The Nearly Impossible Task Of Contact Tracing : Consider This from NPR One in every thousand people has died of COVID-19 in the U.S. And California just passed 2 million confirmed coronavirus cases. This surge, likely from Thanksgiving travel, is making contact tracing efforts difficult across the country.

Dr. Christina Ghaly, Director of the Los Angeles County Department of Health Services, says hospitals are being forced to treat COVID-19 patients in conference rooms and gift shops as beds fill up.

To help contain the spread, Brett Dahlberg reports that some health officials in Michigan are asking people to do their own contact tracing.

In New York City, WNYC's Fred Mogul found a contact tracer who is making home visits in an effort to alert people in at-risk categories.


Contact Tracers Struggle to Keep Up As Coronavirus Cases Surge From Holiday Travel

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ARI SHAPIRO, HOST:

The U.S. is breaking the wrong kind of records. One in a thousand people has died of COVID-19 in this country, and California just passed 2 million confirmed coronavirus cases, the first state to do so.

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CHRISTINA GHALY: Los Angeles is in a terrible situation right now.

SHAPIRO: More than 720,000 of those 2 million cases are in Los Angeles County alone.

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GHALY: Many hospitals are at a point of crisis.

SHAPIRO: Christina Ghaly heads LA's Department of Health Services, and she spoke with my colleague Ailsa Chang.

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GHALY: There are 70 hospitals that operate emergency departments across the broad geography of Los Angeles County, and many of those are really at a breaking point. They have way too many patients coming in. They have patients stacked up in the emergency department, waiting for beds upstairs.

SHAPIRO: And those beds they're waiting for are full, so the hospitals are getting creative.

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GHALY: There might be patients that are being put into conference areas or gift shop areas and really making room for patients in very nontraditional places within the hospital.

SHAPIRO: It looks like this current surge reflects Thanksgiving week, when more people travelled than any time since the start of the pandemic - that is, any time until this past weekend. On Sunday, even more people ignored the guidance to stay home. The TSA screened nearly 1.3 million airline passengers, the highest number since March.

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GHALY: My message to people is to stay home. The best way to show that you care for your health care workers and that you appreciate the value that hospitals bring to you is to stay home and follow those public health restrictions so that you don't need to rely on them for care for yourself or your loved ones.

SHAPIRO: CONSIDER THIS - more coronavirus surges are coming, and it's becoming nearly impossible to trace these growing outbreaks. From NPR, I'm Ari Shapiro. It's Tuesday, December 29.

It's CONSIDER THIS FROM NPR. Contact tracers in Washtenaw County, Mich., are slammed right now.

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MADELINE BACOLOR: There's just so many more people that are gathering and then are exposed.

SHAPIRO: Madeline Bacolor is a contact tracer for the county, which includes Ann Arbor.

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BACOLOR: So it used to be, you know, we'd have a case, and maybe that person had seen two people. And now it's a whole classroom full of daycare students, or it's a whole workplace.

SHAPIRO: Of course, a contact tracer's job is to get in touch with anyone who's been exposed to the virus. Often, that's a friend or a family member of someone who's tested positive for COVID-19.

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BACOLOR: I call people who have been exposed but who don't have symptoms yet and try to keep them away from healthy people who have not been exposed.

SHAPIRO: As the disease spikes, those call lists are getting longer and longer, and the guidance has gotten confusing. See; tracers like Bacolor used to tell everyone who'd been exposed to quarantine for 14 days, but the federal government recently shortened the length to 10 days. So now some Michigan counties require 10, while others still require 14.

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BACOLOR: Yeah, it makes things more confusing (laughter).

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SHAPIRO: Dr. Anthony Fauci told CNN that for the majority of the country, contact tracing is not where it needs to be right now.

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ANTHONY FAUCI: When you get to the numbers that we're in right now, it really is very, very difficult to do effective identification, isolation and contact tracing.

