- As cities and states reopen their economies, many are quickly ramping up their contact-tracing capacity in an effort to keep a lid on Covid-19 infection rates.
- It has turned contact tracing, a little-known public health technique, into a big job opportunity in parts of the country.
- Contract tracing entails calling close contacts of confirmed Covid-19 patients, providing them with information about the disease and encouraging them to self-quarantine for 14 days to potentially avoid infecting others. Testing is also discussed.
- Researchers at George Washington University's Milken Institute School of Public Health say 184,000 contract tracers are needed in the U.S.
The coronavirus pandemic has pushed more than 30 million Americans out of the workforce since mid-March. At the same time, it has turned contact tracing, a little-known public health technique, into a big job opportunity in parts of the country.
As cities and states reopen their economies, many are quickly ramping up their contact-tracing capacity in an effort to keep a lid on Covid-19 infection rates. Simply put, contract tracing entails calling close contacts of confirmed Covid-19 patients, providing them with information about the disease and encouraging them to self-quarantine for 14 days to potentially avoid infecting others. Testing is also discussed.
Interestingly, contact tracing doesn't involve much detective work, although experts say critical-thinking skills and persistence are among the keys to success. Case investigators for health authorities typically reach out to people who test positive for Covid-19 and, in doing so, try to gather the names and phone numbers of their close contacts (usually immediate family members, friends and/or coworkers). That information is passed along to contact tracers — trained, entry-level employees who don't necessarily have a four-year college degree or a background in health care.
Contact tracers usually work from a script, although as you might imagine, things can get messy when you're delivering bad news to strangers and asking them to hole up in their homes, which may mean forfeiting a paycheck.
"The biggest misconception about contact tracing is that you need to have public health training or experience," says Christiana Coyle, a professor at New York University's School of Global Public Health and a former contact tracer for the Centers for Disease Control and Prevention and New York City's Department of Health and Mental Hygiene.
"It's more important," says Coyle, "that you're comfortable with medical terminology, working through a script and cold-calling people. For me, cold-calling was the hardest part. You're giving people news that's potentially very disturbing and serious. You never know what you'll encounter on the other end of the phone."
Be prepared, says Coyle, for some tears and hang-ups.
Contact tracing isn't a new phenomenon. In the U.S. it's been an effective technique for containing the spread of HIV, tuberculosis, measles and even foodborne illnesses. Until the new coronavirus washed up on American shores, contact tracing was practiced more widely in developing countries.
Through stimulus packages, Congress has already allocated nearly $26 billion to help public health departments pay for expanded Covid-19 testing and contact tracing. Several public health organizations are now calling on Congress to include at least $7.6 billion for contact tracing in a possible fifth stimulus package.
How many contact tracers does the U.S. need to safely reopen? Depends who you ask. Researchers at George Washington University's Milken Institute School of Public Health put the figure at 184,000. Their estimate is based on a tool they developed to help state and local governments determine jurisdictional needs. Tom Friedman, director of the CDC under President Barack Obama, has said we need as many as 300,000 contact tracers to curb the spread of the new coronavirus.
In general, states with the largest populations (think California, Texas, Florida and New York) have the biggest need for contact tracers. According to the National Association of County and City Health Officials, a state should have 30 contact tracers for every 100,000 residents — as opposed to the 15:100,000 ratio it recommends in normal times.
States and local governments are taking a variety of approaches to scaling up their capacity for contact tracing. They're hiring new employees; reassigning existing workers; deploying the National Guard; recruiting volunteers; and/or contracting with outside firms for staffing and/or training, according to a report by the nonprofit group United States of Care. Some are also experimenting with new voluntary contact-tracing apps, which have so far seen mixed results.
"Silicon Valley is designing apps to automate contact tracing. Such apps have worked well in parts of Asia, like China and South Korea, but in the United States we have a very different expectation of privacy and civil liberties," says Daniel Gabriel, a former CIA officer and CEO of AM LLC, a health-care information technology firm that has branched out into contact tracing.
The Leesburg, Virginia-based small business has already hired more than a dozen professionals, including epidemiologists and health educators, to oversee its new platform. The firm is vying for contracts to help state and local governments with their contact-tracing efforts, either by augmenting existing staff or providing a turnkey solution. Gabriel says his firm, which now has 45 employees, may hire as many as 1,000 contact tracers by early June. Salaries will range from $17–$38 per hour depending on location.
"We're scaling up to bring the foot soldiers on just as soon as the work is identified," says Gabriel.
Large nonprofits, call-center operators and others are also vying for government contacts, and some have made inroads. For instance, Maximus, based in Reston, Virginia, recently struck a deal with the state of Indiana to handle contact tracing for more than 90 counties. The publicly traded firm, which runs health and human services programs for government agencies, has already hired some 200 contact tracers to staff a 500-person call center for the program, according to a company spokesperson.
Meanwhile, NORC at the University of Chicago, one of the country's largest independent research institutions, is doing contact tracing in Maryland. Through its partnership with NORC, the state has quadrupled its existing Covid-19 surveillance capacity, according to NORC.
To ramp up their capacity, "states have the ability to pull from parts of their public health agencies that don't normally do contact tracing and from other agencies. We saw that early in the epidemic. But that's not sustainable because employees who don't normally do contact tracing have a day job to do," explains Michael Fraser, executive director of the Association of State and Territorial Health Officials.
Recent layoffs in the government and health-care sectors have created a large potential pool of contact-tracer job candidates, notes Fraser. But such experience isn't necessarily required, he explains.
"What's really important is that contact tracers and folks doing case investigation know the communities they'll be serving. Folks who have lost jobs but are very active in their communities may want to apply. The same holds true for students taking a gap year from college, or folks volunteering for AmeriCorps or some other national service program," Fraser says.
"A big part of contact tracing," he adds, "is that you're calling someone to talk about private health-related matters, and so you need to build trust and rapport with those folks."
The push to ramp up contact tracing is pulling people like retired nurse Celia Gillis back into the workforce. In mid-April Gillis landed a job as a contact tracer for Partners In Health, a nonprofit that's working with Massachusetts officials to dramatically scale up the state's contact-tracing capacity. In all, the state plans to deploy some 1,000 contact tracers to combat one of the worst outbreaks in the country.
Gillis, 49, retired from nursing 17 years ago when her first child was born. She now works remotely (about 25 hours a week) from her home on Martha's Vineyard. The job provided her with a path back into the workforce and a chance to make a difference.
"I really wanted to help in any way I could," says Gillis, recalling her motivation for applying to become a contact tracer. "I was kind of honored to think that they choose me" for the position, she adds, noting that her resume had "some major voids" in it.
In less than two months, Gillis has transitioned from contact tracer (for which she was paid a starting rate of $27.50 per hour) to case investigator. In her new role at PIH, she reaches out to Boston residents who have tested positive for Covid-19, provides them with disease-related information, gathers information on their close contacts and helps them find resources they may need to safely isolate for a 14-day period (such as food assistance or access to a field hospital). Not surprisingly, some patients don't know the full names and/or phone numbers of every close contact. So Gillis tries to track down missing information through various sources, like Covid-19 testing sites.
She works from a script, but no two calls are exactly alike. Many of the stories she hears are heart-wrenching, and some cases are challenging too.
"I had one guy in his mid-20s who worked in a fast-food restaurant. I called to tell him that he was a contact [of a Covid-19] patient, and he insisted that he had to go to work or he would lose his job," said Gillis.
She listened patiently to his plight and explained the health risks associated with returning to work. Ultimately, the young man changed his mind and agreed to self-quarantine, she said, adding, "Those are the times when you realize that what you are doing is making a difference."