L.A. County cuts back on COVID-19 contact tracing

After Julianne Cline went out this June and got tested for COVID-19, text messages and voicemails soon began to pile up from Los Angeles County contact tracers wanting to speak to her.

Cline, 32, ignored her. She’d been ill for days, and as she got out of bed to get officially tested, it seemed like “until they did contact tracing, it took so long, these people probably would have already been sick.” said the Manhattan Beach resident.

Additionally, she said, “I just didn’t feel comfortable sharing my personal experience of the county.”

As the pandemic dragged on, LA County contact tracers have struggled to reach and interview people with COVID. In January, amid a spate of cases caused by the Omicron variant, there were weeks when contact tracers reached and surveyed fewer than 10% of the cases assigned to them, county data shows.

This summer, that number has stagnated below 30% for the past few weeks — better than during the winter surge, but well below the success rates observed for LA County contact tracers early in the pandemic. And even when they did persuade people to be interviewed, few of those phone calls resulted in additional conversations with others who may have exposed them, county statistics show.

Many more COVID cases will likely never be assigned to contact tracers at all, as many Angelenos rely on home tests that are never reported to the county.

Cline, for example, had tested positive on a home test days before deciding to confirm her case with a PCR test. At the University of Washington, researchers have estimated that fewer than 14% of positive cases in the United States are detected and reported in official counts.

The bottom line is that only a fraction of COVID cases are traced with phone calls to warn others and try to prevent further infection.

Experts say contact tracing, long prized as a tool to stem the spread of viruses, has become an increasingly Sisyphean task amid rampant COVID infections, increasingly contagious subvariants and a jaded public.

Contact tracing “doesn’t really make the impact it had at any given point in time,” said Adriane Casalotti, director of government and public affairs at the National Assn. of county and city health officials. “With communities largely reopening, it’s very difficult to say how many contacts you’ve had, and even if you can tell that you might have 20 or 30 or 40 contacts. … The logistics of actually contacting these people are very difficult. There is not enough time in the day.”

Newer variants appear to have had a shorter time to symptom onset and spread more easily.

“It really shortens the time you have to reach someone,” said Richard S. Garfein, a professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science. “Cases being ready to speak to a case investigator and finding out who their contacts are – and then being able to go back and notify those contacts within 24 to 48 hours – becomes a real challenge.”

In March 2020, the thinking was, “This is a brand new pandemic and hopefully we can stop it or mitigate the impact and buy time for people to spread it further until we get a vaccine,” said Andrew Noymer, associate professor of public health and disease prevention at UC Irvine.

Now, “I just don’t see us moving out of here through contact tracing,” Noymer said, especially as people have kept mingling but stopped wearing masks. He argued that the time and money should instead be devoted to other endeavors, such as B. the extension of PCR tests to the corona virus or the renewed use of contact tracers to detect monkeypox.

Earlier this year, the Centers for Disease Control and Prevention stopped recommending universal contact tracing for COVID-19, instead urging health officials to focus such efforts on high-risk facilities like long-term care facilities and prisons.

Many cities have halted or scaled back efforts: Washington, D.C. laid off workers in June and officially ended its coronavirus contact-tracing program, The Washington Post reported. New York City said it will end its main program this spring.

At one point, LA County had enlisted approximately 2,800 contact tracers to find people who tested positive and reach contacts who may have exposed them. As of July, the county had about 100 employees dedicated to contact tracing for COVID-19 — a fraction of the manpower once devoted to those efforts.

The LA County Department of Health said its “limited resources are (will be) focused on other strategies, including vaccines and therapeutics that were unavailable when the pandemic began.” Its contact tracers are now prioritizing cases in the elderly and those in “high risk” zip codes, a spokesman said.

It has also started sending out an online interview via cellphone and email so people “can complete the case interview at their own pace and in their own time,” the department said.

A separate team remains dedicated to following up cases in nursing homes and correctional facilities. And as monkeypox has become a public health threat, LA County has also started contact tracing for the disease: Approximately 200 public health nurses conducting disease screening in LA County are now conducting contact tracing for monkeypox as part of their duties, according to the public health department.

