Dr. Daniel Combert, the medical director of the Center for Medical Assistance and the director of the Center for Clinical Teams, at the center, works with other medical specialists when they answer calls and track data at the Hartford HealthCare COVID-19 command center in Newington, Connecticut, March 10 2020
Cassie jackson | Hartford Courant | Tribune News Service via Getty Images
Kimberly Jocelyn graduated from college last month when millions of people across the country took refuge to avoid the coronavirus pandemic. In search of a pandemic-friendly way of communicating with her community, she applied to track contacts in New York.
After a FaceTime interview with the New Health City Health + Hospitals test and investigation unit and a six-hour online course at Johns Hopkins University, Jocelyn joined a city team of approximately 3,500 people to contact those who tested positive for Covid-19. and determine who they could expose to the virus.
This work is critical for cutting the chains of infection before they break out. Along with social distance and wearing a mask, contact tracing is one of the only proven strategies for containing coronavirus. Jocelyn said it was hard work too, and it was non-stop.
“My first call was with someone who was puzzled by how they got the virus,” she said, adding that in order to do the job well, compassion and patience are needed. “We are here to provide information about Covid, to understand how they contracted with Covid, and also to understand how they are to find out if they need any resources.”
Jocelyn, who now leads about 15 other tracers, ideally said that the tracer leaves one of these conversations with contact information for family members, colleagues, and anyone who might have been exposed. Within a certain day, an employee of her team will contact 30-50 people, tracking the virus throughout the city and trying to combine it into identified chains of people.
Public health experts say the strategy is not a “silver bullet,” but it is a time-tested method to contain the most infectious diseases. It has been and is used worldwide to spread viruses from measles to sexually transmitted infections. World Health Organization officials have repeatedly called on countries to expand their contact tracing infrastructure, as well as the ability to widely test for coronavirus.
The White House advised states not to open until they build infrastructure to track contacts. In some cases, this means hiring and training thousands of people, although the federal government has not specified what a reliable tracking infrastructure will look like. Now that the US states are moving forward with the opening, overloaded health departments are trying to create tracking systems on an unprecedented scale. Tracking experts who spoke to CNBC said they were worried that the current systems were not enough, and that the discovery was too aggressive.
“Unable to catch up”
“If you do not take any mitigation measures, so close everything, introduce social distance, as soon as you stop doing it, the only tool that you do not need people to pass on to each other is contact tracing, isolation and quarantine,” said Dr. Karen. Smith, former director of the California Department of Public Health. “This is the only tool you have, and it is a tool that works very well when staffed with the right personnel.”
Jessica Osorio of Contra Costa Health Services during a videoconference with healthcare representatives on Thursday, May 14, 2020, in Martinez, California. Osorio leads the coronavirus contact tracing program there.
Santiago Mejia | San Francisco Chronicle via Getty Images
According to her, Smith began her work in the field of public health as an officer in the fight against tuberculosis, so she understands what investments are made in a great effort to track contacts. She participated in efforts to track contacts with coronaviruses in Napa, Santa Clara, and Mendocino districts in California, she said, adding that departments usually waited until the cases began in California at the end of May to estimate what contact tracing needed will be.
Smith added that counties began hiring employees from local health departments until it became clear that additional shoes would be needed in the field. According to her, there are currently up to 296 tracers in Santa Clara County, and 25 in the Mendosino District, which is more rural. According to her, there are 21 in Napa County, but plans to increase it to 35.
She said most districts in California began to open before they had the infrastructure they needed, such as staff and technology, adding that local health departments, suffering from more than a decade of budget cuts, were using outdated systems that would hamper their tracking efforts.
“[Contact tracing] This is a standard tool, and it really works, but when it is not in place or when you start trying to introduce it after the virus literally spreads in your community, it is almost impossible to catch up with it, ”Smith said. ,
$ 3.6 billion investment
“Ideally, when we started the reopening, it would be great if we asked the states to track the contacts,” said Marcus Plescha, chief medical officer at the Association of State and Territorial Health Officials.
Some states have linked regional discoveries to contact tracking. For example, in New York, resuming work in the regions required 30 contact indicators per 100,000 residents. When applied nationwide, this would mean about 100,000 contact tracking tools.
Infectious Disease Specialists at Johns Hopkins University and ASTHO proposed in early April a plan to expand national trials and track efforts. It will require a workforce of 100,000 people, sentence saidand will cost $ 3.6 billion. Pleschia added that some researchers have called for up to 300,000 national tracers. Instead, the CDC allocated $ 631 million from the $ 2 trillion CARES Act. Dollars in 64 jurisdictions for this effort.
