirus data.
In Santa Clara County, Assistant Health Officer Dr. Sarah Rudman said that “if our ability to keep up with changes changes, we are ready to perform triage as recommended by the CDC and have already trained staff to do it.”
“Fortunately, with existing resources and minor changes to our procedure, we have been able to keep up with the current outbreak of cases and continue to be able to reach all cases and contacts,” Rudman said. “But we focus on the more recent cases first.”
Alameda County is recruiting additional staff to respond to the current outbreak of cases, spokeswoman Neetu Balram said.
While contact tracing was seen as a key tool in mitigating outbreaks and was essential for reopening plans from New York to California in the spring, its effectiveness was limited across the country for a variety of reasons.
“The contact tracing tool is really effective when we have a low level of cases in our communities,” said Crystal R. Watson, senior researcher at the Center for Health Security at Johns Hopkins University. “Because it really takes a lot of resources, you can’t exponentially increase the number of people working on contact tracing.”
She said nationwide, there were only about half of the 100,000 contact tracers that health experts estimated needed in the spring to control the virus. California said over the summer that it hit its target of 10,000 tracers, then dropped a contact tracing recruiting threshold from its reopening metric.
But the pandemic has grown much larger since, even making contact tracing staffing targets too low, Watson said.
“Some states have gotten to this point, but a majority haven’t,” Watson said. “As a country, we are halfway through the initial expected need of 100,000 contact tracers. But I think that need has grown further with the surge in cases nationwide.
While tracing has effectively mitigated outbreaks in some small countries, particularly in Asia, Watson said those countries have varying levels of concern about privacy and trust in their government. Their citizens are more willing to disclose their health status and use phone apps that allow health officials to track people’s movements. In many parts of the United States, investigators are struggling to convince those infected and their contacts to speak to them.
“Other countries have taken a much more intrusive approach, in some cases that wouldn’t really be acceptable in this country,” Watson said.
In the Bay Area, however, health officials have encountered various obstacles to contact tracing. In Santa Clara County, staffing has far exceeded state benchmarks and staff consistently report reaching 80% or more of cases and contacts within 24 hours of confirming the positive test, an industry standard.
But health chief Dr Sarah Cody said while testing is widely available and turnaround times have decreased, there are still days of delays of several days between an infection, a test, a result and a contact by an investigator. In many cases, those infected have no way of isolating themselves from household members, or fear quarantine will cost them a job, she said. And because so many people have no symptoms after being infected, they can spread the virus unknowingly for days.
Even so, she says, contact tracing remains an important tool. Santa Clara County has conducted reverse tracing interviews to learn more about how the virus is spread by tracing infections back to their source.
“It’s one of many prevention strategies, it’s just one layer among many,” Cody said. “It’s really necessary but not enough on its own. Testing is really important, case investigation and contact tracing is really important, universal use of masks, staying home as much as possible – these other levels of prevention, we really need them all to work. as good as possible to change things. “
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