Resuming is contact tracking. Not Ready in Many States | Nationwide

WASHINGTON — In mid-March, the boss of Jeanine Clements asked her to have more than 24 hours a week working hours to call someone who tested positive for COVID-19. The goal was to identify people who were in close contact with infected patients and to quarantine them for two weeks to ensure they stopped spreading.

41-year-old Clements is a disease research expert at the Washtenau County Department of Health in Michigan and has been making similar calls to people who have tested positive for other diseases such as HIV, syphilis, and hepatitis C for over 17 years. I’ve been calling.

Making additional calls to COVID-19 patients meant that Clements had to work in the evenings and weekends. But she said she was happy to do it. If people don’t answer first, she’ll call back up to three times. She said it helped the state issued a public announcement last week from the Public Health Department asking anyone to answer the phone.

“The fear is high right now,” Clements said. “There are so many people isolated from their families that many just want to talk to someone.”

According to epidemiologists, the contact traces that Clemens and more than 2,000 other public health workers nationwide make on a regular basis, according to epidemiologists, suggest that when the coronavirus pandemic began to subside, it was likely that some normal Is the key to resuming your life.

However, there is no national plan, and the federal dollar will fund its own initiative for a large project lasting 18 months to two years, predicted by experts, until the vaccine is developed in the near future. I am.

The result is a nationwide patchwork of contact tracking teams, some more effective than others.

Josh Sharfstein, Vice Dean of Johns Hopkins Bloomberg School of Public Health, said the main challenges were the isolation between those who were positive, called, and local, state, and contract workers. It is to coordinate the flow of information from disparate databases about people. In Baltimore. “Some people don’t want to receive calls and others don’t want to get 10 calls,” he said.

Several large states, including California, Massachusetts, and New York, have announced major projects including millions of state and charitable dollars, thousands of new workers, and partnerships with a wide range of organizations. .

However, so far, most states have deployed existing public health employees, along with volunteers, unemployed school nurses, state employees, and the National Guard to help COVID-19 positive residents. And contact those who have contacted them. I kept in touch.

Some states, such as Colorado, Kansas, North Dakota, and Rhode Island, rely heavily on mobile phone data, online apps, and other technologies to enhance their contact tracking efforts.

“There are many different models out there,” said Marcus Prescia, Chief Medical Officer of the State and Territory Health Authority Association.

“Some states said,” We are not Massachusetts. We cannot afford to undertake such an effort. ” “But there are things each state can do to suit its own circumstances and budget. If they want to get out of this” home “by summer, they have to do something. “

A new report from researchers at the Johns Hopkins Bloomberg School of Public Health and state and territory health officials found that at least 100,000 trained workers were needed to safely manage the spread of the virus after the company reopened. It is estimated that more than $ 3.6 billion of additional workers will be needed. .

Former Center for Disease Control Director and New York City Health Director Tom Frieden estimates that the number of contact tracers needed is close to 300,000.

David Harvey, head of the STD Board of Directors of the United States for workers such as Clements, told the federal government that existing illness intervention experts in the country have helped nearly all public health outbreaks for more than half a century. Requested to utilize. HIV and STD, Ebola and Zika.

“We need a federal plan that provides the state with money and training and leverages the expertise we already have,” he said. “We simply cannot hire an army of youths and integrate them into the public health system.”

This week, a group of bipartisan health professionals, including former Food and Drug Director Scott Gottlieb and Andy Slavit’s agent on behalf of Center Medicare & Medicaid Service Center, invested $ 46 billion in improving national contacts. A letter has been sent to Congress requesting traceability, including a timely test of all who need it.

If you contact the tracer, you will find that you need to track everyone who lives in the patient’s household or shares the same workspace. In other cases, more research is needed. This includes people with infected people sitting near the bus or standing in front of a long grocery store.

When developing a contact tracking program, public health authorities devise criteria to determine who needs to be tracked, starting with criteria such as physical distance and contact time with an infected person. For example, within 6 feet of an infected person for 10 minutes or more.

Depending on the degree of social distance practiced in a particular state or region, the number of people who can be infected with one coronavirus patient may be from 2 or 3 to more than 12 . Therefore, for every 1,000 residents who test positive for COVID-19, there could be over 10,000 contacts who could have been infected. The numbers will be added immediately.

To be effective, contact tracers should contact those who have tested positive for COVID-19 as soon as possible. Often, they are the first to give patients their test results.

