Contact Tracing Is Failing in Many States. Here’s Why.
In Arizona’s most populated region, the coronavirus is so ubiquitous that contact tracers have been unable to reach a fraction of those infected.
In Austin, Texas, the story is much the same. Just as it is in North Carolina, where the state’s health secretary recently told state lawmakers that its tracking program was hiring outside workers to keep up with a steady rise in cases, as a number of other states have done.
Cities in Florida, another state where Covid-19 cases are surging, have largely given up on tracking cases. Things are equally dismal in California. And in New York City’s tracing program, workers complained of crippling communication and training problems.
Contact tracing, a cornerstone of the public health arsenal to tamp down the coronavirus across the world, has largely failed in the United States; the virus’s pervasiveness and major lags in testing have rendered the system almost pointless. In some regions, large swaths of the population have refused to participate or cannot even be located, further hampering health care workers.
“We are not doing it to the level or extent that it should be done,” said Steve Adler, the mayor of Austin, echoing the view of many state and city leaders. “There are three main reasons. One is the sheer number of people, the second is the delay in getting test results back, the third is the wide community spread of the disease.”
The goal of contact tracing for Covid-19 is to reach people who have spent more than 15 minutes within six feet of an infected person and ask them to quarantine at home voluntarily for two weeks even if they test negative, monitoring themselves for symptoms during that time. But few places have reported systemic success. And from the very beginning of the U.S. epidemic, states and cities have struggled to detect the prevalence of the virus because of spotty and sometimes rationed diagnostic testing and long delays in getting results.
“I think it’s easy to say contact tracing is broken,” said Carolyn Cannuscio, an expert on the method and an associate professor of family medicine and community health at the University of Pennsylvania. “It is broken because so many parts of our prevention system are broken.”
Tracking those exposed is so far behind the virus raging in most places that many public health officials believe the money and personnel involved would be better spent on other resources, like increasing test sites, helping schools prepare for reopening and educating the public about mask wearing. Some public health experts now believe that, at the very least, testing and contact tracing need to be scaled back in places with major outbreaks. In some places, they say the effort may never succeed.
“Contact tracing is the wrong tool for the wrong job at the wrong time,” said Dr. David Lakey, the former state health commissioner of Texas who helped oversee the Ebola response in Dallas in 2014.
“Back when you had 10 cases here in Texas, it might have been useful,” said Dr. Lakey, who is now the chief medical officer for the University of Texas System. “But if you don’t have rapid testing, it is going to be very difficult in a disease with 40 percent of people asymptomatic. It is hard to see the benefit of it right now.”
Dr. Thomas R. Frieden, a former director of the C.D.C. who is a strong advocate for robust contact tracing programs, largely agreed that it is impossible to do meaningful or substantial contact tracing with huge numbers of cases. He noted that when testing results lag as much as they have, it becomes almost impossible to keep up with the high volume of infected individuals and those who have been in contact with them.
“At some point when your cases are very high, you have to dial back your testing and contact tracing,” said Dr. Frieden, who now runs Resolve to Save Lives, a nonprofit health advocacy initiative. “We may be in that situation in some parts of the country today.”
Frequently Asked Questions
Updated July 27, 2020
Should I refinance my mortgage?
- It could be a good idea, because mortgage rates have never been lower. Refinancing requests have pushed mortgage applications to some of the highest levels since 2008, so be prepared to get in line. But defaults are also up, so if you’re thinking about buying a home, be aware that some lenders have tightened their standards.
What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.
Is the coronavirus airborne?
- The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
What are the symptoms of coronavirus?
- Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Does asymptomatic transmission of Covid-19 happen?
- So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.