SHAPIRO: And just to put some numbers on that, NPR did an analysis showing that 70,000 extra contact tracers have recently joined the workforce across the country, and still only two states - Montana and Hawaii - have enough people. Even that is only if you include their reserve staff.

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SHAPIRO: Well, whether they can keep up with the demand or not, contact tracers like Madeline Bacolor still need to try to reach everyone at risk. Bacolor spoke with reporter Brett Dahlberg, who's been following another strategy to trace the spread in Michigan.

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BRETT DAHLBERG: On the brink of being overwhelmed, local public health departments have been forced to try something new. They're asking people to basically do their own contact tracing. Susan Ringler-Cerniglia is the spokesperson for the Washtenaw County Health Department in Michigan. She says people who test positive for the virus should start telling their contacts right away.

SUSAN RINGLER-CERNIGLIA: Basically, you know what to do. Don't wait for us to call you.

DAHLBERG: Because the department can't call everyone, Ringler-Cerniglia says they're prioritizing calls to people like the county's oldest residents, those living in nursing homes and people who live in ZIP codes with the highest infection rates. But that means some people outside of those groups won't get calls at all. Public Health Professor Angela Beck says that kind of prioritization is a good response to a bad situation.

ANGELA BECK: It is a last-resort tool. It's not the ideal scenario. Is it better than nothing? Yes, I think it is.

DAHLBERG: Beck is an expert on public health workforces at the University of Michigan. She says cutting back on contact tracing calls means health officials will miss information on where outbreaks are happening and who's at risk. They'll lose chances to break transmission chains and slow the virus' spread.

Beck says without enough contact tracers to track the virus at an individual level, the only option left to contain it is a generalized approach. That's part of what's pushing governments toward really broad restrictions, like shutting down indoor dining and requiring schools to go online. She says this failure was predictable, the result of years of poor funding of health departments.

BECK: The chronic underinvestment in the public health infrastructure in our country has really cost us during COVID-19. We can see the consequences very clearly.

DAHLBERG: Beck and public health officials still want people to focus on the basics, like masks and physical distance. And they still want you to answer contact tracing calls. Just don't be surprised if the person who calls to say you've been exposed is a friend or relative.

SHAPIRO: That's reporter Brett Dahlberg.

So while some places are asking people to do their own tracing, there are also contact tracers all over the country doing in-person visits. WNYC's Fred Mogul asked one contact tracer to record a diary of a day on the job. And he's agreed to give her the pseudonym Tracey because talking to the media could put her employment at risk.

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TRACEY: I've arrived at the first home visit.

FRED MOGUL: Usually, Tracey calls from the car before going to knock on the door, but not always.

TRACEY: I'm not going to call because every note in the system shows that it just goes straight to voicemail, and this person is 83 years old.

MOGUL: Tracey only visits people in person when other tracers can't reach them on the phone.

TRACEY: I use hand sanitizer. I put on gloves. I put on a face mask. I bring the iPad that has their information. I bring a whole extra bag of masks.

MOGUL: She gets further than usual, but she strikes out.

TRACEY: I was surprised to be buzzed into the building, but when I got upstairs, a child answered the door. And she said she didn't recognize the name of the person.

MOGUL: Tracey also ran into the mail carrier and asked her about the 83-year-old woman.

TRACEY: And she said she didn't recognize that name either. So this was just an unsuccessful visit.

MOGUL: That's one of the big things about contact tracing. You often run into dead ends, even when you show up on someone's doorstep. Often, they're not home, or the contact information you have is wrong. So Tracey makes a note and moves on. She drives to another apartment building, where she slips inside behind someone else. She then climbs the stairs to the next unit on her list.

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TRACEY: Hi, how are you?

UNIDENTIFIED PERSON: Hi.

TRACEY: I'm from Health and Hospitals. My name...

MOGUL: It's the 14-year-old boy she's looking for.

TRACEY: OK. So we left you a couple messages. We're just trying to get in touch with you...