National Guard personnel wear face masks as they take part in a case investigation and contact tracing training session at the Washington State Department of Health as efforts continue to slow the spread of coronavirus disease (COVID-19) in Tumwater, Washington, May 20, 2020.
Jason Redmond | Reuters
Instead of developing a coordinated national tracking plan, as countries like Germany did, the CDC instead seeks to support local efforts. Last week, the agency published downloadable table Help local health departments calculate how many tracers they may need based on population and current prevalence. And earlier this month, CDC released infographic identify his expectations for the local departments and encourage them to “expand the scope and prepare a large investigation into the case and contact the tracer staff.”
This guide came well after each state began to reopen, and many had already begun to see an increase in cases. For example, Arizona began to open on May 15, and since then there has been a surge in the number of cases, and some hospitals are close to filling.
The CDC did not submit a comment in time for publication.
Arizona Robo Calls
“The order to stay at home ended before the counties hired the right amount of contact tracing and collected their administrative procedures,” said Will Humble, a former director of the Arizona State Department of Health. “This put the county in a position in which the home-stay order and rebound in business were canceled before they could increase their capabilities.”
Cases began to grow in Arizona after Memorial Day. On Wednesday, Governor Doug Ducey completely changed his previous position that the state will continue to open up and can handle any leap in business. In his updated guide, Ducie emphasized the role of contact tracing and announced that the state was deploying 300 national guards to help counties track contact.
“[Contact tracing] will help contain new infections and prevent and slow the transmission of coronavirus in our communities, ”he said at a briefing, adding that this is one of the criteria for“ readiness for the main condition ”set forth by the White House.
But in Maricopa County, where the virus was most affected in Arizona, the county’s health department hired 82 investigators, spokesman Fields Mosley told reporters and plans to hire another 20 people. This would be a little more than 2 tracers per 100,000 inhabitants in the district.
Smith from California explained not only the number of tracers, but also the availability of a skilled workforce that understands the epidemiology of the virus. As health departments strive to grow, many employ people who are not familiar with epidemiology or contact tracing. For example, students from local universities and Amerikor volunteers were hired in Maricopa County to supplement the 82 Department of Public Health staff involved in the effort, Mosley said.
“Everyone knows that over the past two weeks the number of cases has far exceeded expectations,” Moseley said. “Public health is valuing the addition of more employees and the introduction of technologies such as robust-secure calls and text messaging for positive cases with low risk, while focusing human resources on those that are most at risk of serious complications.”
According to Emily Gerley, an epidemiologist at Johns Hopkins University and a teacher at the new school, effective contact tracing is not only the number of tracking devices, but it is also important that employees have a clear idea of the local outbreak and their role in it. six hour online contact tracking course, New York State, among jurisdictions, used the Garley course to quickly train inexperienced contact tracing specialists.
The course gives students a brief summary of what is known about the virus: how long a person can be without symptoms, when someone is no longer contagious, which can be called close contact and much more. While the course helps prepare the workforce on a scale that epidemiologists had hoped would never be needed and never prepared for, Gurley said that ideally, contact tracing is done by classically trained epidemiologists with a deep understanding of infectious diseases.
“It’s hard to imagine that there were many health departments that had enough contact trackers at the beginning of this.” she told CNBC. “Our public health system is chronically and severely underfunded, so most places need more, and maybe much more [tracers]“But if you have a small team, and all of them are really very qualified, they are very good at their duties, and they have been doing this for a long time, maybe you need less.”
However, anything that helps curb the spread of the virus, Gerley said, adding that her colleagues at Johns Hopkins are working on a model to quantify the impact of tracking programs so that local health officials can see the difference they make. As researchers learn more about how the virus spreads and this information is passed on to the growing workforce of newcomers, Gerley said she is optimistic that such programs will become increasingly fundamental to the country’s response.
“I think that they still often underestimate how difficult this work is and, in fact, what we are facing, to be honest,” she said. “This is not just a fire training, and in a couple of months it may end. You really need to invest in these programs, carefully monitor them so that they work well and follow them with the necessary difficulties. to make them worthwhile. We are in this for a long time “
Governor Andrew Cuomo today announced his intention to transform hostels and a hotel into temporary wards such as the New York Marriott on Brooklyn Bridge.
Justin Hayman | Getty images
Contact trackers do not just identify people who can spread the virus. They are also expected to help patients and potentially susceptible people manage the disease. Jackie Bray, Deputy Executive Director of the Testing and Tracking Corps in New York, said traders in New York are trained to inform contacts about options such as free food delivery, while they are isolated and receive financial advice if they don’t can work from home.
