San Diego County scales back COVID-19 contact tracing program
For more than two years, county contact tracers worked to interview every resident who tested positive for the coronavirus. But that changed on Friday, with only about one in 10 residents receiving calls as the outreach program shifts to a more targeted mode that prioritizes those considered most at risk of serious illness from COVID-19. .
The idea, said Dr Seema Shah, the county’s medical director of epidemiology and vaccinations, is to focus on people aged 65 and over or who live in places, such as correctional facilities, nursing homes or homeless shelters, where infections can spread very quickly.
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“We want to divert more and more resources to this population where they are most needed,” Shah said.
It’s an approach that follows new recommendations made by the US Centers for Disease Control and Prevention.
The CDC says trying to test and trace close personal contacts of every new coronavirus infection made sense at the start of the pandemic when there were no vaccines available and transmission of the disease could be reduced by quickly identifying those who were exposed and requesting quarantine until it was clear they were not infected themselves.
But those days are long gone. As evidenced by Omicron’s recent surge, the coronavirus is capable of generating more than 16,000 new cases in a single day in San Diego County alone. So many infections at once made it impossible to reach all new cases quickly enough to make a difference.
The idea of pivoting to high-risk infections is widely supported in the public health community. On January 24, five different organizations, including the National Association of County and City Health Officials, the Association of Public Health Laboratories, and the Council of State and Territorial Epidemiologists, issued a joint statement calling on all public health agencies to move away from universal investigation of coronavirus cases.
“We urge a refocusing of our public health efforts and resources, with an emphasis on targeting investigations in high-risk settings serving vulnerable populations,” the statement said.
Omicron, experts say, simply spreads too easily and is now too widespread for there to be any realistic hope of individually interviewing and counseling each infected person. This is especially the case, the joint statement says, because many are now carrying out home tests whose results are never shared with public health services. Experts say the latter variant’s shorter incubation period of two to four days and significant amounts of asymptomatic transmission mean that “only a very small portion of the total number of cases and close contacts are reached.”
So many new cases poured in in January that only about 10% of all positive cases were investigated. Overwhelmed labs have also often notified the health department of new positive test results well outside the time frame when newly infected people are still able to transmit to others. For Omicron, this infectious period would continue for about five days after the onset of symptoms.
In addition to surges that tend to overwhelm investigative capacity, it has also become clear over the past couple of years that many have simply not responded when asked to have voluntary conversations with tracers. contacts and case investigators. According to county records, about 41% of the 740,716 people who have so far tested positive through Thursday have participated in surveys. Investigations involve speaking directly with infected people. Additionally, the county has contacted more than 200,000 close contacts of people who tested positive.
Somewhere between 10% and 12% of new cases, Shah said, are expected to meet the new high-risk criteria. With the health department receiving notifications of 500 to 900 new cases per day, the number of people to be interviewed should be between 50 and 100 per day, at least in the short term. Demand would fall further if the number of new cases fell further.
And the reduction in workload doesn’t stop there. Today, in addition to trying to reach everyone who tests positive, those who respond are also asked who else they have recently been in close contact with, and these people are themselves interviewed and invited to self-quarantine. But that work, a county official confirmed by email Friday afternoon, will also be significantly reduced.
Going forward, contact tracing will only take place for people living in congregate settings.
Less work will mean fewer workers.
Currently, the county employs 894 contract tracers and case investigators, several times the number who performed such work for the county’s public health department before the pandemic hit in 2020. Jeff Johnson, service branch chief of Epidemiology and Immunization, declined to put a specific number on the size of the county’s case investigation staff by the summer. But he guessed it’s probably about a third of the size she is today. Workers hired on a temporary basis will be phased out over the next several months, he said, until the county feels the number of workers matches demand.
“We expect our team to be much, much smaller as we head into June and July,” Johnson said.
Presentations from the county’s human resources department, he added, are already underway to explain how temporary contact tracers can apply for permanent jobs in other divisions. He said many handled more than 1,000 conversations with residents who were often scared, mourning lost loved ones or generally angry about one aspect of the pandemic response or another. One worker, who set the conversation record, managed 1,669 COVID case investigations during the pandemic response.
“I think what we need to show for this is not only the highest vaccination rate in Southern California, but also the lowest death rate in Southern California,” Johnson said.
Shah recalled a worker who noticed that one of the contacts they called seemed upset, learning that they were in an emergency.
“They made sure their contact got to the hospital and then followed up to make sure they were okay,” Shah said. “She was really worried and let us know right away.”
There were other times, Johnson added, when contact tracers and investigators responded to medical emergencies reaching out to ask questions about COVID-19. And the calls became a key way for many to be connected to other government programs, from temporary stays in public health hotels to applying for government wage benefits for those who had lost their jobs.
“Over $20 million in income allowances have been facilitated,” Johnson said.