MOGUL: She asks to speak to his parents.

TRACEY: You're not in trouble.

UNIDENTIFIED PERSON: I know. I know. I know.

TRACEY: OK.

UNIDENTIFIED PERSON: No. But, like, right now, like, they can't talk. So, like, maybe if you guys call next time, they might pick up.

MOGUL: At first, he says he doesn't want to take anything from her at all. But Tracey finally persuades him to take a business card.

UNIDENTIFIED PERSON: OK, this one?

TRACEY: Yeah, they can call the top number.

UNIDENTIFIED PERSON: OK. This one?

TRACEY: Yeah.

UNIDENTIFIED PERSON: OK, thank you.

TRACEY: Thank you.

MOGUL: Once she's back in the car, she's frustrated. She vents a little.

TRACEY: In general, it can be kind of hard to tell how effective this system is.

MOGUL: It's just too easy for people to not pick up the phone or answer the door. And then when they do, they really just want to get away from her.

TRACEY: Many people, if I actually do get through the script with them, they sometimes act really chill when it comes to the part about quarantining for 10 days or however long. And they say, OK. And then it's like, well, is it really OK, or are you just saying that because you want to get off the phone with me?

MOGUL: Tracey's young. She's interested in a possible career in public health. And this is an incredible opportunity to help fight the greatest public health crisis in recent history. But it often feels to her like she's accomplishing very little.

TRACEY: Almost no one knows where they've gotten it and how they might have transmitted it.

MOGUL: It's time for another call from the car.

TRACEY: We've been trying to reach him. Let's see what happens.

MOGUL: The first number she dials doesn't work. The second one does. Tracey gets the man she's looking for, and he's not pleased.

TRACEY: He didn't know if he had COVID or not. And I told him he was only exposed, and then he really wanted to know who exposed him.

MOGUL: Tracey explains, she can't say who exposed him due to patient confidentiality. And this gets him even angrier.

TRACEY: And then he said he goes to work at certain hours, so can we call him at other hours? And I said, no, sir, I'm sorry to tell you - you can't go to work right now. And then he was very frustrated by that.

MOGUL: All around Tracey, the world seems to barely care about rapidly increasing coronavirus numbers and how deadly the disease can be, like the two guys hanging out on the street outside her car.

TRACEY: They're 6 feet apart, but they've been talking together for probably 20 minutes, and they're not wearing masks. And it's like, why are we doing this? Like, it just makes me feel crazy.

MOGUL: The city's public hospital system runs the contact tracing program. They say they reach 90% of the people who test positive. And 75% of the time, the tracers get through all their questions and warnings. But Tracey says that's not what she sees.

TRACEY: Today, I had five cases, and I didn't complete intake with any of them. Oh, no, that's not true. I completed intake on the phone with one of them. Maybe I completed intake with two of them.

MOGUL: And that's not even getting into the main point of contact tracing - locating those secondary contacts who've been exposed and convincing them to quarantine so they don't spread the illness.

TRACEY: No one gives contacts. I almost never hear people give contacts to me, but maybe they give them more to other people.

MOGUL: About 45% of people who test positive share their contacts. Officials say many people are isolating on their own and simply haven't interacted with anyone recently. But Tracey's skeptical about this. She says she just talked to one woman who said she didn't have any contacts over the previous two weeks until Tracey pushed her a little. And she admitted she wasn't counting the people she saw at the store or at her rehab program or in her household. And Tracey says that woman either didn't know or wouldn't share any of their names.

SHAPIRO: WNYC's Fred Mogul.

That day on the job was recorded back in November, but Tracey gave Fred an update today. She says she has more cases these days - about 10 per day - and it does feel like she's actually reaching more people. But Tracey says that could just be because there are so many more people to check on. This episode's reporting from New York and Michigan was done in partnership with Kaiser Health News.

You're listening to CONSIDER THIS FROM NPR. I'm Ari Shapiro.

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