Intensive contact tracing has helped contain COVID-19 outbreaks in some Asian countries. People test positive, they quarantine, and the folks they’ve had contact with are tracked down and asked to — or, in some nations, forced to — quarantine as well.
The U.S. has spent billions on contact tracing, and California alone will have spent $300 million on it through the next fiscal year. But researchers have found that 2 of 3 people with confirmed COVID-19 in the U.S. were either not reached or wouldn’t name contacts when interviewed, and public health authorities haven’t been able to monitor enough cases to stem the tide.
Now, as the pandemic enters its third year, the highly contagious omicron variant spreads like fire through dry grass. The incubation period can be as short as two days. The Centers for Disease Control recommends isolation for as little as five days. More people are testing at home — cases authorities don’t even count in their tallies — and some officials are throwing their hands up and suspending contact tracing.
“(T)he sheer speed of omicron’s transmission means people are exposed, infected and then contagious before the local health department can even identify an outbreak, much less get word to those who are exposed,” said officials in Oregon’s Multnomah County. “Because of that dynamic, contact tracing has become much less effective at lowering COVID-19’s risk, especially when cases are surging so high and when spending time in any indoor public space is essentially considered an exposure for anyone who isn’t up-to-date on their vaccines.”
Financial commitment waning
The financial commitment to contact tracing in California appears to be waning, but remains. The governor’s proposed budget shows that $258.3 million was spent on contact tracing over the first two years of the pandemic, with another $38.9 million going forward through the end of the next fiscal year.
The current and future spending breaks down to a projected $20.6 million this fiscal year, and $18.3 million next fiscal year, said Sonja Petek, principal fiscal and policy analyst for the Legislative Analyst’s Office.
“Contact tracing remains one of our many key tools in responding to the spread of COVID-19,” said a statement from Gov. Gavin Newsom’s press office. “It’s also an important measure utilized in high-risk and congregate settings. Contact tracing assists with notifying exposed people for possible post-exposure treatment, testing, and quarantine in a timely manner.”
Overall, Newsom’s budget proposes $110 million to increase public health and humanitarian efforts at the California-Mexico border — including vaccinations, testing, isolation and quarantine services — “and expanded statewide contact tracing activities to help keep Californians safe and slow the spread.”
Currently, 268 state employees have been redirected to contact tracing efforts, the governor’s press office said. But experts aren’t sure the investment will bring great returns — at least not right now.
“As higher and higher levels of COVID-19 transmission occur in a community, the importance and efficiency of contact tracing becomes diminished and exceeds the capacity of health departments to effectively conduct such tracing in a timely manner when staff are overwhelmed by the sheer number of cases,” said Dr. Robert Kim-Farley, professor of epidemiology and community health sciences with the UCLA Fielding School of Public Health, by email.
“Also, with so much asymptomatic spread occurring, contact tracing of known cases becomes a smaller part of the total transmission occurring in the community. Under these circumstances, everyone needs to take increased precautions (e g, vaccination, masking, and testing) under the assumption that some of the people they are in contact with may be infected.”
Kim-Farley is not alone.
“Omicron has an average incubation period of about three days,” said Dr. John Swartzberg, clinical professor emeritus with UC Berkeley’s division of infectious diseases and vaccinology, by email. “Individuals may be contagious up to 48 hours before they become ill. Thus, many infected people will be spreading the virus a day or two after being infected. This would represent a temporal challenge to effective contact tracing.”
Andrew Noymer, an epidemiologist and demographer at UC Irvine, agrees.
“It is widely understood by now that omicron is the most contagious COVID variant yet,” Noymer said by email. “Under-appreciated, I think, is how its shorter incubation period (which is probably not unrelated to the contagiousness) is acting synergistically to drive the explosiveness of the current omicron wave. Which brings us to the question of contact tracing.
“Public health experts are often loathe to cast aspersions on the usefulness of contact tracing, because it is a cornerstone principle of our field. But the sheer contagiousness of omicron, plus its shortened incubation period, both affect the margin of error for contact tracing on a case-by-case basis, and really hamstring it in the aggregate. For the moment, doubling-down on contact tracing is not where I would allocate additional resources. The money is better spent on securing N-95 masks for those willing to wear them, who aren’t already, and on making tests available to safety-net populations.”
Richard Carpiano, a public health scientist and medical sociologist at UC Riverside, laments the nation’s underinvestment in vital pieces of the pandemic puzzle — particularly clear communication and public education to combat rampant mis- and dis-information — and passionately believes we need to direct more money there.
Much of the work is happening at the county level. San Bernardino County, for example, spent $16.5 million on contact tracing through the end of 2021, and has 183 contact tracers on staff. That’s down from the 440 tracers it had at its peak, said spokesman David Wert.
The omicron surge may hurt the efficacy of contact tracing now, but Berkeley’s Swartzberg has hope for the future. The infusion of money will allow government to make contact tracing more robust, and “as the number of omicron cases wanes, contact tracing should become a much more potent public health tool,” he said.
Dr. George Rutherford, professor of epidemiology and biostatistics at UC San Francisco, is in this camp as well.
“Once we’re over the hump in the next couple of weeks, contact tracing is going to be doable again,” Rutherford said by email. “I’d probably focus primarily on schools.”
All told, California expects direct COVID‑19 expenditures — testing, contact tracing, vaccine distribution and administration, hospital and medical surge — to total $3.2 billion this fiscal year, and $1.3 billion in the next fiscal year, according to the legislative analyst’s most recent analysis.
The governor’s budget tallies the state’s total pandemic response — including things like medical supply purchases, housing for homeless people, food programs and support for small businesses — at $9.5 billion. Of that, about $235 million, or about 2.5%, has been spent on community engagement.
Source: Orange County Register