WASHINGTON: The soaring number of COVID-19 cases in the United States has far outstripped many local health departments ability to trace the contacts of those infected, a step critical in containing the virus spread.
With the pandemic claiming about a thousand American lives a day, many city and county departments say they lack the money and staff to expeditiously identify people who have been exposed, according to a Reuters survey of 121 local agencies, as well as interviews with dozens of state and local officials, epidemiologists and tracers.
The United States badly lags other wealthy countries in contact tracing, including South Korea and Germany, which ramped up their programmes months ago. Contributing to the faltering US response is the governments failure to provide accurate and timely diagnostic testing, something other countries were able to roll out much faster and more broadly.
On Alabamas hard-hit Gulf Coast, health department staffers are stretched so thin they are directing individuals who test positive to notify any contacts themselves, said Rendi Murphree, director of Mobile Countys Bureau of Disease Surveillance and Environmental Services.
“Everything is overwhelmed,” she said.
Adding to the challenge has been a sharp politicisation of the COVID-19 response, with many Americans, from President Donald Trump on down, often portraying mask-wearing and other measures as an infringement of personal liberty.
The United States has by far the worlds largest COVID-19 caseload, with over 4.6 million confirmed infections and more than 155,000 deaths.
Yet public health measures during the pandemic have been largely decentralised, coming down to patchwork efforts by state, and especially local, governments. Federal funding has proved unreliable, caught up in fierce debate over the crisis.
Now, as part of log-jammed negotiations over new relief legislation, Republicans and Democrats in Congress are arguing over funding proposals for testing and tracing that are tens of billions of dollars apart.
As of June, US Centers for Disease Control and Prevention director Robert Redfield said the country had 27,000 contact tracers – about a quarter of what has been recommended.
Although some local health departments told Reuters their efforts have proved successful – and many said they were worthwhile – several researchers described US contact tracing overall as too little, too late.
“You dont clean up an oil spill with paper towels,” said Marc Lipsitch, a professor of epidemiology at the Harvard public health school.
On this point, the Trump administration does not disagree. Admiral Brett Giroir, Assistant Secretary for Health at the US Department of Health and Human Services, told Reuters that given the spread of the disease, mask wearing and other prevention measures are more effective.
"It is really impossible to contact trace," Giroir said, until the numbers come down.
The agencies responding to the Reuters survey serve at least 27 million residents in large cities such as Minneapolis, Boston, and Cleveland, as well as smaller communities including Allentown, Pennsylvania, and Dare County, North Carolina.
Collectively, as of last week, they accounted for at least 230,000 COVID-19 cases and 7,300 deaths. The responses cover the week ending Jun 22. Reuters followed up in late July with several departments, such as Las Vegas and Kansas City, Kansas, where officials said circumstances had not improved.
Among the findings:
• The 40 local health departments with the highest caseloads have fallen far short in their efforts to reach patients who tested positive. Only about half the departments with more than 1,000 cases had reached close to all infected people at the time of the survey. The CDC recommends that newly positive cases be interviewed within 24 hours.
“Its just impossible with the kind of numbers that we are seeing,” said Devin Raman, a senior disease investigator at the Southern Nevada Health District, including Las Vegas.
• Nearly half of the local departments said they lacked sufficient staff and funds. In Missouri, many said they hadnt received any additional money for contact tracing. “Some of them are literally running out of money right now,” Diane Weber, executive director of the Missouri Association of Local Public Health Agencies, said in July.
• Local health officials in six states complained that efforts to create statewide contact tracing systems have been hampered by issues including technical problems and poor coordination. In some cases, this has led to tension and a costly duplication of efforts, with state and local tracers calling the same people.
“Were not going to drop the ball on tracing in our county and leave it to the state. If we did that, wed probably all be dead,” said Joni Wise, administrator of the Vigo County Health Department in Indiana.
A spokesperson for the Indiana Department of Health acknowledged that people are more likely to answer a local call from a municipal health department than an “833” number from the states centralised call center.
• More than three dozen public health departments said they were hindered by some residents failure to answer their phones or to provide accurate information when they did. Several departments said people they called had objected to contact tracing as an infringement on their privacy rights.
“We get a variety of responses from yelling and hanging up, to those telling us that they have already contacted all of their friends and will not give us those names,” said Kenosha County health director Jen Freiheit in Wisconsin.
"A LAME EXCUSE"
From the early days of the pandemic, public health experts emphasised the importance of contact tracing, a decades-old strategy aimed at interrupting infectious disease transmission. It involves interviewing infected people, identifying people whom they may have exposed to infection and trying to keep those individuals from passing the virus to someone else.
“If any country is saying contact tracing is difficult, it is a lame excuse,” World Health Organization Chief Tedros Adhanom Ghebreyesus said in June. He pointed to the WHOs success in halting an Ebola outbreak in eastern Congo by tracing 25,000 contacts a day in a remote area, where some 20 armed groups were fighting.
