A line of cars drives up North Street in Harrisburg, a few blocks from the state Capitol building, during a protest of the state’s response to the COVID-19 pandemic. Experts say stay-at-home orders shouldn’t lift until the state has a robust plan for testing and contact tracing. (Capital-Star photo by Stephen Caruso)
When Jake Stein started to feel sick in early April, he figured there was a good chance he had COVID-19, the disease caused by the coronavirus.
His fiancé had already tested positive for the disease following days of coughing, lung pain and exhaustion. Keeping their distance while sharing a one-bedroom Philadelphia apartment proved futile, Stein said, so he prepared to become infected himself, leaving their building only to walk their dog.
Once Stein started to cough and feel fatigued, his doctor confirmed that he couldn’t get tested unless his symptoms got worse.
“She was pretty confident I had it … but she knew I didn’t qualify for a test,” Stein said. “She said, ‘just act as if you have it, self-isolate for two weeks.’”
That’s what Stein ended up doing. But in an ideal world — one where Pennsylvania had an ample supply of testing kits and a robust public health workforce — here’s what experts say should have happened instead.
First, Stein would have gotten a diagnostic test as soon as he developed mild symptoms.
If the test came back positive, health workers would have asked Stein who he’d had contact with in the weeks before he became symptomatic.
They would have then called those people (a short list, Stein says, since he was only leaving his home to walk his dog) to alert them to the potential exposure, and urge them to self-quarantine for 14 days — the amount of time it takes for COVID-19 symptoms to incubate.
This process — of identifying and contacting people who may have been exposed to the virus — is called contact tracing.
It’s one of the strategies laid out in a recent report from the American Enterprise Institute, a conservative-leaning think tank based in Washington, D.C., where researchers have charted a national roadmap for recovering from the COVID-19 pandemic.
The plan resembles the multi-step approach that Gov. Tom Wolf recently outlined for Pennsylvania’s recovery, which he said will rely on “adequate testing” and widespread monitoring and surveillance to prevent potential infections.
But even as Wolf prepares to lift stay-at-home orders and certain business restrictions on May 8, the state’s public health response remains stymied at every stage.
Experts say that could leave the state vulnerable to a second wave of new infections as Pennsylvanians start to venture out of their homes for work and business.
“The most important thing I could tell governors is to reopen things very slowly and make sure there is a testing and contact tracing infrastructure in place,” Cindy Prins, a professor of epidemiology at the University of Florida, said. “If there is a hot spot, you need the ability to identify it and control it.”
Identifying cases means being able to test people, such as Stein, who have only mild symptoms, Prins said. And controlling outbreaks means tracking down everyone who had contact with patients and asking them to self-isolate, in order to prevent new cases before they occur.
By both measures, Pennsylvania is falling short.
Data from the state Department of Health indicate that testing across the state is actually reaching a plateau, even as officials say they’re prepared to ramp up capacity. The state reported more COVID-19 tests in the first and second weeks of April than it has over the last seven days.
The state also lacks a contact tracing plan to identify and isolate residents who may have been exposed to the virus.
Wolf told reporters on a conference call Tuesday that the state is working with private sector companies to acquire more testing chemicals and swabs for use at mass-testing sites and hospitals.
But when it comes to contact tracing, state officials have no idea how much such a program would cost or what it would look like, Wolf said.
“I don’t think, as far as I’m concerned, and the Department of Health is concerned, that we have found the best way to do that,” Wolf told reporters. “We don’t have a lot of good leads on that at this point.”
While lawmakers in the General Assembly have called for an even more accelerated timeline to reopen businesses, proposals to create contact tracing programs did not arise from the legislative branch this week, either.
State officials may have limited power to change the nationwide shortage of chemicals and medical equipment required to do testing.
Building a contact tracing program, on the other hand, only requires people — and lots of them, Prins said.
“You definitely have to have the workforce, the manpower to call people,” Prins said. “But it’s not a high-skilled [job.]”
How it Works
Here’s how a program might work: contact tracers would call up patients who test positive for COVID-19 to ask who they had close contact with in the days before they developed symptoms. The tracers would track those people down to warn them of their potential exposure, ask them if they’ve developed symptoms, and urge them to self-isolate for 14 days.
As Wolf said Tuesday, Pennsylvania officials don’t know how large their contact tracing workforce would be. And while House Majority Leader Bryan Cutler told reporters Wednesday that the program will likely be in the state budget this year, neither he nor Wolf know how much it will cost.
Other states and countries, though, offer some insight.
Prins said officials in Florida have recruited public health students to work as contact tracers in county health departments, where they feed their reporting into a state database. According to the news site Slate, some of the tracers are volunteers.
In Massachusetts, Republican Gov. Charlie Baker has budgeted $44 million to hire an army of 1,000 contact tracers to investigate confirmed and potential COVID-19 cases. The initiative, part of a partnership with a Boston-based public health non-profit, requires tracers to have a high school diploma and good interpersonal skills, according to a job posting.
Governments in South Korea and Singapore, meanwhile, have relied on technology, using cell phone data to identify people who may have come in contact with COVID-19 patients and then sending them push notifications to urge them to self-quarantine.
Tech giants Apple and Google are working to develop cellular contact tracing for American markets, Reuters reported last week.
Those companies said users would have to opt into the programs to avert concerns about user privacy. But epidemiologists warn that could make programs less effective, if enough people decline to participate.
Capital-Star reporter Stephen Caruso contributed to this report.
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