“This is testing, tracking, and isolation, or testing, tracking, and, as we call it here in New York, a safe separation,” she said. “They come as a package.”
According to Bray, the city has rented several hotels that are currently vacant, because the pandemic limited travel, as temporary housing for potentially vulnerable people living in crowded houses. While about 20% of the contacts accept any support from the agency, Bray said that only a few dozen accepted the offer to move to one of the rented hotels at this early stage of the program.
As New York continues to step up its tracking efforts and the public adjusts to it, Bray says she hopes they will continue to get more community involvement and believes that other parts of the country should take note of the work that they have done. long away.
“Invest in your testing infrastructure. Invest in contact tracking, but remember that both of them are a means to an end. And the goal is isolation, ”she said that other municipalities could learn from New York.
Technology cannot replace tracers
Countries such as South Korea and Singapore have made contact tracing known when they used it to contain the first infections at the beginning of their outbreaks. Health professionals in these countries were able to quickly implement it using surveillance technology, including credit card transactions and location tracking data.
Some companies, including Google and Apple, have spearheaded efforts to introduce tracking technology that can help the US replicate the successes seen in Asia. But such technology is unlikely to be widespread in the United States because of concerns about privacy and government invasion, said Smith from California.
Smith works with the constituencies with which she is affiliated to ponder how technology could help increase local search efforts. The Apple and Google initiative shares anonymous location tracking data with apps created by public health departments that can alert users if they come in contact with someone who has tested positive.
Smith said that such a program might be useful, but it would be much more useful to equip underfunded local health departments with simple data entry systems to help track who is infected and his contacts. She added that some health departments across the country have yet to digitize and build their systems.
“[Tech] can help, but cannot replace, “she said.
The Care19 mobile app, which the governors of North Dakota and South Dakota asked residents to download to help track contacts during the global outbreak of coronavirus disease (COVID-19), can be seen on the phone April 24, 2020.
Dave Paresh | Reuters
“Save the life”
Instead of federal coordination, some cities, counties, and states seek support elsewhere. In Louisville, Kentucky, the Metro government has decided to contract for contacts with Louisville-based Lacuna Health, which is owned by Kindred Healthcare.
Lacuna – это медицинский колл-центр, в котором работают в основном зарегистрированные медсестры и другой обученный медицинский персонал. Ранее компания фокусировалась на предоставлении телездравоохранения и других удаленных услуг больницам, но когда в США началась пандемия коронавируса, компания начала переосмысливать, как она могла бы повлиять на местный ответ, сообщил CNBC генеральный директор Брайан Холзер.
По словам Хольцера, в среду Lacuna взяла на вооружение 50 человек для отслеживания, добавив, что она официально стартовала в понедельник. Он сказал, что колл-центр обслуживает в среднем до 500 человек в день, что удовлетворяет спрос, поскольку вирус не сильно пострадал от Луисвилля. Но Хольцер сказал, что он ожидает, что вирус в конечном итоге распространится по всему городу, и поэтому он надеется, что, поскольку Lacuna нанимает больше людей и ослабляет материально-техническое обеспечение системы, в конечном итоге он будет связываться с 2000-4000 человек в день.
«Нас приняли на работу из-за наших технологий, наших платформ центров обработки вызовов и нашей способности ориентироваться в сложной медицинской среде», – сказал Хольцер. «Мне было бы страшно, если бы местный или государственный муниципалитет думал, что когда потребуется время, они создадут среду для отслеживания контактов, наймут штатную фирму, дадут людям кучу мобильных телефонов и поедут в город. Это невероятно сложно».
По словам Хольцера, партнерство Lacuna с городом, которое, по оценкам доктора Сары Мойер, директора Департамента общественного здравоохранения и благополучия Louisville Metro, может стоить до 1 миллиона долларов, позволяет компании использовать городскую базу данных телефонных номеров. Он добавил, что тогда компания сможет эффективно развернуть свою рабочую силу, чтобы трассировщики не тратили время на оставление голосовой почты или набор номеров. Минуты, потраченные на эти действия, складываются, сказал он, и время имеет первостепенное значение для отслеживания.
«Не быть чрезмерно драматичным, но если все сделано правильно, это спасет жизни», – сказал он. «Это чрезвычайно важно для обеспечения безопасности людей, для перезапуска экономики, чтобы позволить работодателям и владельцам малого бизнеса начать возвращаться к работе».