Distrust and lack of funds prevent COVID-19 contact tracking

Crook County, Oregon, located in a rural area approximately 150 miles southeast of Portland, has been successful in tracking the majority of contacts associated with positive COVID-19 cases.

County Health Department Karen Eargain (LPN) considers her community one of the lucky communities.

“The number of cases is small, but the workload is still enormous,” said Yeargain. MedPage Today, Public health officials add that they have never needed to step up these efforts at such a national scale. Currently, Crook County has a population of approximately 24,000 with a total of 13 cases.

Contact traces, which have long been used to control the development of other infectious diseases such as sexually transmitted diseases and tuberculosis, include secretly calling COVID-19-positive individuals to identify potential exposures and resources. Includes a workforce to connect to. This has traditionally been done in-house by public health staff, but the vast number of COVID-19 cases overwhelms public health capabilities and is a more creative way to perform contact tracking in counties and states. Forced to find.

While this practice has been successful in some areas, contact tracking efforts in other states have been hampered by lack of testing, funding and national guidance. With growing distrust of public health, some Americans have completely opted out of contact tracking efforts, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. US contact tracking paradigm said In the context of COVID-19, it’s just “not working”.

Shortage of personnel and funds

According to the CDC, as of the last week of June, 27,000-28,000 people were working as contact tracers across the United States. However, public health officials estimate that at least 30 contact tracers per 100,000 are needed, something like 100,000 to 300,000.

Alabama Relocate health department staff Massachusetts Working with a non-profit health agency A health partner to hire a contact tracer. Oklahoma And North Dakota Employing recent public health graduate students to conduct academic performance contact tracking, and Kansas using technology platform Track anonymized mobile phone location data.

“The US National Academy of Health Policy (NASHP) executive director Trish Riley (MS) said: ),It Track contact tracking plans by state.

“This disease should be consistent throughout the country because the disease is not known to the state lineage and people are not aware of the state lineage,” Riley said. MedPage today.

April, Coronavirus Rescue, Relief, and Economic Security (CARES) Act $631 million for local Ministry of Health surveillance Includes contact tracking. But the cost of hiring 100,000 contact tracers on the low demand side is Costs about $3.6 billion, According to the Association of State and Territory Health Authorities (ASTHO) and the Johns Hopkins Health and Safety Center,

According to NASHP data, many states have allocated funds from the CARES Act to hire and train contact tracers.

Others have relied on non-federal funds to make up for their expenses. For example, Hawaii $2.5 million contract with University of Hawaii Using state funds. New Jersey and New York rely on funding from donors such as Bloomberg Philanthropy. We have invested $10 million in tracking contacts.

But not all of these dollars are used well. In Utah, State Spent $2.75 million with contact tracking app, $300,000/month will be allocated for maintenance. But just under 2% of the state’s residents downloaded the app Business insider.. Spanish speakers and members of Navajo Nation Against that, Said those dollars may have been better spent to meet their urgent needs.

Sense of distrust

Less involvement in tracking contacts means that Politicalization of public health issues. This may be one of the reasons for the relatively successful contact tracing. Germany And TaiwanNot shaped to be as effective in the US

A snapshot of data from a public hospital in New York, the state with the most contact tracers in the US (50 per 100,000) Only 50% of contacts were successfully traced The first 3 weeks of June. The rest didn’t have the correct phone number, couldn’t be reached, or refused to complete the interview.

Public health authorities Need to extract, identify and test 75% of contacts Within 24 hours before implementing resumption measures.

But other states are having even more difficulty reaching people. In Louisiana, 13% of contacts were tracked as of July 1st, and since then contact numbers have dropped to about 11%. COVID Act Now, A database of statewide testing and contact tracking rates. State legislators and their members Publicly expressed skepticism about this practice, Quoted privacy concerns.

Contact tracking is completely voluntary, but a concern is that the contact tracking app unknowingly tracks your location.

“Many people are very reluctant to adopt the idea of ​​contact tracking,” said Louisiana Rep. Raymond Cruise. May hearing.. “We don’t know the extent of that.”

Keith Humphreys of Stanford University says that while the technical and human resources challenge is to constrain contact tracking efforts, there are deep-rooted issues in American culture, identity and individualism.

“The vast majority of Americans…do not trust the government that much, trust public health officials, and hardly intend to do that,” Humphreys said. MedPage today.. “Culture has a strategy for breakfast.”

Maximize effect

Former director of the Arizona Department of Health, Wilhamble, said testing and contact tracking work together, equating the role of appropriate testing in responding to COVID-19 to the “pyramid base.”

However, in some states, Not enough test supplies to meet demand, Leading to shortages and long lines.

“Every road leads to a test,” Humble said MedPage today. “Contact tracking doesn’t work without robust testing.”

Humble says contact tracking is most effective for communities in early or late stages of development, rather than peaks. Overall, public health officials should focus on implementing the highest return on investment strategies, he said.

“The return on investment can be significantly higher in the early stages of the epidemic, or as circumstances change, but it is always worth it,” Humble said.

One way to enhance contact tracking responses is to align resuming incentives with monitoring. This ensures that the company can resume only after a sufficient number of contact tracers have been hired in the community.

“It will mobilize stakeholders in the county to drive a governing body, the governing body of the county governor,” said Humble. “Companies will do [say] …”Where are the resources to improve contact tracking capabilities in our county?”

The growing pool of unemployed Americans could also be used as a potential workforce for contact tracking, ASTHO report announced in April.. To maximize traceability, we suggest hiring laymen to work with experts from epidemiologists, public health officials, and specialist disease investigators.

“Public health and healthcare systems also need to be prepared for future outbreaks and associated medical surges,” he said. “Time is the essence.”