Experts said monkeypox may be a better fit for contact tracing than COVID because it’s more difficult to transmit, comes in fewer numbers, and has a longer incubation period.

Alexander Morgan, who until recently worked as a contact tracer through an LA County contractor, was dismayed that the county had reduced the number of contact tracers for COVID as case numbers remain high.

“It doesn’t make sense,” Morgan said. “They want experienced contact tracers during a surge. It’s like a hospital gutting its staff.”

Morgan said that during the winter, when cases piled up, contact tracers made fewer attempts to reach people before abandoning those cases. At one point in January, LA County contact tracers called only about a quarter of the cases assigned to them in one day, county data shows.

By July, contact tracers were again reaching the vast majority of cases assigned to them within a day, according to the county. But most of these attempts did not end in a successful interview. Morgan said that many people he’d called would say, “I don’t have time for this.”

Cline, the Manhattan Beach resident who ignored calls from contact tracers, said that when she called them back, she eventually received text messages offering her gift cards. That only made her more skeptical. “I was like, ‘Is this a scam?'” she said.

It wasn’t: The county health department said it does indeed offer gift cards through its contact tracing program. Garfein said that more than two years into the pandemic, “unfortunately, I feel the public has burned out — and I don’t know how to get it back.”

Even when contact tracers reach people who have tested positive for the coronavirus, the trail is often cold afterwards.

In a final week of July, LA County’s contact tracers were assigned nearly 24,000 cases; fewer than 5,000 of these individuals were successfully interviewed; identified 466 contacts from their calls and ultimately interviewed just 62 of those contacts, according to the county.

While reaching relatively few people, contact tracing can have other benefits, health officials have pointed out. In addition to preventing the spread of cases, the phone calls can connect people to district help and encourage immunizations and booster shots.

“Any contact tracing is good contact tracing — as long as the resources aren’t diverted from other things that are more effective,” said Dr. John Swartzberg, clinical professor emeritus at the UC Berkeley School of Public Health. Right now, “there’s just so much COVID that contact tracing plays a secondary role.”

But “contact tracing can be incredibly valuable in keeping us at very low levels” when cases have gone down, Swartzberg said. And when health departments abandon such programs when cases are overwhelming, it can be difficult to reinstate them when contact tracing could be more effective, Swartzberg argued.

“Dismantling the infrastructure for effective contact tracing does not serve public health at all,” said Dr. George Rutherford, Professor of Epidemiology at UC San Francisco. In recent decades, “public health has been systematically dismantled and underfunded. We paid the price during COVID. We do not want to pay the price again.”

Rutherford added that although the incubation period for the latest variants is short, making it harder to reach people before infections spread, such calls can also alert people who may have been exposed to get tested and treated more quickly allow. If 80-year-olds have been exposed, “you want to start them on Paxlovid if they’re positive,” Rutherford said.

“There’s probably certain situations where it’s very warranted — like a nursing home — and others, like a rock concert or walking around downtown Los Angeles where you wouldn’t be able to name your contacts anyway,” Rutherford said.

dr Christopher Longhurst, chief medical officer of UC San Diego Health, said another tool — anonymous notifications of COVID exposure via a smartphone app — can still help control infection by alerting strangers spending time without a mask have spent with someone who has tested positive.

The California Department of Health and Human Services sponsored app CA Notify now has an estimated 7.5 million active users and notifies an average of five people each time someone reports they’ve tested positive, said Longhurst, who has helped manage the app’s system.

The results are still being evaluated, but “we’re clearly helping to prevent hundreds of thousands of infections,” Longhurst said.

Cline said she didn’t activate an app to warn people who may have been near her during her infection.

“If I were asked to share all the places I’ve been and all the people I’ve seen — there would probably have been hundreds who would have passed me,” she said. “We’re no longer in a place where your only interaction per week might have been with just four people.”

https://www.latimes.com/california/story/2022-07-30/l-a-county-has-cut-back-on-covid-contact-tracing L.A. County cuts back on COVID-19 contact tracing

Alley Einstein

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