UNDATED – Public health experts are questioning the extent and effectiveness of contact-tracing efforts in South Dakota and across the country, arguing that an inadequate number of investigators and lags in testing times have reduced the efficacy of the tracing process.
Contact tracing aims to reduce the spread of infectious diseases, including COVID-19, by quickly identifying people who may have been exposed to the virus. Investigators question people who test positive for the virus and then try to determine who else they may have come in contact with. Those people are then warned to isolate, watch for symptoms and get tested if they feel sick.
The process is seen as a critical tool in the fight against COVID-19 and other diseases such as tuberculosis because it can break or slow the cycle of transmission from one person to another.
When combined with high rates of testing and social distancing, contact tracing has been shown to slow the spread of COVID-19 and speed up the ability of countries such as South Korea, Singapore and Germany to safely re-open their national economies.
Investigating COVID-19 cases has taken on heightened importance in South Dakota in recent weeks as the state has seen a surge in its number of new cases. On Aug. 20, South Dakota reported 125 new cases of the disease and had the nation’s second-highest rate of transmission, according to state and federal data.
The state also reported on Aug. 20 that at least two dozen COVID-19 cases were related to the Sturgis motorcycle rally, including two notices about the potential for significant public exposures, and school districts and colleges were already reporting cases among students just days into the new academic year.
South Dakota Department of Health leaders say their contact-tracing efforts are keeping up with the increasing caseload. The state’s goal is to make contact with everyone who tests positive for COVID-19 in South Dakota within 24 hours of the department being notified of the new case.
The 131 contact tracers now working for the health department are making initial contacts with known COVID-19 patients within about 15 hours on average, said Cassie Deffenbaugh, who leads the contact-tracing team. The state contact-tracing workforce has grown to five times its pre-pandemic size since March, and has been able to identify 35,000 close contacts of coronavirus patients during the pandemic so far. Deffenbaugh said she is confident that the state’s contact tracers would be able to keep up with the virus.
“We are adequately staffed to be able to support our current workload,” Deffenbaugh said. “We are constantly assessing to make sure we are adequately staffed at this time and that we will be moving forward.”
But some disease researchers say the contact-tracing workforce is not widespread enough in South Dakota to handle the rising number of cases. Without increased availability of COVID-19 testing and speedier test result reporting — along with extensive social-distancing and increased mask usage — experts worry that contact tracers likely will be overwhelmed and the benefits of the process will be muted.
“I don’t think that we can afford, at this point, for contact investigation to stop the epidemic alone. It would have to be done at such a national scale with such speed and efficiency, that I don’t think that’s feasible,” said Travis Porco, an ophthalmological biostatistician and disease transmission researcher at the University of California at San Francisco who has been studying contact tracing since the pandemic began. “We really just don’t have a single magic bullet at this point, we need a little bit of everything to try to turn the tide.”
The Centers for Disease Control and Prevention told Congress, in June, that the country needed a minimum of 100,000 contact tracers to adequately manage the COVID-19 pandemic.
But an Aug. 7 survey of state health departments conducted by Johns Hopkins Center for Health Security and National Public Radio found that there were just 41,122 contact tracers actively working in the U.S. Adding 59,000 more contact tracers to the workforce would cost billions of dollars, CDC officials said.
The Johns Hopkins/NPR survey also found that just three states — Maine, New Hampshire and Vermont — had enough contact tracers on staff to adequately track their COVID-19 cases. Three additional states — Montana, Michigan and Hawaii — would have enough contract tracers if they would bring in reserve staff. The South Dakota health department did not participate in the survey.
A News Watch analysis of the Contact Tracing Workforce Estimator created by the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University shows the state would need 638 contact tracers in order to adequately cover the average number of new cases found between Aug. 4 and Aug. 18. Hiring several hundred more contact tracers could cost millions of dollars and could likely take months.
Contact tracing can be an essential public health tool for managing a pandemic, according to the Centers for Disease Control and Prevention. Breaking the chain of transmission can prevent widespread outbreaks, reducing both the number of deaths from the disease and its negative economic effects.
“Contact tracing is useful because it allows us to help people at direct risk of infection, rather than only being able to act in ways that help the whole community, which helps us use broad actions like shelter-in-place more sparingly, and also ensures that we can direct our time and attention to where they’re needed most.,” said Eric Lofgren, an epidemiologist and assistant professor at Washington State University.
South Korea, for example, was once second only to China in the severity of its COVID-19 problem. But an aggressive, nationwide contact-tracing campaign, combined with high levels of testing, have helped contain outbreaks and keep the number of new cases under control. Since the beginning of July, the country of 50 million has seen an average of fewer than 60 new cases per day.
Contact tracing can also help identify people at the most risk from COVID-19 due to old age or a preexisting health condition such as diabetes early so they can be monitored more closely and provided health care more quickly when needed. Contact tracing is also about the only way to find people who are carrying the virus but aren’t displaying symptoms so they can be quarantined, Porco said. Any delay in testing people or in getting test results will reduce the value of contact tracing because infected people have more time to spread the illness to more people.
Investigating disease transmissions through contact tracing is not a new concept in South Dakota. It has been common practice in the public health field for decades.
Prior to the pandemic, the SDDOH employed 21 contact tracers officially known as Disease Intervention Specialists. After the pandemic began, the health department spent an additional $1.2 million on contact tracing and added 110 contact tracers, known as COVID Intervention Specialists. Increased funding for contact tracing came as part of federal pandemic relief efforts such as the CARES Act.
The contact tracing process begins when DOH is notified that someone has tested positive for the virus. The state’s goal is to make contact with a person who has tested positive for the COVID-19 virus within 24 hours of the department being notified of the test.
Contact tracers can even help people find places to self isolate if quarantining in their home isn’t feasible, Deffenbaugh said. So far, the health department has helped 48 people find a place to quarantine outside their home.
But the most important thing contact tracers do is identify a COVID-19 patient’s close contacts, which includes anyone the patient had been within six feet for 15 minutes or more up to 48 hours before showing symptoms. The interview includes questions about the patient’s workplace, social gatherings, activities and home life.
The patient’s close contacts are then advised to self isolate, monitor themselves for symptoms and get tested for the disease if symptomatic.
Once the investigation has been completed, each contact is supposed to be enrolled in a daily monitoring program so contact tracers can follow-up via text message or phone calls to ask about symptoms and provide resources for quarantining or isolating. Monitoring lasts until a person is deemed recovered from COVID-19 or fails to develop symptoms for up to 14 days after being exposed.
Sometimes a contact-tracing investigation reveals that someone spent time at a crowded event or a bar and can’t provide information on everyone they came into close contact with, Deffenbaugh said. When that happens, the state issues an alert with the date, time and location of the potential exposure. Recent examples include notices issued on Aug. 18 and 20 after a person who spent time in a Sturgis saloon and a tattoo parlor worker tested positive for COVID-19.
For all of its importance, contact tracing has a number of shortfalls. For one thing, contact tracing in South Dakota relies on people to answer phone calls, often from strange numbers. In today’s world of random robo-calls and phone scammers, that can be a big ask, Deffenbaugh said.
Editor’s note: This article was produced through a partnership between SouthDakota News Watch and the Solutions Journalism Network, a national non-profit group that supports rigorous journalism about responses to problems.
