By Iris Hentze and Tahra Johnson
Contact tracing may be a new term to many people due to the COVID-19 pandemic, but to public health professionals, it’s old news and has been around for decades.
Contact tracers reach out to individuals who have had a specific type of contact with a person who tested positive for COVID-19 or other infectious diseases. They conduct interviews, monitor cases, provide appropriate isolation and quarantine instructions, provide basic crisis counseling and refer individuals to medical or social resources, all while maintaining patient confidentiality.
According to several national guidelines, having an adequate contact tracing workforce is a key component to a “reopening” state’s ability to manage COVID-19 cases. A report by the Association of State and Territorial Health Officials (ASTHO) and National Governor’s Association (NGA) recommends states pursue a few actions to bolster their contact tracing workforce, including working with public and private sector stakeholders to identify sources of potential workers and removing barriers to hiring and training these workers.
George Washington University, in partnership with ASTHO and National Association of City and County Health Officials (NACCHO), published a contact tracing workforce estimator tool showing the estimated number of contact tracers each state will need based on its size, number of COVID-19 cases and its existing public health workforce. The tool, as well as other reports published on the contact tracing workforce, also examines the experiences of China, New Zealand and South Korea to see what lessons may be applied locally. According to news reports, North Dakota is the first state to meet the estimated need of 30 contact tracers per 100,000 people.
Massachusetts was the first state to launch large-scale contact tracing worker hiring efforts. In early April, the state partnered with a local health nonprofit to hire and train 1,000 workers to carry out contact tracing. According to NBC News, more than 9,000 people applied in the first 24 hours for jobs paying between $20 and $25 an hour. Washington, the site of one of the earliest COVID-19 outbreaks, has hired 1,371 contact tracers, including 351 workers from the National Guard.
Washington Senator Steve Hobbs, a lieutenant colonel in the National Guard, is leading various COVID-19 response initiatives with the National Guard. “The reason there is such a ramp up, including the National Guard, is because we need to get up to scale,” he said. “Filling in the gaps to scale up and aggressively track COVID and inform folks. One thing we need is for people to be informed and understand that this [contact tracing] isn’t new, it’s already being done with other diseases.”
Washington also reallocated some of its other state employees to contact tracing, including 390 from the department of licensing and 630 from state and local health departments and announced plans to hire more tracers in the coming weeks. Tennessee pursued a similar strategy, retraining 230 state workers from other positions as health investigators, and will be hiring more.
Several state legislatures introduced measures to establish, coordinate or fund contact tracing (e.g., Illinois, Hawaii, Minnesota) and measures around privacy (e.g., New York). In Rhode Island, for a business to reopen, the department of health requires the establishment to cooperate on testing, contact tracing and disease investigation.
Several companies created new digital contact tracing tools or platforms to assist with notifying individuals about their contact with someone who tested positive for COVID-19, while others provide communications systems and staff to assist states to contact people who may have been exposed. States are using technology to improve or speed outreach by the workforce, and several states are working with industry to bolster the workforce.
Indiana works with a company to centralize contact tracing and assist with the volume of calls. “Our local health departments have been doing an incredible job with contact tracing for COVID-19, but we know that as the number of cases increases, the strain on local resources will be significant,” said Health Commissioner Kris Box. “This centralized approach will free up local health departments to connect people with supportive services in their communities, help with large outbreaks in congregate settings and continue to provide other essential public health services, such as immunizations.”
Utah and Texas are experimenting with app technology. Utah uses an app relying on Bluetooth and GPS signals to help health workers track infections. Texas awarded a local technology company with a contract to help implement a contact tracing system.
Both states face uncertainty from policymakers and the public in outsourcing contact tracing and working with technology companies to assist the state workforce. The privacy and security of residents is a key concern, as is the lack of legislative oversight and involvement in the decision-making process. The Centers for Disease Control and Prevention (CDC) published a document on digital contact tracing tools for COVID-19, recognizing the tools vary in purpose, features and complexity and noting they can add value to traditional efforts.
Iris Hentze is a policy specialist in the Employment, Labor and Retirement Program.
Tahra Johnson is a program director for public health and maternal & child health in the Health Program.