HOUSTON (AP) – Health departments in the United States that use contact tracers to contain coronavirus outbreaks struggle to strengthen their ranks amid a wave of cases and resistance to cooperation from those infected or exposed.
With under-trained contact tracers to accommodate soaring caseloads, a hard-hit Arizona county relies on National Guard members to join. In Louisiana, people who have tested positive usually wait more than two days to respond to health officials – giving the disease crucial time to spread. Many tracers find it difficult to break through suspicion and apathy to convince people that compliance is crucial.
Contact tracking – tracking people who test positive and everyone they came in contact with – was challenging even when there were home orders. Tracers say it is exponentially more difficult now that many restaurants, bars and gyms are full and people are gathering with family and friends.
“People are probably a bit wary … they think there is no more threat,” said Wendy Hirschenberger, health officer from Grand Traverse County, Michigan, who was warned by health officials in another part of the state who had infected tourists visited vineyards and bars in its area.
Her health department was then able to urge local residents who had visited these companies to self-quarantine.
Hirschenberger was lucky to receive that information – only possible because the tourists had worked with contact tracers. But that is often not the case.
Dr. Anthony Fauci, the country’s top infectious disease expert, said on Friday that contact tracking just doesn’t work in the US.
Some who test positive don’t cooperate because they don’t feel sick. Others refuse testing even after being exposed. Some never call back contact tracers. And yet others simply object to information sharing.
Another new challenge: more young people become infected and they are less likely to feel sick or think they are a danger to others.
While older adults were more likely to be diagnosed with the virus earlier, figures from the Centers for Disease Control and Prevention indicate that the picture almost reversed as states reopened. It is now most likely that people aged 18 to 49 will be diagnosed.
On Monday, the United States reported 38,800 newly confirmed infections, totaling more than 2.5 million, according to a note from Johns Hopkins University. For several days, daily reported cases in the US have broken the April record. That partly reflects the increased testing.
Some states have been caught off guard by the wave and are trying to rapidly increase the number of contact tracers.
“At this time, we do not have sufficient capacity to do the work that is needed,” Arkansas Governor Asa Hutchinson recently announced that he wanted to use federal coronavirus tools to increase the number of contact tracers to 900.
Arkansas already has 200 of them, but infections have increased by more than 230% since Memorial Day and hospital admissions by nearly 170%. Businesses that were closed due to the virus were allowed to reopen in early May, and the state has eased its restrictions further this month.
In addition to requiring more staff to handle the rising case numbers, contact tracking teams should also build confidence in people who may feel uncomfortable or scared, Dr. Zoe said. Umair Shah, director of Harris County Public Health in Houston, where an outbreak threatens overwhelming hospitals.
That is difficult to do if infected people do not call back.
In Louisiana, only 59% of those who have tested positive since mid-May have responded to calls from contact tracers, according to the latest data from the state’s health service. Only a third replied within the crucial first 24 hours after the test results. Tracers receive an answered call there on average more than two days after receiving information about the positive test.
Perry N. Halkitis, dean of the Rutgers School of Public Health, said COVID-19 is spreading so fast that contact tracers must contact 75% of potentially exposed people within 24 hours of their exposure to successfully combat the spread.
“Is it as good as we would like? Well, of course not, ”said Dr. Jimmy Guidry, Louisiana’s health officer. “Better than not having it.”
Contact tracers around Utah’s capital city in Salt Lake City have seen double workloads increase, and collaboration has declined since the economy reopened, health researcher Mackenzie Bray said. A person who didn’t answer phone calls told Bray they didn’t want to waste her time because she and their contacts were not at high risk – a dangerous assessment because the person may not know the health history of their contacts, Bray said.
Getting people to respond to the advice of tracers is also a challenge. In the Seattle area, only 21% of infected people say they became isolated the day they developed symptoms. People go on average three days from the time they develop symptoms until they test, said Dr. Matt Golden Golden, a physician from the University of Washington who leads case studies for King County’s public health department.
Because people are contagious two days before the symptoms, it means many spread the virus for five days, he said.
In hard-hit Maricopa County, Arizona, officials hired 82 people to support contact tracing, helping them reach 600 people a day, said Marcy Flanagan, executive director of the Maricopa County Department of Public Health.
But the daily average of confirmed infections has risen, from 1,800 in May to 1,800 a day, according to figures from the county. That means the county should leave the rest of the business to colleges, health agencies, and the Arizona National Guard, Flanagan said.
They all have to triage: each infected person is asked in an automated text to complete a survey to assess their level of risk, and tracers only contact people who appear to be at high risk or work in environments that have a high risk can cause a dangerous outbreak, such as a residential care center.
Contact tracking is key to avoiding worst case results, said Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention and current president and CEO of Resolve to Save Lives, a non-profit organization committed to prevent epidemics. But the explosion of the American case has made it nearly impossible for even the most staffed health departments to keep up, he said.
Contact tracking is “a proven public health feature,” Frieden said. “When the health department calls, answer the phone.”
Webber reported from Fenton, Michigan and McCombs of Salt Lake City. Associated Press journalists Andrew DeMillo in Little Rock, Arkansas; Carla K. Johnson of Seattle; Melinda Deslatte in Baton Rouge, Louisiana; and Terry Chea in San Francisco contributed.
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