While everyone's hopes are trained on COVID-19 vaccines to lead the way out of the pandemic, public health experts say that other public health tools are still crucial for stopping the virus.
One of those tools — contact tracing — may finally be ready to have its moment, says Crystal Watson, senior scholar at the Johns Hopkins Center for Health Security. During the winter surge, contact tracers were overwhelmed; they couldn't possibly reach everyone who tested positive — and their close contacts — to tell them to stay home to slow the spread.
That's starting to change, Watson says. Case numbers are entering the zone where contact tracers can get on top of transmission. Vaccinations are ramping up and injecting hope into the public health response.
And there's finally billions of dollars — in the American Rescue Plan — to boost these efforts, so that if concerning coronavirus variants continue to spread through the summer and beyond, health departments can be ready, Watson says.
Contact tracing only works to stop the spread, though, if everyone who's infected or exposed is able to follow the public health guidance to stay home for days or weeks. For people who can't — because they don't have money to pay for utilities or rent, or friends who are willing to get groceries for them and drop them off — health departments have a fix.
It's called care resource coordination. It's so little known, it's like a secret weapon in the pandemic public health response — one that can make it more effective and more equitable. And public health experts urge that this is the time to take advantage of new funding opportunities and expand the reach of this service.
"Why are you calling?"
Karina Acuna has been doing this work since July, when the public health department in Pima County, Ariz., started its care resource coordination program.
"Almost every call that we have it starts off — it's like, 'Why are you calling and how do you have my number?' " says Acuna. The people she's calling have either just been diagnosed with COVID-19 or have just found out they're a close contact and need to quarantine. They're often stressed or sick; it can be a scary time.
She talks them through what they might need for the time they need to stay home — groceries, prescription medications, cleaning supplies. Then she looks through her list of 95 local health and social service agencies and connects them to programs that might be able to help.
"It always ends up being a good call for them because they're getting the help that they might need or didn't even know that they had available to them," Acuna says.
Sometimes, it's simple things that people need, like extra masks. Larissa Morgan, a community health representative who does this work for the Navajo Nation, says for people there, it's often cleaning supplies.
"[It's been] hard to get Clorox wipes; it's hard to get Lysol sprays," she says. "I would say that food would come next and then water, because we do have individuals who still don't have running water."
Sometimes, the needs are even more substantial. People need help planning funeral services for loved ones who died of COVID-19. Care coordinators describe comforting people who are grieving in isolation. Or helping them find housing.
"I can tell you, I have had to help a client where they were actually being evicted — the marshal was at the residence, putting them out," says Sharonda Wright, a care resource coordinator at the Fulton County health department in Georgia. "They were needing shelter and needing financial support and trying to gather their belongings at the same time."
The person was able to stay with a relative briefly, and then Wright connected them to transitional housing, she says.
Meeting these needs isn't just important for those individuals. If staying at home isn't possible for people who are infected, the virus has more opportunities to spread, which makes it a public health problem. Care resource coordinators provide a kind of temporary safety net that helps people stay nourished with chicken soup when they're sick with COVID-19, and helps families take care of each other by providing them with masks and cleaning supplies.
The best and the rest
These programs exist all over the country. An NPR survey done in December in collaboration with the Center for Health Security and the nonprofit Partners In Health found that the vast majority of state health departments that responded to the survey do ask about social needs as part of the contact tracing process.
But an analysis of these findings published Friday shows the size and reach of these programs varies a lot — from a basic help line people can call if they need help, to dedicated specialists who know their communities and resources deeply.
For this process to work, the details matter, says Dr. Shada Rouhani, who advises Partners In Health on care resource coordination and collaborated with NPR and Johns Hopkins on the survey.
Rouhani's analysis found that only 39% of states that responded said that their contact tracing teams included dedicated care coordinators. Nearly a third of these programs don't do systematic follow-up with people to make sure their needs were met.
And 1 in 5 programs just hand out a phone number like 211. "Simply giving somebody a phone number to call to try to find a resource or to connect with a food bank or to connect with their resource bank can be difficult, particularly if there are language barriers, if that person has limited access to technology or even something as simple as limited phone minutes to make that phone call," explains Rouhani.
Actively making those connections for people can make a big difference, she says.
In Pima County, Ariz., when Acuna figures out which local agencies can help someone, "we can transfer them on the spot." Sometimes, though, it makes sense to email or text the information so they can follow up later.
"Some of these people are too sick to talk — to be on the phone for that long," she explains.
Wright keeps close tabs on what the requirements are for each local program in Fulton County, Ga. — which ones have wait lists and which don't. She sometimes actually enrolls people in programs they qualify for — especially seniors without Internet access. "With their permission, we can go forward and complete those applications for them," she says.
In New Mexico, Larissa Morgan's team includes people who will actually drop off supplies and groceries for people who have to isolate at home. "They don't have anybody who is willing to go get [supplies for] them because they were afraid to come by their home because they didn't want to be infected by COVID," she explains.
Her expertise — in public health resources and in the part of the Navajo Nation she serves — has started to be stretched in new directions as the pandemic evolves.
"We've been working with our public health nurse to get individuals who are homebound their vaccination at home," she says. They may live in remote areas or lack transportation. So far, she and a public health nurse have driven out to vaccinate five people at home, and more are in the works.
Finally, funding on the horizon
If state and local health departments want to scale up programs like these, they should soon have access to federal funding to help make that happen. The American Rescue Plan, signed into law by President Biden last week, has earmarked $47.8 billion for testing and contact tracing and other mitigation measures.
The law also includes $7.7 billion for a new public health workforce. "It's still being worked out how that's going to be implemented," says Watson of Johns Hopkins.
During a pandemic, that workforce could work with contact tracers to support people who need to stay home, but more broadly, "the main goal of that program is to hire people for the long term so we can bolster our public health infrastructure," she explains.
There is also funding for some of the support programs care resource coordinators connect people with, like rental assistance and paid leave for employees. "That, I think, is a big boost to contact tracing in and of itself," Watson says.
Shada Rouhani is hopeful that lots of public health departments will seize this opportunity to expand this piece of the pandemic response, even as the vaccination effort has the nation's focus.
"We are all incredibly hopeful that the vaccine progress will continue to be great and that we are all looking forward to returning more towards normal," she says. But investing in these programs and designing them to be effective is still important.
"These care resource coordination structures that we're building now and using now very well may come into play in the future," she says.
That's true when it comes to preventing new COVID-19 outbreaks if the current vaccines are less effective against emerging variants than we hope, she says. These programs could also be important to help the country mount a more equitable and effective public health response when the next pandemic hits.