The mechanism is as follows. If tested positive for COVID-19, the lab, like any other infectious disease, will send a report to the doctor and medical department. The health department then generates a split list between the contact tracers who immediately start calling.

When they reach infected people, they are contacted by talking to them and, in some cases, by asking them to jog their memories by checking their phone call logs, calendars, credit card receipts, and photos. The name of the person is collected. . The potentially infected people are then called in and asked for two weeks of self-quarantine. When available, the contact tracer will provide people’s housing, food delivery and cash to make up for the wages lost during quarantine.

Most public health agencies have extensive experience in disease surveillance. State and local health departments are required to track food poisoning and other toxic outbreaks and infectious diseases such as Ebola and the H1N1 strain of influenza.

One of the biggest of these efforts centered around HIV / AIDS in the 1980s and 90s. It was a highly condemned illness at the time, but it had a more pronounced pattern of spread due to sexual relationships and sharing of drug needles. In that way, it turned out that contact identification is probably easier than for the COVID-19 virus, where infected people may not know who caught the virus.

And certainly, according to Jonathan Zenilman, professor of epidemiology at Johns Hopkins University, contact tracking programs will never approach the scale currently needed.

The virus occurs after a sharp decline in public health investment. According to the non-profit Trust for America’s Health, federal funding for public health has declined 10% in the last decade, leaving a serious deficit in the number of public health workers. I will.

In early April, Republican Governor Charlie Baker of Massachusetts was one of the first to announce a large-scale contact tracking project. With a budget of $ 44 million and working with the public health organization Partners in Health, Baker promised to initially hire and train 1,000 new workers. The state’s local health department had already conducted contact tracking with the support of 1,700 volunteers from state universities.

Last week, Democratic Governor Andrew Cuomo, along with Connecticut and New Jersey, announced that he would join Michael Bloomberg in a partnership with Bloomberg Philanthropy to create a regional contact tracking program. The state is coordinating some of the COVID-19 policies.

As part of the project, Johns Hopkins University will build an online curriculum and training program for contact tracers. Bloomberg Philanthropies has pledged $ 10.5 million for this effort and will work with the New York Department of Health to identify and recruit contact tracers.

The state says it hopes to draw tracers from the pool of 35,000 students in the medical field of the public health department, other state agencies, and state public universities. Connecticut and New Jersey have not released details of plans in their states.

Earlier this week, Mayor Bill de Brascio, the New Yorker’s Democratic Party, said he would immediately hire 1,000 contact tracers.

Governor Gavin Newtham of the California Democratic Party announced last week that the state would develop an academy to train 10,000 public health workers to become contact tracers.

By mid-May, Washington will recruit and train 1,900 contact tracers to track and manage the spread of the virus as the state embarks on a resumption of the economy.

At a press conference, state health official Dr. Kathy Lophie warned that at least a few of the tests we’re currently doing should be done in order for contact tracking to be effective. She said 600 state governments had been trained in contact tracking, and an additional 800 volunteers were trained. Democratic Governor Jay Insley also called on the National Guard to deploy 500 soldiers as contact tracers.

Maryland Republican Governor Larry Hogan approved the deal with the University of Chicago-based National Opinion Research Center, quadrupling the state’s current number of contact tracers to 1,000.

Michigan’s Department of Health and Human Services completed training more than 2,200 volunteers last week and is ready to assist approximately 130 state health department workers and hundreds of county contact tracers such as Clements. Announced that

Contact tracers have already reached approximately 12,000 residents who tested positive for COVID-19, according to state authorities. Later this week, the state will announce the names of companies that will work with them to oversee their operations.

Although small, the Utah Department of Health has a staff of 200 Health Department staff in April to keep track of contact with the local Public Health Department. It will also be available to 500 state employees from other agencies, said Tom Fudachiko, a spokeswoman for the bureau. .

In Alaska, 80 state-wide registered nurses and a small number of traveling nurses traveling to remote villages have come into contact with COVID-19 since the first case was diagnosed in Anchorage in early March. I’ve been tracking it full-time.

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Before the virus hit, they carried out contact tracing of sexually transmitted diseases and tuberculosis and worked with the community to combat homelessness, addiction, domestic violence, hunger and other public health issues.

According to Sarah Hargrave, a public health nurse in the southeastern region of Alaska, Alaska, who lost the entire village to the 1918 Spanish flu epidemic, employs an additional 20 to 30 nurses.

“We will continue to grow as needed,” she said. “We really want to keep this COVID spread.”

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