Contact Tracing: A critical next step in the COVID-19 pandemic, but not without challenges and controversy
Having at least partially passed phase 1 (Rapid Spread) and Phase 2 (Flattening), Illinois advances to Phase 3 of its 5-phase COVID-19 recovery plan. Phase 3 marks an important milestone: the state will allow many businesses to open their doors while trying to maintain many aspects of the social distancing program that led to the statewide shutdown in mid-March. Due to the groundwork laid in Phases 1 & 2, Illinois will proceed with aggressive means to test potentially infected citizens, keep track of whom they may have come into contact with, and treat emerging cases.
Governor Pritzker has committed $80 million to implement a large-scale testing program during Phase 3. The funds will cover employment and training of thousands of investigators, tracers and managers throughout the state, with details specific to each county’s needs. The state has set a goal of hiring 30 contact tracers for every 100,000 citizens.
Who are these tracers? Tracers will be employees hired from a variety of backgrounds for $18-$24 per hour. Tracing is key to keeping us safe.
Lake and St. Clair are two counties chosen to provide a model for how Illinois can proceed with contact tracing. With Lake County’s contact tracing program already underway, Executive Director of the Lake County Health Department Mark Pfister is optimistic about the program’s prospects. Pfister reported that Lake County received a $5 million grant to implement its program.
“Ideally we will need 210 tracers,” he said. “Lake County’s population is almost 700,000. We are one of a few counties that has been able to shift some current county jobs into tracing, giving us a jump start. With free-of-charge testing now at the rate of 750 COVID-19 tests per day, we have seen the infection rate skyrocket in certain areas of Lake County. Our tracers will be pursuing the high risk contacts and finding ways to keep them isolated, along with other people they have been in contact with.”
The goal of reaching adequate tracing capacity faces significant challenges. The process begins with a Case Investigator who follows up with those who test positive for the virus. Investigators ask where the individual has been, who have they come into contact with and then determine if the person can isolate at home or if the county should provide a motel room for their 14-day isolation. Alternative housing options are essential when patients’ living conditions are cramped and there exists no extra living space for someone with the virus to live while in quarantine.
A Contact Tracer then calls contacts of the person infected. Without identifying the patient, the tracer asks if the new contact has symptoms, encourages them to get tested and to stay at home until the test results come in.
Finally, a Case Resource Manager organizes alternative housing and provisions, as well as additional testing. The entire process is critical to mitigating risk and minimizing the county’s rate of the infection.
According to Pfister, specialized training for each role is critical. Lake County established its own in-house training program but will soon be working with a statewide program, ASTHO (Association of State and Territorial Health Officials). The free training entails three hours of online instruction with a certificate provided upon completion.
Ensuring confidentiality and cultural sensitivity are the program’s highest priorities, according to Pfister. However, it has been difficult to establish a balance between mitigation efforts and privacy. Cook and Lake Counties have made clear that they will not share names and addresses of COVID-19 patients with law enforcement.
Tension between law enforcement and public health as we are seeing in Lake County is playing out throughout the country. Broadly, law enforcement wants to know specific individuals who are infected in order to protect officers from the disease in case there is contact. Pfister and others in the public health community have advocated for alternatives like equipping officers with personal protective equipment, out of concern that divulging patient data will stigmatize testing and discourage sick individuals from pursuing testing. The Illinois Department of Public Health (IDPH) helped clarify the state’s official position, providing guidance that healthcare professionals should maintain confidentiality of personal information.
“I am so proud of IDPH and how they laid out the rules of the road for not unveiling private information,” Pfister said. He added that cultural differences also can present a barrier to contact tracing; especially in the LatinX community where disclosing race or ethnicity is perceived to carry risk. “There is fear, especially if one is undocumented as to what will happen with their jobs and their ability to pay their bills.”
However, capacity remains the principal challenge: “Having enough person power to handle the hundreds of cases every day. We have been working on contact tracing since April 8th – and we have a long way to go. But we are making progress every day,” he added.
*Evan Williamson contributed
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