As the spread of COVID-19 in Wisconsin reaches wildfire proportions, one of the key strategies to control it is nearing collapse: contact tracing.
Public Health Madison & Dane County has shifted to the “crisis model” of contact tracing. People who test positive for the virus will be notified, and “our contact-tracing team will try their best to follow up,” health director Janel Heinreich said at a news conference Wednesday. “If you are exposed, we will not be able to call you to notify you of your exposure.”
At a media briefing on Tuesday held by the state Department of Health Services (DHS), there was a change in the message that DHS Secretary-designee Andrea Palm delivered in her opening remarks. In place of the usual admonition to the public to answer when a contact tracer calls, Palm had this advice for people who take a COVID-19 test: “Quarantine while you wait for your results, and call anyone you’ve been in contact with, to tell them to get tested and to quarantine as well.”
In short — contact tracing is becoming a do-it-yourself task.
That’s not the way public health officials want it.
“We are absolutely seeing a strain on the public health infrastructure in the state of Wisconsin, as many other states across the country are,” Palm told reporters.
On Wednesday, DHS reported a record number of COVID-19 deaths for one day: 48. The department also reported 4,205 new people who have tested positive for the virus, which has now been confirmed in 182,687 Wisconsin residents. And the state recorded it’s first admission to the alternate care facility set up at State Fair Park in West Allis.
“The bottom line is, things are far worse than they were even just a few days ago,” Dr. Nasia Safdar, medical director of infection control at UW Health, said at the Madison and Dane County press conference. “ And we seem to be on a fast increasing trajectory in not a favorable direction.”
To control the spread, Safdar, Heinrich and Madison Mayor Satya Rhodes-Conway all emphasized, people need to observe physical distancing with everyone outside their immediate household, wash their hands thoroughly and often and wear masks, to prevent transmitting the virus when they don’t know they have it. And, they said, they need to return to the sort of behavior that was mandated under the state’s Safer at Home order from late March through early May.
“The single most important thing is to prevent the transmission of this virus to others, meaning that we have to reduce our physical movement and our physical mobility,” said Safdar. “As people travel, so does the virus.”
But as long as the virus continues to spread, one pressure point is contact tracing.
Professional contact tracers are a longstanding public health tool to help track and curb the spread of diseases that easily pass from one person to another. They contact people who have been identified as infected with the illness and advise them on how to stay safe and avoid spreading it. They also get the names of others who might have been exposed to the infected person and advise them on their risk of exposure and measures they must take for their own health and to avoid passing on the illness as well.
With COVID-19, the contact tracer explains to the infected person the importance of staying home for up to 14 days in isolation to avoid infecting others. The tracer also gets the names and contact information of anyone who might have been around that person during the incubation period of the virus. Tracers then call those exposed people, advising them to get a test for the virus and to quarantine for two weeks — whether or not they have tested positive — to minimize the chance of transmitting the virus.
“We’re having three to four thousand cases a day,” said Dr. Ryan Westergaard, chief medical officer in the DHS communicable diseases bureau. State and local public health personnel assigned to contact tracing “cannot keep up.”
Instead, health departments have begun to ask the people identified as infected to do some of that work.
“We want to be able to communicate to everyone who was exposed, so they know how to stay safe. We’re not able to do that now,” Westergaard said. “We have really highly trained public professionals who do this work very, very well. We don’t have enough of them right now.”
Faced with this “strain on the public health infrastructure,” said Palm, DHS and local health officials have had to adopt practices aimed at making the process “more efficient, so that we can continue to get the minimum information that is necessary to continue to contact trace in a way that is helpful.” The questionnaire form that contact tracers use has been shortened, and people who test positive are being asked to notify their own close contacts.
Those kinds of tactics point to a more pressing necessity, Palm said — “the need for all of us to do what we need to do to stop the spread, so that our local public health departments and contact tracers have the bandwidth that they need to do contact tracing in the way it was designed to be done.”
In February, before the pandemic took hold in the state, Public Health Madison & Dane County employed seven contact tracers, said Heinrich; now it has deployed 180 — more than the entire staff count at the department. “And that number is still growing,” she said.
To fill the gap, some states are trying contact tracing apps, but none has yet been approved for use by the state Department of Health Services.
A month ago, national organizations monitoring the spread of COVID-19 were recommending that Wisconsin’s case levels required the state to field 9,000 contact tracers, when it had about 1,200.
The state’s total number of contact tracers, including those working for DHS and those working for local health departments, has increased some since then.
Now, though, Wisconsin needs 17,610 contact tracers according to an estimation formula from George Washington University that calculates the number of tracers needed in every state and county based on infection levels.
But to think simply in terms of the number of tracers needed misses the larger point, according to public health officials.
“We shouldn’t have to have that many people if we can control transmission,” Westergaard said at Tuesday’s DHS media briefing. By adhering to guidelines that keep people in the smallest groups possible, the demand for a large army of contact tracers can be reversed.
“If everyone keeps their circles small, we don’t have large gatherings. If you limit close contact with people outside your household, it’s easier, because we don’t have to notify large networks of people who are potentially exposed,” he said.
“It’s really up to us,” Westergaard added. “We really have control over how many contact tracers are needed by how many people we are in contact with, and how good of a job we do in controlling transmission.”