Contact tracing transformed in 2020 from a routine part of public health work to a massive effort to contain COVID-19. Experts from the CDC and public health departments reflect on lessons learned.
MARY LOUISE KELLY, HOST:
Here's one sign the pandemic is on the decline. NPR's latest survey of state health departments with the Johns Hopkins Center for Health Security finds many are winding down their contact tracing programs. This is NPR's sixth contact tracing survey since the pandemic began. After the biggest scale-up of contact tracing in U.S. history, how did it go and what's next? NPR's Selena Simmons-Duffin has this report.
SELENA SIMMONS-DUFFIN, BYLINE: There were tantalizing stories early on in the pandemic about how Singapore and South Korea had contained the novel coronavirus by tracking down every positive case, figuring out their contacts and quickly getting those people to quarantine. At the time, the U.S. had only about 11,000 contact tracers according to NPR's first survey, which clearly wasn't enough to do something like that in a country this big. Public health experts told Congress they needed to increase the workforce tenfold or more. Then, CDC director Robert Redfield told NPR in April of 2020 this was a major priority.
(SOUNDBITE OF ARCHIVED NPR BROADCAST)
ROBERT REDFIELD: We are going to need a substantial expansion of public health field workers, and it is going to be critical.
SIMMONS-DUFFIN: Over the course of 2020, as NPR and the Johns Hopkins Center for Health Security surveyed state health departments, the contact tracing workforce grew month by month to a peak of over 70,000 in December. Looking back, CDC's Melanie Taylor says it's clear that ramp-up wasn't enough to match the winter surge.
MELANIE TAYLOR: We still did not have enough people to respond and deliver case investigation and contact tracing during those surge months.
SIMMONS-DUFFIN: One reason the U.S. was not able to bring on enough contact tracers...
ADRIANE CASALOTTI: You weren't just starting from zero, you were starting from a deficit when it came to the workforce and public health departments.
SIMMONS-DUFFIN: That's Adriane Casalotti of the National Association of County and City Health Officials. And they were scaling up in the late spring and summer while communities were starting to reopen.
CASALOTTI: Probably too far to say we set it up to fail, but we certainly didn't set it up for success.
SIMMONS-DUFFIN: In those early weeks and months, no national army of contact tracers materialized, as CDC Director Redfield envisioned, to meet this need. Instead, it was a hodgepodge. Some health departments created statewide programs. Others left it to local departments or volunteers or contracted call centers. Katherine Feldman runs the contact tracing program in Maryland. She says finding people to hire was only part of the challenge.
KATHERINE FELDMAN: You know, contact tracing also is a skilled job. And it takes a minute to recruit qualified staff and train them up and get them going.
SIMMONS-DUFFIN: She says tracers also might only work part-time or leave. It's intense work calling people all day, hearing people's stories of illness and loss. Now, NPR's latest survey finds health departments are starting to scale those programs back. More than half of respondents have fewer contact tracers than last winter, and the vast majority aren't planning to hire more.
Crystal Watson is a senior scholar at the Center for Health Security who collaborated with NPR on the surveys. She notes most departments did respond, however, that this is still a critical part of the response. That's good, she says, because now is actually a time when contact tracing could keep the virus in check.
CRYSTAL WATSON: Really trying to find every case that we can and trace all their contacts who are unvaccinated especially.
SIMMONS-DUFFIN: Even so, Nicole Roberts, who runs the contact tracing program in Utah, says they're having to move staff around.
NICOLE ROBERTS: Cases dropped pretty drastically. And so then, we had a ton of people, and we were wondering what to do with everyone.
SIMMONS-DUFFIN: Some tracers have been helping with mobile testing teams or vaccine clinics, she says. At the same time, there's finally a big pot of money on the table. President Biden's COVID relief bill, passed in March, includes $7.4 billion for the public health workforce. In the survey, most departments didn't have clear plans for how to use that funding. That includes Utah, says Roberts.
ROBERTS: Right now, we're just being inundated with so much funding that it's, you know, almost like you're scrambling trying to figure out what all to use it on.
SIMMONS-DUFFIN: There's a concern that this is one-time funding. It's usually feast or famine with public health funding, Roberts says. Right now, it's a feast, but...
ROBERTS: You know, a few years from now, we might be hitting famine, where we've built all of these programs, and we have all of this capacity. And then the funding will dry up because, you know, pandemic response is no longer sexy (laughter).
SIMMONS-DUFFIN: Watson of Johns Hopkins and other public health experts are hoping the U.S. will break this cycle.
WATSON: So it has to go beyond how do we sustain this specific workforce who are very focused on contact tracing, and how do we make sure that we have the workforce we need to do better public health every day.
SIMMONS-DUFFIN: Doing restaurant inspections and rabies control and HIV outreach, who can pivot to contact tracing when there's an emergency. She says that way, in the next pandemic, the U.S. won't have to build the contact tracing plane while flying it.
Selena Simmons-Duffin, NPR News.
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