(TNS) — California communities are scrambling to track down people exposed to the coronavirus after the state let many accelerate reopening without meeting minimum standards for contact tracers, a review of county data shows.
The state initially told counties they must have at least 15 contact tracers for every 100,000 people before they could speed up their economic reopening.
Of the 55 counties that attested they could safely reopen, at least 17 wrote that they did not meet that contact tracing threshold when they submitted their attestation forms to the state, although many outlined plans to expand their staff.
When they submitted their forms in May, most of those counties said they could handle their coronavirus caseloads with their existing contact tracing staff. But as coronavirus cases rise rapidly across the state, some of those counties now say they don’t have enough staff to call every person who tests positive for COVID-19 and their contacts within 24 hours, the standard recommended by the federal Centers for Disease Control and Prevention.
Gov. Gavin Newsom’s administration did not respond to questions about why the state allowed those counties to reopen more quickly without meeting the requirement.
Even some counties that did meet the state’s staffing threshold at the outset have been overwhelmed. Fresno, for example, had enough staff when it filed its reopening documents in May. But the number of positive cases in the county has grown by an average of 280 a day over the past two weeks, outstripping capacity.
“We don’t have enough personnel at this time,” interim health officer Dr. Rais Vohra said last week. “The numbers have just kind of grown by such degrees that it’s really hard for us to keep up.”
In some areas, tracers face challenges beyond limited capacity. In Yuba and Sutter counties, some people they call yell, hang up, or simply decline to participate. Sometimes tracers can’t reach a contact at all. Infected people don’t always remember who they were with or where they have been.
As a result, the counties are failing to get information on about 40 percent of cases.
“Our contact tracers are overwhelmed, not just by the number, but the emotional burdens,” Yuba County spokeswoman Rachel Rosenbaum said. “Maybe it is fear combined with mistrust of government. It’s tough, but we are working every day to try to push back on those misconceptions.”
Contact Tracer Shortages
California now has trained more than 10,000 people to be contact tracers, more than enough to meet the state’s initial goals.
The National Association of City & County health officials recommends 15 tracers per 100,000 people in “non-emergency situations,” but in April recommended doubling that number given the “magnitude of COVID-19.”
Brad Pollock, associate dean for Public Health Sciences at the UC Davis School of Medicine, estimates the state needs about 40,000 contact tracers statewide. He said some counties are struggling more than others.
“The contact tracers are not being deployed evenly throughout the state,” Pollock said. “The smaller counties that don’t have a huge staff, they’re going to need help.”
California Health and Human Services Secretary Mark Ghaly acknowledged Tuesday that some counties are now concentrating their efforts on the more serious outbreaks rather than tracking the contacts of each infected person.
“We did not build the current contact tracing program on this level of transmission,” he said.
Once someone tests positive, a worker with a county health team is supposed to call that person and ask them who they interacted with closely since the estimated infection date. Tracers then call those people, tell them that they have been in contact with someone who tested positive and advise them to get tested and quarantine for 14 days.
Tracing identifies which people need to be isolated and shows where the virus is spreading, Pollock said.
“It’s super, super important,” Pollock said. “Contact tracing gives you an idea of what the patterns of spread are like.”
Newsom credited contact tracing with showing that the virus is much more likely to spread indoors, which informed his announcement Monday to close indoor activities in all restaurants, museums and movie theaters across the state.
In Sacramento, public health officials used contact tracing to track some big local outbreaks back to family gatherings, including parties and a funeral.
Counties Forced to Triage Cases
Sacramento went from six contact tracers when the virus hit to 60 as of last week. But even the expanded team isn’t enough, county health chief Peter Beilenson said.
When Sacramento secured permission in May to reopen faster than the rest of the state, the county said it had enough contact tracers to handle three times its then-current case rate of 10 infections per day, according to the documentation it submitted.
Although the county didn’t meet the state’s target of 15 tracers per 100,000 residents — in Sacramento, that would be about 225 tracers — the county said it could call on county employees from various departments, nursing and public health students at local universities and medical reserve corps volunteers to add more.
Now, the county’s infections are skyrocketing, averaging over 130 new cases per day over the last 7 days for which data is available.
The increase has overwhelmed Sacramento’s contact tracers, preventing them from thoroughly tracking each infection. Instead, they are triaging — focusing on cases that represent more serious clusters or geographic outbreaks.
About 400 miles south in Orange County, officials have to make similar choices. To meet the state’s threshold, the county would need 476 tracers. Instead the county has about 185 staff working on COVID-19, not all of whom are always available for contact tracing, said Marc Meulman, acting deputy director for the county’s public health services.
“Staff shift from one activity to another to make the best use of available resources,” he wrote in an email. “Given the high volume of cases and public health activities more critical than (case and contact investigation), there are not adequate resources to make contact with all cases.”
Although Yolo County, with at least 37 contact tracers, meets the baseline number of contact tracers laid out by the state, spokeswoman Jenny Tan said the county also needs more to handle the surge in cases. Since early June, the county’s cases have tripled, landing it on the state’s watch list, Tan said.
Easing Fears About Contact Tracing
To encourage Californians to take calls from contact tracers, Newsom has launched public service announcements and said his team is focused on reaching communities “where there’s still a little bit of nervousness” around tracing.
“In the Latinx community, we’ve got to do a lot better in terms of getting the right messengers to give people confidence that their information will be maintained as confidential and will not be shared with federal authorities,” the Democratic governor said during a press conference last week.
Fresno County is collaborating with local schools, whose nurses could trace cases associated with their students and staff, as well as with farmworker advocacy organizations and groups that work with people in underserved communities, Vohra said. The goal, Vohra said, is to create “a decentralized network (of tracers who) more familiar with the populations we need to serve.”
“We need to meet people where they are, and they’re not always on the phone,” Vohra said of the traditional means of tracing. “They’re rarely on the phone when we’re trying to call them.”
©2020 The Sacramento Bee (Sacramento, Calif.) Distributed by Tribune Content Agency, LLC.