One of the disappointments in our pandemic response has been the limited ability of our contact tracing—one of the fundamental activities of public health during an infectious disease outbreak—to control Covid-19 transmission. Hong Kong and Singapore initially contained their outbreaks by deploying thousands of public health workers to track down every person with a newly positive test, figure out whom they had been in contact with, and quickly get those people to quarantine. The United States did not. Which raises the question: have we now learned something about how to better perform this ancient public health function to make us confident that we could do better the next time around?
The US public health system faced three challenges in its attempt to make contact tracing work. First, we had inadequate Covid-19 testing early on: we could not identify all positive cases. The testing system failed—long waits to get tests and then more waiting for results. Without being able to readily identify and test those who have been in contact with an infected person, the chain of infection continued. By the time testing was readily available, rapid, and mostly free, the number of people infected far outstripped the supply of contact tracers.
Even if we had accurate testing available soon after Covid-19 was identified, workforce limitations was our second problem. Four months into the pandemic, in May 2020, we had only a fraction of the public health workers needed to launch an effective national contact tracing effort. At that time—with only 30,000 persons having tested positive—public health experts told Congress the country needed to increase the number of contact tracing staff tenfold to 100,000 or more. Yet even in December 2020, at the peak of US case load, there were still only 70,000 contact tracers nationwide. Widespread community transmission across the country occurred within a few months of Covid-19’s arrival; it is unclear that any number of contact tracers could have kept up. The numbers grew too big too fast.
Read the full post at The Turning Point.