Containing COVID-19 Outbreaks: The Role of Contact Tracing
By Debra Wood, RN, contributor
After weeks of shutdowns and social distancing enacted during the first wave of the COVID-19 pandemic, public health officials and politicians continue to debate the specifics of reopening the United States. What can be opened, and how quickly? What if there are surges in coronavirus cases in certain areas?
Contact tracing offers a way to curtail COVID-19 outbreaks during the reopening phase. But it will need a great deal of buy-in and financial investment to make it work.
“We need to dramatically scale-up contact tracing for the nation,” said Crystal Watson, DrPH, assistant professor at Johns Hopkins Bloomberg School of Public Health in Baltimore. “Contact tracing is a core public health tool. It’s not new, but we do not have enough capacity in our system.”
Shortages of tests also affect the ability to track cases and contain outbreaks, and testing remains in short supply in many parts of the country, reported Shandy Dearth, MPH, director of undergraduate epidemiology education at Indiana University in Indianapolis.
“We need to do more testing to find more cases,” said Emily Gurley PhD, associate scientist at Johns Hopkins Bloomberg School of Public Health. “You cannot contact trace on cases you do not find.”
How Contact Tracing Works
Once a patient has tested positive for the coronavirus, that person is placed in isolation or, if seriously ill, in the hospital in an isolation room. The contact tracer asks the infected person about who he or she has had contact with in the prior two weeks, and then sets about to track down those people—ideally within 24 hours.
The tracer then builds a relationship with those who had been in contact, places them in quarantine for 14 days, and monitors and supports them during that time. At the end of the quarantine, each person is tested for the coronavirus again.
Contact tracing “is used to break chains of transmission, to manage epidemics at an ongoing low level, to prevent future waves, and to enable us to get back to work in a much safer way,” Watson said.
Recruiting and Training Contact Tracers
Estimates of how many contact tracers are needed vary. A new workforce tool from researchers at George Washington University, in Washington, D.C., estimates that the country will need 184,000 contact tracers to safely reopen.
The Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials (ASTHO) estimate public health departments employ about 2,200 tracers, and the country needs to add at least 100,000 more contact tracers to quickly identify, isolate, support, and retest people who have been exposed to the coronavirus.
ASTHO is the national nonprofit organization representing public health agencies in the United States, the U.S. Territories, and the District of Columbia, and over 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, formulate and influence sound public health policy and ensure excellence in state-based public health practice. ASTHO’s primary function is to track, evaluate, and advise members on the impact and formation of public or private health policy which may affect them and to provide them with guidance and technical assistance on improving the nation’s health.
“[Contact tracing] is a tool we have to ramp up to meet the challenge of COVID-19,” Gurley said. “While contact tracing is not new, this disease is different. That makes it more difficult to control than other diseases.”
Health departments will need to hire and repurpose staff. That may include pulling from the large numbers of unemployed individuals. They also may partner with other entities, such as the State of Massachusetts has done with Partners in Health, which hires, trains and supervises the tracers.
The New York State Health Department has partnered with Johns Hopkins University and former New York City Mayor Mike Bloomberg to prepare 30 contact tracers for every 100,000 people, between 6,400 and 17,000 new tracers. The university is creating an online curriculum and exam to ensure competency.
“Our goal is to take people with no background in public health and get them ready to absorb the training,” Gurley said, who noted that contact tracers should have strong people skills and be good at gaining a person’s trust.
In San Francisco, the health department has recruited university staff, employees from other city departments and medical students to become contact tracers.
California Gov. Gavin Newsom announced in April that the state plans to train 10,000 contact tracers, including some who will come from the state workforce.
ASTHO considers three tiers of contact tracers:
- 1st tier: Laypeople
- 2nd tier: Professional disease investigation specialists who can supervise the lay teams
- 3rd tier: Advanced COVID-19 professionals and clinical specialists
Occupational health nurses could help with contract tracing in certain settings, such as hospitals, skilled nursing facilities or large corporations.
The Centers for Disease Control and Prevention (CDC) also is scaling up its workforce, Watson said. “This is an unprecedented effort to conduct contact tracing on this scale,” Watson said. “I do think it is achievable.”
For more information:
Contract Tracing Workforce Estimator – George Washington University
Preliminary Criteria for the Evaluation of Digital Contact Tracing Tools for COVID-19 – CDC