Under the best of circumstances, contact tracing is not a panacea. It is only one of many public health tools commonly deployed against infectious disease.
The approach is particularly challenging during a fast-moving epidemic in which people may be infectious but dont fall sick right away. In addition, a culture of individualism and legal protections inhibit US authorities from forcing people to stay inside and divulge their social relationships.
Still, some other democracies have devised a more coordinated testing and tracing strategy than the United States.
In Germany, a country with about 400 public health offices, contact tracing early on was part of a collaborative effort. Workers from other municipal government offices lent a hand.
The national Robert Koch Institute said it deployed hundreds more “containment scouts” – mostly medical students – to help. Daily confirmed cases in Germany now number in the hundreds. Deaths per day are down to the single digits, from a peak of over 300 on Apr 16.
In the United States, daily case counts that had been falling since mid-April began climbing again in July, reaching a peak of 77,299 Jul 16.
The federal government has largely taken a hands-off approach to contact tracing, as well as other public health measures during the pandemic. Though the CDC has issued guidance for contact tracing, it is not deeply involved. And though Congress authorised billions of dollars in aid that could pay for tracing, the money is not required to be used that way.
Trump and many of his fellow Republicans in Congress have often downplayed the threat posed by COVID-19.
In July, the White House tried to block new funding for testing and contact tracing – something the White House later disavowed amid opposition even from Trump's own party.
Since then, Senate Republican leaders have proposed a relief bill that would dedicate US$16 billion for the effort, while a bill passed by the Democrat-dominated House would provide US$75 billion for testing, tracing and hospital support. Negotiations are at a crawl.
A senior CDC official told Reuters in a statement that the agency has provided more than US$12 billion across the country to address the COVID 19 crisis, including a recent grant of US$10.25 billion for testing and other activities such as contact tracing. In addition, the official said, the CDC has provided staff and extensive technical support to states.
“Contact tracing is most effective when local communities embrace it and drive it,” said the official, who declined to be named. “The Administration has empowered states with funding to lead these efforts."
REALITY SINKS IN
A few days before Las Vegas casinos reopened in June, state health officials in Nevada predicted a wave of coronavirus cases.
The state should have as many as 700 people working on contact tracing to meet the surge, the officials wrote in a May 29 COVID-19 “plan of operations”, which Reuters obtained under a Freedom of Information Act request. Referring to the roughly 100 tracing staffers then aboard, the plan said staffing “falls short of what is needed to effectively manage the need”.
It took two months to staff up. As of Julys end, Nevada had 744 staffers statewide, a Nevada Health and Human Services department spokeswoman said.
Still, Las Vegas and surrounding areas have struggled. The Southern Nevada Health District (SNHD) saw about 1,000 new cases a day by mid-July, up ten-fold from the first week of June (although new cases have dropped precipitously in recent days).
A SNHD official told legislators last week that the district had less than half the tracing staff needed to serve Clark County, home to Las Vegas.
Raman, the senior investigator in the southern district, estimated in mid-July that her department was able to interview between 25 per cent and 40 per cent of people who recently tested positive.
“Right now, unfortunately, we are just trying to keep our heads above water," she told Reuters.
It was a similar story in other hotspots. Health officials for Harris County, Texas, who serve the Houston suburbs, have reported about 550 cases a day since Jul 1, up from about 200 a day during the first half of June.
Harris County reported reaching about 60 per cent of the newly positive people to interview about contacts. In general, epidemiologists told Reuters, the goal should be at least 75 per cent.
Martha Marquez, a county spokesperson, described the 60 per cent figure as “good” but said the county was “looking into how to grow our success rate”.
Other departments struggle to keep potentially infectious people in quarantine.
Ideally, a tracer notifies contacts, refers them for testing and advises them to stay home and away from others. Then someone in the department follows up to see if they need anything to stay indoors – house-cleaning supplies or food, for instance. Its no guarantee they wont go out, but tracers say it can make a difference.
In Alabama's Mobile County, with case counts exploding to more than 1,000 cases a week by mid-July, follow-up was next to impossible. “It is not going well,” said Murphree, the disease surveillance director.
For months, the health department in Mobile relied only on existing health staff for contact tracing – as well as a few volunteers. It took until mid-July for the department to hire two people dedicated to that work, positions that the federal government has promised to fund, Murphree said.
The county has not yet received the money, she said.
This lack of resources is being felt across the country.
Despite pleas for assistance, local health departments in Missouri have received little to no COVID-19 funding from the state. Meanwhile, the state recently announced a US$15 million package to help support tourism, using funding from the federal CARES Act – a US$2.2 trillion COVID-19 relief package passed by Congress in March.
"Tourism is a major employer and a major boon to the economy of Missouri,” said Scott Clardy, assistant dirRead More – Source