U.S. health experts say a force of as many as 300,000 contact tracers is crucial for coast-to-coast reopening in the wake of the new coronavirus. So far, though, the country has a far smaller ragtag army that’s many weeks, if not months, from full deployment.
West Virginia wants tracers to go unpaid. Texas, advertising jobs at $17 to $22 an hour, calls the gig a “simple” matter of telling people to stay home. New York City is seeking 1,000 hires with public-health backgrounds.
North Carolina, which is targeting unemployed people with high-school educations, received about 1,500 applications for 250 positions in just 24 hours.
“That shows you that there are a lot of people out of work,” said Paul Mahoney, a spokesperson for the program’s coordinator, Community Care of North Carolina. Five weeks into the pandemic, a record 26 million Americans had filed for unemployment benefits, more than 875,000 in North Carolina.
That wave of desperation explains why Texas, Georgia and other states are stirring to life this week. Gov. Gary Herbert said Tuesday that Utah will reopen in a limited capacity Friday, including gyms, salons and dine-in restaurants so long as they “exercise extreme precautions,” and Wyoming will do likewise. California Gov. Gavin Newsom is considering opening schools as early as July to make up for lost class time.
But experts say long-term stability won’t come without a way to quickly spot COVID-19 outbreaks and stop them. So the U.S. — with the world’s richest economy, but a flagging public-health system — is asking trainees to press total strangers: Where have you been, for how long, and who else was there? And their phone numbers, please?
“This is a workforce that needs to be scaled up right now,” said David Harvey, executive director of the Washington-based National Coalition of STD Directors, longtime practitioners of tracing for sexually transmitted diseases. “There’s no time to waste.”
In all, America could use 300,000 tracers and specialists, according to Tom Frieden, a former U.S. Centers for Disease Control and Prevention director and New York City health commissioner. By comparison, the New Deal’s Civilian Conservation Corps employed about 500,000 people at its peak.
“Early in the outbreak, many health departments began systematic contact tracing but rapidly became overwhelmed,” Frieden said in an email. “Now that cases are coming down in some areas, we have to trace contacts in a simple, more scalable way.”
Lacking clear guidance from President Donald Trump — and with no commitment on an estimated $12 billion needed to stand up a national program — state and local government leaders are assembling ad hoc workforces. So far, the federal government has promised just $631 million for the effort.
In Massachusetts, with more than 58,000 cases, Gov. Charlie Baker has budgeted $44 million for 1,000 tracers. Six days after his April 3 announcement, the program had 9,000 applicants, according to Joia Mukherjee, chief medical officer for Partners in Health, which coordinates the program.
“This is all going to be phone calls, not just some automated bot,” Mukherjee said in an interview. “We want phone calls, people to feel cared for.”
Workers are contacting everyone who within the past two weeks has spent 15 minutes within six feet of someone with COVID-19, Baker said. In the first week, 765 residents testing positive were found to have had more than 1,000 close contacts. Tracers have reached 626, according to managers of the program.
One early problem: getting them to pick up the phone. Tracers feel some are ignoring the calls, so officials have been working with telecom companies to make sure when a call comes in that “MA COVID Team” pops up on caller ID.
Massachusetts is far ahead of several other members of a seven-state Northeastern coalition whose governors are making regional reopening decisions.
Connecticut will use 300 state health employees and as many as 500 academic volunteers, but Gov. Ned Lamont said Tuesday the system won’t begin running until the third week of May.
Estimates of how many tracers are needed vary widely. New Jersey Gov. Phil Murphy said a proper program would require as many as 7,000 to serve 9 million people. Next door, Gov. Andrew Cuomo said New York needs roughly 5,700 for 19.4 million residents.
Meanwhile, New York City Mayor Bill de Blasio has a separate plan: paying $57,000 to $65,000 annually for 1,000 tracers with public-health backgrounds.
Some states are hardly so demanding.
“The basic idea is simple: Track down infected people, then find everyone who has been near them and encourage those people to stay home until it is clear they are not sick,” says a ZipRecruiter.com ad for the state of Texas.
Others simply aren’t ready.
“We need to hire more,” said Gov. John Carney of Delaware, whose tiny state plans on 200 tracers.
Since the Great Recession, the country has lost 50,000 public-health jobs, according to an April 22 “Coronavirus Containment Corps” proposal by Sen. Elizabeth Warren and Rep. Andy Levin of Michigan, both Democrats. By May’s end, they want the CDC to report to Congress on hiring a national contact-tracing team, and to pay state and local governments to carry out the strategy.
This week, 16 health experts — including physician and former U.S. Senate Majority Leader Bill Frist and ex-Food and Drug Administration Commissioner Scott Gottlieb — called for $12 billion to hire 180,000 tracers.
Meanwhile, the states forge on.
California’s Newsom, who wants a force of 10,000, this week said 22 of 58 counties have “robust tracing capacity.” California has been tracing tuberculosis, measles and AIDS for decades. “We’re building off that local expertise that already exists,” he said.
West Virginia University will offer a 14-hour online course to train as many as 300 tracers, ideally National Guard members or those with health backgrounds. But the force will be unpaid, according to Allison Adler, a spokesperson for the state health and human resources department.
“By initially focusing on volunteers and students we will be able to assess the feasibility, sustainability and need for paid employees,” Adler said.
As many as 150 Iowa Guard soldiers and airmen may assist 200 tracing workers, said Sarah Reisetter, Iowa health department deputy director. The governor can activate as many as 1,000 troops, with expenses paid by the federal government.
In Alabama, where Gov. Kay Ivey plans a Thursday reopening, a crew of 50 to 60 has pitched in to help 10 health department staffers who regularly do tracing.
“Until we have a vaccine or at least an effective treatment, we’ll have to scale that up quite a bit,” said Scott Harris, the state’s health officer.
The U.S. needs far more than mere bodies, said Harvey, the National Coalition of STD Directors chief. It needs a system to track state tracing capacity, he said, and far more higher-level professionals called disease-investigation specialists. Every 10 tracers, he said, will need such a specialist. Only 2,200 exist nationwide.
“You can’t just turn this on overnight,” Harvey said.