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Contact tracing has proved to be a challenge for Pennsylvania throughout the coronavirus pandemic.
HARRISBURG — As coronavirus cases continue to rise in Pennsylvania, the state health department has received approval to spend nearly $27 million to ramp up contact tracing efforts, warning of potentially dire consequences if it’s unable to do so quickly.
Contact tracing–the practice of locating people who have come in contact with individuals infected with COVID-19 and asking them to quarantine–is a key public health tool. Alongside wearing masks, practicing social distancing and implementing widespread testing, experts say it’s one of the best ways to slow the spread of the coronavirus.
Now, the state is looking to outside companies for help with this critical work.
Official documents show the health department has filed at least two emergency requests, using an expedited contracting process, to hire companies to assist with contact tracing. One proposed contract for $25 million is with an Atlanta-based staffing agency to recruit, hire and train up to 4,000 tracers in 90 days. The other, for nearly $2 million, is with an Irish software company to launch a Bluetooth-enabled smartphone app that could notify users if they’ve been in close contact with an infected individual.
Neither contract has been finalized yet, according to a department spokesperson.
“At present, the spread of COVID-19 in the community is so overwhelming that the ability to track, trace, isolate and test the individuals suspected to have the virus is impossible without the influx of additional staff and use of technology-assisted applications,” the health department wrote in one of the requests for emergency funding.
Over the past 14 days, about one third of Pennsylvania counties have seen a rise in cases. The state’s seven-day average of new cases is double what it was last month, driven by infections in the western region.
The concerning trend has prompted Gov. Tom Wolf and Secretary of Health Rachel Levine to impose tighter restrictions on bars, restaurants and indoor gatherings, and to require people to wear masks in public. With surges in the southern and western parts of the nation, they worry travel could bring more cases to the state if action is not taken swiftly.
As of Wednesday, there were 661 contact tracers across the state, the health department said. That includes state and county employees, as well as volunteers. Although the department has met its original goal of 625 tracers, spokesperson Nate Wardle said, “we know that we will need to continue to increase our capacity as we move toward the fall.”
But public health experts–much like the state’s own emergency funding requests–say the time to ramp up contact tracing is now.
A tool built by George Washington University’s Institute for Health Workforce Equity estimates Pennsylvania needs nearly 4,500 tracers based on its current case count. Other public health experts have cited 2,000 to 4,000 as the target.
The main question, said Edward Salsberg, a senior researcher who helped build the George Washington University tool, is whether the state can reach all contacts of new cases within 24 hours. By notifying people who may have contracted the virus within that timeframe and advising them to stay home, you limit the spread, Salsberg said.
On a day like Friday, when Pennsylvania announced a recent high of 1,213 new cases of COVID-19, that would mean contact tracers would have to call between 1,000 and 13,000 people, depending on how many contacts each infected individual had.
The question is whether 661 tracers can reach that many people the next day, Salsberg said.
Contact tracing has been a challenge for Pennsylvania throughout the pandemic. When the coronavirus first struck in March, the state’s roughly 130 community health nurses led the charge. But a Spotlight PA investigation found that decades of budget cuts and court battles had left only a skeleton workforce, and the nurses were quickly overwhelmed by the deluge of coronavirus cases.
At the height of the pandemic, the nurses were forced to forgo calling contacts themselves and instead ask individuals who tested positive to pass on the information to others.
Once cases began declining in late April, the nurses resumed these efforts, alongside a patchwork system of local health departments, hospital networks and nonprofits. The state health department has been working to corral those efforts into six regional collaboratives, but as of mid-July only three collaboratives had been formed.
Now, with concerns about increasing case counts and the fear of a second wave in the fall, the department is looking to bolster its contact tracing systems further.
It has posted 12 job openings for contact tracing field managers and community health nurses. And one of the emergency contract requests it filed suggests a plan to hire thousands more.
The request is for a one-year contract with Insight Global, a staffing agency that launched a health-care division during the pandemic. The document specifies that the health department currently has resources to hire up to 1,000 staff, and “any staffing partner should be prepared to accommodate up to 4,000.”
Insight Global has experience with this type of work, the health department wrote in the funding request, citing the company’s ability to hire 1,600 “resources” within 30 days for the state of New York.
Alongside the boost in personnel, Pennsylvania is also looking to supplement traditional contact tracing efforts with an app built by an outside company.
Typically, this kind of technology relies on a large number of people downloading an app and consistently carrying their smartphones. A user is notified when they’ve been in close contact with someone who’s self-identified as having COVID-19, though identifying information like the infected person’s name and location is not revealed.
Pennsylvania’s proposed vendor, NearForm, has already built a contact tracing app and implemented it successfully in Ireland, a country with strict privacy regulations. The company has made the technology’s source code publicly available, allowing outside engineers to vet the app for potential weaknesses, and recently joined a new global technology initiative to help public health agencies combat COVID-19.
Still, social factors could hinder any app’s ability to provide meaningful information in Pennsylvania.
When two users come into close contact, Bluetooth technology isn’t able to discern whether they’re both wearing masks or whether the contact was outdoors–factors that have been proven to reduce the risk of infection.
Additionally, bottlenecks in lab capacity occurring around the country mean COVID-19 test results can take days or even weeks to come back. If users don’t have up-to-date information on their results, the technology won’t be effective.
And in Pennsylvania’s political landscape, where the coronavirus has become a divisive debate, questions remain about whether enough people would be willing to download an app–and self-report honestly–for the technology to actually be useful.
But experts say Pennsylvania currently has a critical opportunity to get a handle on cases.
“Now that numbers are coming up and we’re reopening society, you want to stem this,” Salsberg said. “This is how you keep your society open.”
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