Disease sleuths searching for clues in coronavirus spread. Can they stop it?
As South Carolina takes steps to reopen after its disease-induced shut down, the state will rely on a small army of people to investigate whether the coronavirus is still spreading and, if so, where it’s flaring up..
Those investigators are known as contact tracers, effectively disease detectives, whose jobs are to look into every reported case of coronavirus as part of an effort to stop more outbreaks of COVID-19.
The effort is considered a vital part of the state’s recovery plan after weeks of business shutdowns, restrictions on restaurant dining and social distancing recommendations. Some restrictions were eased Friday.
Without an aggressive disease contact tracing effort, states that reopen could suffer more outbreaks of the coronavirus. Contact tracers spot potential disease clusters so states can take action before large numbers of people get sick.
“Opening prematurely — or opening without the tools in place to rapidly identify and stop the spread of the virus — could send states back into crisis mode, push health systems past capacity and force states back into strict social distancing measures,’’ according to a recent report by the Association of State and Territorial Health Officials.
The organization is recommending that the United States hire as many as 100,000 workers to conduct disease contact probes, an effort that could cost up to $3.6 billion. South Carolina may need as many as 1,569 disease tracers to conduct coronavirus probes, according to the group, which has asked Congress to fund the effort.
“We need to quickly onboard and scale up the current disease investigation work force,’’ said Mike Fraser, chief executive officer of the state and territorial health association.
Whether the state will find enough workers or has enough testing capability to help with the investigations remains an open question.
The S.C. Department of Health and Environmental Control has nowhere near the more than 1,500 workers the association estimates the agency may need during the next year to trace coronavirus cases.
When asked by The State, DHEC did not directly address whether the agency could find that many workers or if it even thinks that many are needed. Some people have questioned whether states can deploy enough contact tracers to make a major difference before and after reopening because the task is so massive.
Still, DHEC says it is trying. The department has increased its disease contact investigation workforce tenfold since early March, agency officials and Gov. Henry McMaster said.
The state had only 20 disease contact tracers before the outbreak was first documented March 6, a department spokeswoman said this past week.
Of the 230 people now assigned to investigate cases of COVID-19, about 60 were hired recently, said Jennifer Read, the department’s chief of staff. The remainder are existing agency staffers, including nurses, who have been reassigned to trace cases of the coronavirus. DHEC did not explain why it did not have more contact tracers before the disease outbreak. .
“We have over 200; that number is growing,’’ McMaster said during a news conference Friday afternoon. “That’s not enough. We hope to get more.’’
Read and Joan Duwve, the department’s new public health director, said the agency will add as many people as necessary to its coronavirus investigation team. Read said she’s optimistic the state will have enough testing capability to fuel full contact investigations.
“As we expand testing now that the national testing supply is starting to open up and we have more access to more tests, in time, we will need more contact tracers,’’ Read said.
The Association of State and Territorial Health Officials figures the workers would be paid $17 per hour. Most of the disease contact tracer positions would be entry level jobs. The expectation is that people could be trained quickly.
School teachers, furloughed health care workers, pastors and others are among those who could be hired by the agency as contact tracers, said Rick Toomey, the department’s director.
Key soldiers in disease fight
Many health professionals say contact tracers are important to stop the spread of the coronavirus now and in coming months. Their jobs are to interview people who have tested positive, determine whom the infected people have been in contact with and warn those contacts that they may also have been infected.
“You are going to start with the people they have spent the most time with,’’ said former DHEC nurse Malinda Martin, who oversaw contact tracing in the Upstate. “These are your home contacts, work contacts, church contacts, that sort of thing. You basically go to those closest with the infected person and work your way out.’’
People who have been in contact with those infected by the coronavirus would likely be advised to stay home for several weeks so that they won’t potentially infect others. The original person who got sick also would be encouraged to stay away from other people as he or she recovers.
Michael Schmidt, an immunologist at the Medical University of South Carolina, said an aggressive contact-tracing effort should identify hot spots that could guide McMaster on how to proceed.
