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State’s contact tracing is inadequate, experts say

Copyright © 2020 Albuquerque Journal

In the race to stop the spread of COVID-19, New Mexico’s contact tracing effort is falling behind.

Data released by the state last week showed the median time for the state to contact and recommend isolation for a person who has tested positive for the virus has nearly tripled over the past month to 81 hours.

At the same time, the median time for the state to identify and notify those who have been exposed to someone who tested positive has more than doubled to 108 hours.

The large increase in COVID-19 cases over the past month is to blame, state officials said.

“It’s really a volume issue,” said Dr. David Scrase, the lead medical adviser on Gov. Michelle Lujan Grisham’s pandemic response .

The numbers of tests and new cases have soared in the past month, although positive tests appeared to be hitting a plateau last week at a little over 300 a day. And testing hit a snag due to a supply problem.

In the first step of contact tracing, the state notifies a person who tested positive of the need to self-isolate. The second step is identifying who may have come into contact with that person and alerting them of their exposure and need to quarantine.

Time is of the essence, experts say. Some say those exposed should be notified within 48 hours after a positive test is reported.

“The window of opportunity to find them (those exposed) before they themselves become infectious and could infect someone else is pretty quick,” said Emily Gurley, an infectious disease epidemiologist with the Johns Hopkins Bloomberg School of Public Health. “They (contact tracers) have a very short time to be optimally effective.”

During a Journal interview, Scrase noted the success New Mexico contact tracers have had reaching people by phone – 83% of the time. That percentage is nearly double that reported by other states, such as Louisiana, he said.

“The effectiveness of contact tracing only kicks in when you talk to people, and the 83% both in cases and contacts is really a good sign,” Scrase said.

But one national group, Covid Act Now, reported that with only 250 or so contact tracers statewide, New Mexico had “insufficient tracing to stop the spread of COVID.” The group estimated that only 17% of contacts are being traced in the state and that more than 1,000 more tracers are needed.

New Mexico Department of Health spokesman David Morgan told the Journal that while the DOH is hiring “hundreds of temporary employees to work as contact tracers, additional Department of Health employees have had to be reassigned from daily duties to conduct contact tracing investigations.”

The state has contracted with Accenture Healthcare Services to set up a call center for contact tracing at a cost of more than $12.5 million, according to records obtained by the Journal. The contract says that up to 600 tracers could eventually be hired. The call center is now open.

But two months after the contract was signed, the New Mexico State Personnel office was seeking last week to hire two top DOH administrators for the state’s contact tracing effort.

A contact tracing bureau chief is needed to work with the state epidemiologist, the Health Department director and the governor to develop a regional based plan for contact tracing in New Mexico, the state’s job listing said.

The state is also advertising for a new chief state epidemiologist, after Dr. Michael Landen retired in June.

Meanwhile, Health Secretary Kathy Kunkel has also announced her retirement but will stay in the job until a replacement is hired.

“There’s a million reasons why New Mexico and America need to get its case numbers under control: preserve life, of course; spare people severe, sometimes unpredictable, illness – but another item not often discussed in media is the public health labor force,” Morgan told the Journal in an email.

Changing behavior

Typically, those infected with coronavirus can be contagious two days before the onset of their illness.

“Every case requires action to be sure they’re limiting their contact with people and to make sure they’re changing their behavior,” Gurley said during a Johns Hopkins online course about contact tracing.

Self-quarantine by those who may have been exposed is “one of the best ways we can limit the spread of this disease,” she added.

Lovelace Medical Group CEO John Cruickshank recently told the Journal that instead of waiting for the state, Lovelace did its own contact tracing after a COVID-19 outbreak of four cases at its New Mexico Heart Institute in early July. More than 100 patients were notified of their potential exposure.

“The DOH, I would say, is struggling to keep up with the amount of contact tracing that needs to be done,” Cruickshank said, noting he meets with state officials regularly for updates on the pandemic. “We’re not going to wait for the DOH; we’re going to collaborate with them.”

CNN quoted a health expert at Baylor College of Medicine in Texas earlier this month as saying contact tracing was near impossible in the South and Southwest because of the rapid surge in cases.

Other states, including Delaware, Iowa, Nevada, New Hampshire, Oklahoma, Rhode Island, South Dakota, Washington and West Virginia, have brought in the National Guard for help with contact tracing.

Contact tracing is a decades-old practice in public health for addressing communicable diseases and illnesses, Morgan said.

“However, it’s never been done on a scale like this in America,” he said. “The (New Mexico) Department of Health has just switched all COVID-case investigations to a single online platform that not only protects the medical and contact information of patients and those potentially exposed to them, but documents when they were called, what was discussed and every attempt to contact throughout the process,” Morgan said.

Morgan said the causes of New Mexico’s increasing case numbers are “not enough staying home, minimizing contact with people in large public places, and not enough masking or distancing as they do it.”

Asymptomatic cases

COVID Act Now, a multidisciplinary team of technologists, epidemiologists, health experts and public policy leaders, provides state-by-state data analysis and modeling on COVID-19 in the United States.

The team’s website said that as of July 22, New Mexico needs to boost its number of contact tracers to 1,430, given its average at that time of 286 of new daily cases.

“At these lower levels of tracing, it is unlikely New Mexico will be able to successfully identify and isolate sources of disease spread fast enough to prevent new outbreaks,” COVID Act Now said.

Scrase said that estimate of the tracers needed was “too high.”

He said new data shows that 50% of New Mexicans who have tested positive for the virus do not have symptoms.

“I am certain that part of that is effective contact tracing. In the contact tracing world, we’d like all our cases to be asymptomatic so we can track down people before they get sick and further isolate them,” he said.

Another key to stopping the spread is rapid testing, which in New Mexico can take from under 48 hours for a result to sometimes more than 10 days if the test is sent out of state for analysis.

Scrase said he learned of a case in which someone had to wait 13 days for a result.

“When it takes you longer to get the test results than you would have spent in isolation, you kind of have defeated the purpose of getting the test.”

Aiming for shorter times

Gov. Michelle Lujan Grisham’s administration adopted “gating criteria” that lists contact tracing among the factors to consider as the state tries to safely reopen during the pandemic.

For a contact of a person who tested positive, the gating criteria target is within 24 hours or less. For those potentially exposed, it is 36 hours or less.

“NM aims to have contact tracing times as low as possible. A downward trend is the desired development,” a state website says.

That data, reported regularly, showed that on June 20, the median time reported for public health contact of a person who tested positive was 28 hours – close to the target. But by July 17, the median time jumped to 81 hours.

For those deemed potentially exposed, the median time for a contact was 56 hours on June 20. By July 17, it was 108 hours.

Those who miss a phone call from a state public health contact tracer cannot return the call but should wait for a call back, according to a state website.

And for those reticent to pick up the phone if they see an unknown number on caller ID, Scrase urges them to answer the call anyway.

“It could be the Department of Health calling you because you could be a contact of somebody that you don’t know has COVID. And you don’t want to miss that call.”

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