Public Health Experts Warn The U.S. Lacks Resources To Contain The Coronavirus
MARY LOUISE KELLY, HOST:
As new coronavirus hotspots emerge around the country, we want to focus on this question. Do states have two key weapons they need to contain the pandemic - testing and contact tracing? NPR's Science Desk has been closely tracking both of these things and today is releasing the results of a survey on the contact tracing workforce around the country. NPR health policy reporter Selena Simmons-Duffin is here to tell us about that. Hey, Selena.
SELENA SIMMONS-DUFFIN, BYLINE: Hi.
KELLY: Also health correspondent Rob Stein, who has been all over reporting on testing and where that stands - hey, Rob.
ROB STEIN, BYLINE: Hey, Mary Louise.
KELLY: So, Selena, I'm going to get you to talk about those survey results, but first - the basics. When it comes to coronavirus, keeping the virus in check, how are testing and contact tracing connected?
SIMMONS-DUFFIN: Well, testing really comes first. You want to have enough tests that if someone is sick or if they've been exposed, they can quickly get a test. And if they're positive, they can stay home and not be out in public, where they could infect other people. But that's only step one. Then you need contact tracers, public health workers who get that sick person to think through all their close contacts and then reaches out to those contacts who may have been exposed so they can stay home and well. And that way, people who are sick or exposed know their status and can stay isolated. And if you don't have both of those pieces of the puzzle, you're not going to be able to effectively stop the virus from spreading out in the community.
KELLY: Rob, since you're our expert on step one on the testing, I want to ask you about that. There was so much reporting early on in this about how we didn't have enough tests. People who needed tests couldn't get them. Everything was falling short. Where does that stand now? Does the U.S. have enough tests? Are we testing enough?
STEIN: Yeah. Well, that's a big question, and the answer depends on who you talk to. I spoke today with Adm. Brett Giroir about this. He's the Trump administration's testing czar, and he notes that 25 million Americans have now been tested and almost 500,000 are now being tested every day. Here's what he said when I talked to him about this.
BRETT GIROIR: Testing is in a really good place overall in the country no matter what metric you look at, and nobody's ramped up testing as much as we have.
KELLY: Rob Stein, is that true?
STEIN: Well, the public health experts I've been talking to say, well, you know, yes, things are definitely much better than they were, but we're still nowhere near close to where we really need to be. The U.S. may be testing more than any other country, but the U.S. is a huge country and has the biggest coronavirus epidemic in the world by far.
STEIN: Here's Dr. Marcus Plescia. He's the chief medical officer for the Association of State and Territorial Health Officials.
MARCUS PLESCIA: What we don't have yet is the full-fledged capacity and scale of testing to really do the kind of testing that we would do to get a step ahead of the pandemic and really start to tamp down some of the current levels and particularly to try to tamp down some of the areas where we're seeing increases in infection.
KELLY: All right - so a couple of perspectives there on testing and what still needs to be done. Selena, let me turn you to this survey. You have some new answers today about whether states have enough contact tracers. You surveyed all 50 states and Washington, D.C. What did you find?
SIMMONS-DUFFIN: Right. This was the second time we asked states how many contact tracers they have. In early May there were 11,000 tracers across the country, and this time, we found more than 37,000. And that means the workforce has tripled in about six weeks. But when we dug into whether states have enough tracers, in most places, that staff still comes up short. We used a calculator created by researchers at the George Washington University's Mullen Institute and analyzed the number of tracers in each state with recent COVID cases. So a place that's seeing lots of cases will need more tracers. And our results show that only seven states, along with D.C. and the territories of Guam and the Northern Mariana Islands, currently have enough tracers. And we have a lookup tool on npr.org so you can see how your state stacks up.
KELLY: That's fascinating. Only seven states have enough tracers. What are the holdups...
KELLY: ...In the other states? Why are so many states still behind?
SIMMONS-DUFFIN: A big barrier is money. Early in this epidemic - in, you know, around April - there were calls for an army of contact tracers funded by billions of dollars. And there was the thinking - OK, there are these tens of millions of people who filed for unemployment. Some of these roles are entry-level. There's potential here. But a big initiative from the federal government has just not happened yet.
Some funding and coronavirus relief packages could be used for contact tracing, but there just hasn't been the same attention or energy around contact tracing than there's been for testing. And in the absence of that federal leadership and funding, states told us they've had to kind of muddle through to find the staff. Some turned to private sources like New York, which has support from Bloomberg Philanthropies. Nevada and West Virginia have partnered with local universities. And others are reassigning - other government workers are using volunteers.
And beyond funding, there's another barrier that this country has, which is a really decentralized public health system. In most states, local health departments are units of local government. They don't report to the state health departments. And some - so some state health departments like Wyoming told us, we really have no idea how many contact tracers we have in this state. And that can create challenges. If there's a spike in cases in a new place and you want to quickly know what your contact tracing capacity is and send reinforcement, it helps to know what your starting point is.
KELLY: Just before we move on from this, Selena, I am really curious about how this is playing in some of the hotspots, the new hotspots we're hearing about like Alabama and Arizona and Texas. What'd you find there?
SIMMONS-DUFFIN: So according to NPR's analysis, none of those states have enough contact tracers, and none are planning to hire or reassign more people to do that work. And that finding really concerns Crystal Watson of the Johns Hopkins Center for Health Security. Here's what she told me.
CRYSTAL WATSON: I worry, especially for those places, that they will get into a hole quickly that they won't be able to keep up with contact tracing. And then without social distancing measures to control the spread, then it will be fairly uncontrolled. And we haven't seen what that looks like yet.
SIMMONS-DUFFIN: So as bad as it's been in the U.S. - so far, there have been 2.2 million cases and 118,000 deaths - Watson says uncontrolled spread without these public health tools to keep it in check could really be much worse.
KELLY: It's still just so hard to hear those numbers - 118,000 deaths and climbing. I want to end with testing and, Rob, bring you back in on this and just get another snapshot of where we stand because we are hearing now about places that say they have more tests than they need, that they have more testing sites set up than they have people who want tests and also hearing this argument that maybe one thing that explains why cases are rising in so many places is that we're actually doing so much testing, the logic being you do more tests; you're going to find more cases. Does that logic hold up?
STEIN: Yeah. So there are places that have gotten enough testing to start trying to recruit people to get tested, but that could just be evidence of a problem, actually - that the tests aren't getting to the people who really need them. Many people and doctors may not realize that the tests aren't being rationed the way they were in the beginning. Tests may not be available in some places, especially like minority communities or at times that are practical for people. Some people can't afford the tests, and some people are afraid to get tested because a positive test means they won't be able go to work and get stuck at home.
And as far as, you know, whether the testing is driving the apparent hotspots, most experts say the surge in cases in some places may be due in part to testing, but that doesn't really explain it. For one thing, infections are going up in some places that aren't doing more testing like Tulsa, Okla. And in places where they are doing testing, the percentage of people being tested and testing positive is going up with the testing, which is the opposite of what you'd expect to see if we were doing enough testing. And that's happening in a lot of the hotspots, too.
KELLY: All right - a little report card there on how several states are doing. That's NPR health correspondent Rob Stein and health policy reporter Selena Simmons-Duffin. Thanks very much to you both.
SIMMONS-DUFFIN: Thank you.
STEIN: You bet.
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