State and local health leaders say that over the past year, they had some success with contact tracing — the process of notifying people who came in close contact with a positive COVID-19 case — but acknowledge that trouble with remote training, changing protocols and understaffing during surges of the disease hobbled the program.
San Mateo County public health leaders say that while the winter surge of COVID-19 cases stretched their contact tracing capacity, the $19 million effort to find those exposed to the disease led to some success in stopping the spread of COVID-19.
According to County Health Deputy Chief Srija Srinivasan, the county ramped up its contact tracing program in the summer of 2020 while also building resources for those infected with the disease to make sure they had meals, a safe place to isolate and wages for missed work. Then the winter surge hit. The county struggled to meet demand, but she said when supply of contact tracers was adequate, the program was successful.
“In periods in which our contact tracing capacity has been sufficient to get to all positive cases quickly and assess and support residents to safely isolate and quarantine, we have been able to mitigate spread,” Srinivasan wrote in an email to the Review.
Contact tracing is a tool that public health departments use to identify, track and notify those who may have gotten an infectious disease. During the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention defined a “close contact” as anyone who has been within six feet of a person who has tested positive for the disease for 15 minutes or longer. Usually, the next step is for those “contacts” to quarantine for 14 days, get tested for COVID-19, watch for symptoms and to isolate if they become infected.
The sooner a close contact is notified of exposure, the quicker they can begin quarantine and the better they may be able to recall any others they may have infected, thereby minimizing the spread of the disease.
But without adequate staff to track down and warn all of the people a person with COVID-19 may have infected, the disease can continue to spread uncontrolled. That’s what happened over the winter surge, an April 1 audit of California’s contact tracing program found.
The audit, released by California State Auditor Elaine Howle, found that while COVID-19 testing efforts exceeded state targets and expectations by millions of processed tests, state and local health departments struggled with contact tracing, particularly during the winter surge.
“Contact tracing data and survey results highlight persistent struggles to expand tracing staff capacity to meet the initial plan’s estimated levels,” the report reads.
By January 2021, nearly a year into the pandemic, the state had built up a contact tracing staff of state and local employees of just half the stated goal of 30,000 contact tracers. Most difficult was the month of December, when state data shows that contact tracers attempted to reach 85 percent of COVID-19 patients, but reached only 40 percent, which led to new contacts identified in just 16 percent of cases.
The report explains that public health officials attribute the low percentages of new references to successful isolation practices, but did not offer an explanation as to why fewer than half of cases were reached by contact tracers in the first place. But it posits that troubles with
understaffing and remote training amid changing
protocols and an overwhelming number of cases, with new daily cases hovering around 25,000 during the worst of the pandemic, are to blame.
The county had similar struggles meeting contact tracing demand last winter, when daily new cases reached peaks of more than 500. The county did not provide a yearlong average response rate to calls from contact tracers, but Srinivasan said that by March of this year, contract tracers were reaching, on average, 82 percent of cases within 24 hours.
While the number of calls a contact tracer may make in a day can vary, Srinivasan wrote that most employees begin one to three new cases per day, if necessary making multiple attempts to contact people. The county currently employs 115 contact tracers, half of whom are bilingual, Srinivasan wrote.
Meanwhile, some of the burden has been shifted to local school districts, which have taken on their own contact tracing programs, with school nurses responsible for notifying the county of cases, and sometimes even tracking down COVID-19 infections themselves and notifying parents and families when an outbreak has occurred.
In San Mateo County, Srinivasan also noted that contact tracers aren’t just tracking COVID exposure. Sometimes, they go beyond their role and have referred thousands of residents to county-run programs that help with food, rental assistance, isolation in hotel rooms or health care. They’ve also been able to target COVID-19 hotspots where the county can send out mobile testing sites to better understand the local spread of the virus.