As states seek to loosen wide-ranging restrictions imposed to constrain the novel coronavirus, they’re also looking to deploy a huge new fleet of workers to keep cases under control.
Enter the contact tracers.
With interpersonal contact certain to increase as states lift COVID-19 restrictions, tracing the who infected people had contact with — and then isolating those contacts — will help contain it. But to be effective, states will need much more than the handful of full-time staffers county and city-level public health offices employ to track patients with more routine diseases like sexually transmitted infections.
“We’re concerned about having the workforce that we need,” said Janet Hamilton, the executive director of the Council of State and Territorial Epidemiologists.
Hamilton’s group signed onto a letter late last month that called for $7.6 billion in federal funding to support about 100,000 new contact tracers and 1,600 new epidemiologists. Another group of experts called for $12 billion to hire another 180,000 tracers.
States have just begun spending money from the $2 trillion aid package signed into law in March for contact tracing.
But the demand for testing comes as state budgets have been “decimated” and unable to solely meet their tracing needs, said Joanna Dornfeld, director of state affairs for the United States of Care, a nonprofit group that supports universal health care.
“While there has been some federal dollars for contact tracing… it’s not sufficient,” Dornfeld said. “So states have been approaching contact tracing in a variety of ways.”
Many states have moved their own employees around to focus more on contact tracing. Tracers don’t have to have a clinical background, though most do have an advanced degree, but others can be trained to do the work, said J.T. Lane, the chief population health and innovation officer for the Association of State and Territorial Health Officials.
Public health officials first repurposed employees with related backgrounds. Other public health workers, social workers and others with case management and interview training are natural targets for assignment, Lane said. Even some librarians in the San Francisco area were reassigned to tracing.
Johns Hopkins University has a free online course for aspiring contact tracers.
Nevada is receiving an $88.9 million grant from the Centers for Disease Control and Prevention for enhanced testing and contact tracing, Sens. Catherine Cortez Masto and Jacky Rosen announced last week. It’s unknown where the funds will be used.
The Southern Nevada Health District has some 60 staff members engaged in contact tracing. It also has the help of call center employees from Wynn Las Vegas.
“We tripled the amount of contact tracing ability, on us, for our state to get that moving,” Wynn Resorts CEO Matt Maddox said at a White House roundtable last month.
“Given the long incubation period of this disease, it can be difficult to determine epidemiological linkages and clusters,” says Jennifer Sizemore of the Southern Nevada Health District. “However, multiple cases will be linked as staff completes their contact investigations. Some individual cases will not be linked to others as we are seeing community spread.”
Ohio and Michigan hired outside firms to help with tracing and volunteer recruitment. Maryland contracted a University of Chicago-based research firm for some of the state’s tracing efforts. Others have activated their national guard and recruited volunteers.
But to reach the level of tracing needed for a disease as deadly and widespread as COVID-19, states will have to massively increase their workforce.
Bipartisan health leaders including Andy Slavitt, who led the Centers for Medicare and Medicaid Services during the Obama administration and Scott Gottlieb, the former Food and Drug Administration chief under President Donald Trump, estimated $12 billion would boost the number of contact tracers nationwide by 180,000.
Tracers will also need tools, including technology that makes interviewing, accurate tracking and reporting more efficient, and more epidemiologists to support their work, Hamilton said.
Parts of the $3 trillion bill U.S. House Democrats passed this month would help address the issue. The bill would create a $6 billion public health program, which would send grants to states to expand testing capacity, contact tracing and other activities.
But the bill has little chance of becoming law after it passed the House on a nearly party-line vote. U.S. Senate Republicans have derided as a liberal wish list, packed with items like funding for abortion services and changes to banking rules for marijuana businesses.
Republicans have also said they’d like to see how the funding in the $2 trillion aid package works before sending out new funds.
“We need to assess what we’ve already done, take a look at what worked and what didn’t, and we’ll discuss the way forward in the next couple weeks,” Senate Majority Leader Mitch McConnell (R-Ky.) said at a recent news conference.
Advocates for state health programs are hopeful that contact tracing funding can be a source of bipartisan agreement. Any economic recovery will depend on keeping the virus in check, and contact tracing will be crucial for that.
“From my conversations on the Senate side, particularly with Republicans, they understand that this might be something additional that the federal government needs to fund,” said Andrew Schwab, the United States of Care’s director of policy and federal affairs. “Particularly because they see it as linked to people feeling safe enough and confident enough to participate in the economy.”
Dana Gentry contributed to this story.