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Contact Tracers: Are There Enough Of Them? What Do They Do?

Courtesy of MD Dept of Health

During this pandemic, contact tracers have been doing the critical job of tracking down people who might have come in contact with those who tested positive for COVID-19.

While the program has been expanding, there is a debate over how many tracers are needed and whether Maryland has enough.

Andre Bogle, a contact tracer in Howard County, used the image of an octopus to explain what a tracer does. The head is the person who tested positive for COVID-19. The tentacles represent the people with whom that person has been in contact. The tracer starts at the head and follows the tentacles. By phone.

Bogle said the tracer is trained to jog the memory of the person who tested positive to find out where his tentacles have been.

Bogle said a typical call can go like this. “So 14 days ago, when you first got ill, when did you notice it? Where were you? ‘Well I was at a party.’ ‘Where was the party?’ ‘It was in Delaware.’ ‘What was so special about Delaware and that party?’ ‘Oh, it was my cousin’s birthday.’”

And so on.

Claire Fisher, a contact tracer for the Baltimore County Health Department, said the reactions vary when you tell someone they have been in contact with a person who tested positive for COVID-19 . It's not easy to tell someone they need to self-quarantine for two weeks, she said. Sometimes people are angry or refuse to help, but usually they are appreciative.

“I always go back to the basics which is, it was somebody who cared enough about you to let me know that you needed a phone call,” Fisher said.

Whether Maryland has enough contact tracers making those calls depends on who you ask. It’s critical because a state needs to have enough tracers to quickly reach each person who tested positive for COVID-19 and then track down their contacts.

Vicki Fretwell, the special assistant and senior advisor to the state secretary of health, said Maryland has 1,400 tracers, which is enough for now.

“We had originally thought we wanted a thousand, we decided we needed a little bit more,” Fretwell said. "We got ourselves up to 1,400. Should we end up having another surge and more cases we have other people who are interested and could expand.”

One thousand four hundred works out to about 23 tracers for every 100,000 people in Maryland.

There are those who say that ratio is too low.

Crystal Watson, senior scholar at the Johns Hopkins Center for Health Security, said 30 tracers per 100,000 people is more on target. Watson said a majority of states have not met that mark.

“This is really a hard thing to do,” she said. “It’s unprecedented for public health to try to scale up our workforce to these levels and so it’s going to be difficult and take a little bit of time and we should still keep pressing to meet that goal.”

That goal for Maryland should be even higher, 42 tracers per 100,000 people, according to an online contact tracing workforce estimator developed by George Washington University’s Milken Institute School of Public Health.

Candice Chen, an associate professor of health policy and management at Milken, helped to develop the estimator. It’s a guide for how many tracers each state needs.

According to the estimator, Maryland needs 1,100 additional tracers.

Chen said when the stay at home order was in place, there were fewer contacts for tracers to track down.

“As people go get their hair done, as people go back to work, the number of contacts per case increases,” Chen said. “And when the number of contacts per case increases, the workload of your contact tracers is going to increase, the number of people they have to notify.”

Chen said the estimator takes into account variables that can make a tracer’s work easier or harder.

For instance, an area with unreliable phone service could slow down a tracer’s work because they might have to make in-person visits. On the other hand, a tracer working in a tech-savvy area can reach people more quickly by texting.

Chen said state officials can use the estimator to ask themselves questions about their contact tracing program.

For instance, according to Chen, “What are the measures we have in place to show us that if the number of contact tracers seems low, that we’re still able to meet the contact tracing needs of our county, of our state?”

One measure is whether people who test positive for COVID-19 are contacted within 24 hours after they have results.

According to the Maryland Department of Health, everyone with a positive case is called within the 24 hour window, but not every person is reached. 

Fretwell said the state is prepared to add 400 more tracers if they are needed.

“We could go up to 1,800 if we started to get cases that presented the need for that,” Fretwell said. “But all of our jurisdictions are not experiencing as many cases per 100,000 as some of the jurisdictions are.”

Watson said it’s still early days for COVID-19 contact tracing and the data is incomplete on its effectiveness.

She said a good sign will be if most confirmed cases of COVID can be linked to another known case.

“Which means that the public health system has been in contact with that previous case,” Watson said. “And so the higher the percentage of linked cases, the better we’re doing with contact tracing.”

Watson said another good sign will be if a majority of new cases are people coming out of quarantine, meaning they were staying home and not infecting others.

“Even if it’s not perfect, even if we’re not able to get every case and every contact, it’s still really important that we do contact tracing because any amount of contact tracing is going to be beneficial to our communities,” Watson said.

Contact tracing is nothing new. Health departments have been using it for decades to control the spread of infectious diseases.

But when COVID-19 hit with all of its fury in March, tracing programs had to ramp up fast. In Baltimore County, that included recruiting about 40 school nurses to do the work. Debbie Somerville, the coordinator of health services for Baltimore County Public Schools, said the nurses made more than 4,000 calls before stepping aside a couple of weeks ago.

“When you have a health emergency it’s kind of all hands on deck,” Somerville said. “And so at the beginning of the pandemic we really needed to identify all qualified staff that could help out.”

But now there are far more people who want to be contact tracers than the state is asking for. For instance, more than 1,900 people took the Community College of Baltimore County’s introductory tracer training course. That’s more people than there are slots statewide.  There is also a free course offered at Johns Hopkins. 

You are not required to take a training class to do the work.

Baltimore County Health Officer Dr. Gregory Branch said a tracer needs to have the gift of being able to successfully interview all kinds of people.

“And the ability to be able to probe without feeling as if you’re probing,” Branch said.

But you can’t probe if they don’t pick up the phone and that is one of the biggest problems tracers have. Fisher said for now people should answer the phone even if they don’t recognize the number, particularly if they have tested positive.

“Let us help you,” Fisher said. “ Let us help your friends and your family. That’s really what it’s all about.”

This week the state health department launched a media campaign asking you to answer the call from a contact tracer. You will see MD COVID or the number 240- 466-4488 on your phone.

All conversations with contact tracers are confidential..

John Lee is a reporter for WYPR covering Baltimore County. @JohnWesleyLee2