If contact tracers find that one area of the state has a growing number of coronavirus cases, the governor could keep or reimpose sanctions in that area without locking down the entire state, Schmidt said.
Schmidt used the example of a restaurant or the city of Camden, where the outbreak first occurred in large numbers. Should contact tracers discover multiple people with the coronavirus visited the restaurant at the same time, leaders could take action, he said.
“You effectively do targeted closures,’’ Schmidt said. “You close down the restaurant with a sick employee. Or you effectively say to a place like Camden, ‘We’re not going to let anybody new in, we’re not going to let anybody else out.’’
Schmidt said contact tracing investigations allow the state “to build a fence. From the governor’s office, he is going to put selective stay-at-home orders on various locations, so he doesn’t have to crater the whole state.’’
While investigating new cases of the coronavirus is important to head off more outbreaks, it doesn’t have much of a chance unless South Carolina has enough testing supplies, experts say. If tests aren’t run on people suspected of having the coronavirus, contact tracers don’t know to investigate.
Michael Sweat, an MUSC professor who examines community health, urged the state to do as much testing as possible.
“If we had better testing or if we had testing available on demand, that would help a lot because you would test people before they really got sick,’’ he said.
DHEC epidemiologist Linda Bell could not say Friday what percent of the state’s population is now being tested, but statistics indicate it isn’t much. The total number of tests performed is about 60,000, according to DHEC’s website. Bell said the state’s goal isn’t to test all of South Carolina’s 5.1 million residents but the department also said it wants to conduct more testing.
Read said testing and contact tracing “go hand in hand.’’
The agency had difficulty gaining testing supplies in March as the virus swept through the state, causing DHEC to limit testing. The agency at one point was recommending testing for only the sickest people. But many people who have been infected don’t show signs of it, even though they are contagious.
McMaster’s stay at home orders, like those of governors in other states, caused businesses to scale back or shut down, people to lose jobs and the economy to generally suffer. But while drastic, they were intended to limit the spread of the life-threatening disease by limiting contact between people.
Now, Read said DHEC is able to do more tests because supplies — mainly the chemicals needed by laboratories to process tests — have become easier to get.
The coronavirus, which has no known cure, has killed more than 250 people in South Carolina since early March, while infecting more than 6,000. Easily spread, the virus attacks the lungs, making breathing difficult for those suffering the most severe cases of COVID-19.
The percent of patients testing positive each day has fluctuated over the last 14 days, falling anywhere between 8% and 24% throughout that period, state records show.
Botched contact investigation
Martin, the former DHEC nurse, said contact investigations are important to protect people’s health.
But Martin said she knows first hand how a poorly done or inadequate disease investigation can expose people unnecessarily.
In 2013, Martin and her staff learned that a janitor at a school in Greenwood County had an infectious case of tuberculosis. By procedure, they interviewed the janitor, tracked down a dozen people he had been in close contact with, some of them school teachers, and had them tested, court records show. Eight of the 12 people tested positive for tuberculosis, a lung disease, in the early spring of that year.
But she was unable for more than a month to continue the disease investigation because her supervisors in Columbia dismissed additional investigation as unnecessary, court records show.
By the time DHEC’s higher level staff realized the problem and took action in late May of that year, more than 50 children had tested positive for tuberculosis.
DHEC fired Martin for what it said was a failure to take action, but records produced in a lawsuit she filed against DHEC showed that higher level agency staff had not allowed it. She settled her lawsuit out of court for an undisclosed sum, said her attorney, John Reckenbeil of Spartanburg.
“Once the DHEC director (Catherine Templeton) found out, she flooded the area with an all-hands-on-deck’’ investigation, Reckenbeil said. “But that was the approach that needed to be taken two months before.’’
Martin said she hopes the coronavirus effort this year is important to protecting public health.
“Someone has to be trying to figure this out,’’ she said.
Staff Writer Emily Bohatch contributed to this story.
This story was originally published May 2, 2020 at 9:59 AM.
