4,000 calls a day? How is SC’s contact tracing handling surge in COVID-19 cases
As coronavirus cases continue to soar, South Carolina has pledged a robust system to trace the movements of those who come down with COVID-19 symptoms, helping alert those who have been exposed to the disease. In May, Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, even said South Carolina’s response was one he would “almost like to clone.”
But as new reported cases in the Palmetto State have climbed to more than 1,000 a day, some have said they’ve waited days for the state’s contact tracers to get in touch — if they ever do.
Those stories are emblematic of the challenges for South Carolina’s contact tracers, who are tasked with tracking how many people each coronavirus patient has come in contact with and warning those people about their exposure to a potentially deadly disease. For 13 consecutive days, South Carolina recorded more than 1,000 new cases of COVID-19 announced per day until July 7, making the ability to reach each person exposed that much more difficult.
“With cases continuing at this level daily, with 1,000 cases one day after the next after the next, this is severely hampering our ability to conduct contact tracing for cases,” said Linda Bell, the state epidemiologist, at a press conference earlier this month. “It’s a significant challenge to interview 1,000 patients each day. And if we think about an average of three contacts per case, that leaves us with having to interview approximately 4,000 people every single day.”
On Saturday, the state passed 2,000 new cases in a single day for the first time. Roper St. Francis Healthcare has even suspended all elective, non-urgent cases at its four Charleston-area hospitals, due to an “unrelenting flood of COVID-19 patients.”
The S.C. Department of Health and Environmental Control says it has hired more than 500 people to conduct contact tracing during the pandemic, and another 600 have now been trained and are in the process of being brought on board. That’s short of an initial goal of 1,000 contact tracers by the end of June, but a department spokesperson said DHEC has access to an additional 4,000 tracers working for private firms.
“We continue to bring more on board each week as the state’s positive cases continue to increase,” said spokeswoman Laura Renwick.
Those contact tracers are tasked with making contact with everyone diagnosed with the coronavirus and getting detailed information on them and their contacts for the period preceding their diagnosis. But what once seemed doable has grown more complex as the number of new cases reported every day has grown over the past month, from the low hundreds to well over a thousand.
A DHEC spokeswoman said the 500 figure includes 343 tracers, who conduct the initial confidential interview with positive cases and identified close contacts, and 225 contact monitors, who monitor and provide guidance throughout the duration of individuals’ isolation or quarantine periods. The same worker may float between the two roles depending on need, DHEC said.
If 4,000 people need to be contacted per day, that would mean each of 568 tracers would need to contact roughly 12 people per day.
Tracers strive to contact positive cases within 24 to 48 hours, said Renwick, but she couldn’t say how many people have been contacted by tracers so far.
Michael Schmidt, a microbiologist and immunologist at the Medical University of South Carolina, isn’t directly involved in contact-tracing efforts. But the pandemic expert says many more contact tracers will be needed if South Carolina is going to get a handle on so many cases.
Even then, he said, it will be hard to get an accurate number of contacts from someone who is as active as usual. And locating casual contacts can be even more difficult. Someone eating in a crowded restaurant, for example, could pay cash and leave no record they were sitting next to someone who later tests positive.
“It’s like a bad game of telephone,” Schmidt said of gathering this kind of data. Even when tracers know who to call and how to reach them, “half the time they don’t answer the phone.”
Jenny Meredith is the director of microbiology at Prisma Health and a former director of DHEC’s Public Health Laboratory, where she oversaw past contact-tracing efforts. She said some hospitals’ reporting systems can slow down tracers’ efforts.
Prisma Health’s hospitals, including those in Columbia, are tied in to DHEC’s reporting system, sending updates on new diagnoses every hour. But other hospitals enter results manually, which can take longer.
“If there’s not a creative way to work around, that’s going to slow down the system,” Meredith said. “There are some hospitals that probably still send paper faxes to DHEC.”
She said 500 tracers are not enough to keep up with the current number of rising cases, but that outside contractors could make up the difference. Meredith said she even knows of some who have lost their jobs during the outbreak who have volunteered as tracers, although they would still need to be trained.
“If you’re not doing the interviews, then other than not being a jerk, you just need to be able to touch base with people,” she said.
With larger numbers of cases spreading through the state, epidemiologists say trying to contain individual cases is less effective, and community-level interventions like social distancing and wearing masks are more necessary to curb the spread of the virus.
In South Carolina, many have gone back to normal, even as many local governments now require residents to wear masks in public, and fears grow that the Fourth of July holiday weekend could exacerbate case numbers in the Palmetto State.
“DHEC is currently building a management software database that will expand our capacity to rapidly reach out to the close contacts of those who have tested positive so we can provide education and guidance on the importance of quarantining, if necessary,” Renwick said. “This new database also will allow us to stay connected with these individuals during their period of quarantine so we may provide additional information as needed.”
She emphasized that individuals behaving responsibly — both on the part of those working to avoid getting sick and those who need to keep from spreading the virus to others — will be key to curbing the spread of the disease. Faced with ballooning numbers, Bell said the state health experts are now focused on the spread of the disease in large group settings, rather than individual-to-individual transfer.
“In institutions where people congregate, such as nursing homes, correctional facilities, certain businesses and other facilities, the intent is to prevent local outbreaks within those facilities, rather than contain individual cases throughout the entire population,” Bell said.
While the goal is still to contact each individual who tests positive, the priority will be case investigations in such group settings because of the higher risk scenario, DHEC said.
DHEC is not currently using mobile apps to trace contacts, but both Apple and Google have created a function on users’ phones that can generate data to help track a user’s contacts. Schmidt said allowing those features to operate on your phone could be a good way to improve tracing.
“It literally records if you’ve been within spitting distance of someone,” Schmidt said.
If a user who has activated the feature is later diagnosed with the coronavirus, a program will contact other phones it has “pinged” within the last 14 days. Schmidt encourages users to activate the feature to help alert people to their exposure.
“We’ve got to get over this fear of privacy,” he said. “Apple has an iron-clad privacy policy, and Google is not as good, but they have told the Congress of the United States that they will not share this data.”
Bell said tracers have had difficulty reaching as many people as they should in a timely manner, especially when “many people don’t want to be notified.” Bell said tracers will focus on care facilities and other transmissions within defined populations, “with the workforce limitations and the time involved and thousands and thousands of cases each day.”
“Those are our priority because those are settings where we can do containment,” Bell said.
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