As Pennsylvania counties embark on a phased reopening plan that allows day-cares, retailers and some offices to re-open for business, infectious disease experts say the state should be hard at work contacting newly confirmed COVID-19 patients, and tracking down people they may have exposed to the virus.
This process – known as contact tracing – is underway and “doing well” in parts of the state that began to reopen last week, state Health Secretary Dr. Rachel Levine said Monday.
Done correctly, contact tracing can help Pennsylvania avoid another surge of infections in areas that begin to reopen, experts say.
But those professionals also told the Capital-Star that Pennsylvania’s current tracing programs appear to be understaffed, and is likely hobbled by persistent shortages in testing materials.
“We’re just not doing enough,” Dr. Ping Du, a professor of epidemiology at Penn State Hershey Medical Center.
Du argued that if Pennsylvania had a robust contact tracing program, it likely wouldn’t be seeing an average of 960 new COVID-19 cases per day, as it has over the last week.
She fears the state’s existing system will be strained “once some places start to reopen and people come [together] and socialize with each other. We’ll see more cases, and we will need more tracers.”
The Pennsylvania Department of Health currently has 200 staffers and 100 volunteers dedicated to COVID-19 contact tracing, spokesman Nate Wardle said in an email Thursday.
Since April 20, they’ve contacted 433 people in the 24 counties in north-central and northwestern counties that began to reopen last week.
Even though those areas have logged relatively few cases in recent weeks, “those numbers seem really low” to Edward Salsberg, who directs the Institute for Health Workforce Equity at the George Washington University School of Public Health.
A team of researchers Salsberg leads estimates that the 24 counties that reopened last week require a combined workforce of more than 250 contact tracers, based on their populations and recent case counts.
Pennsylvania as a whole will need as many as 7,000 tracers statewide to interview COVID-19 patients and track down and notify their contacts, the researchers estimate.
The workforce figures Wardle cited don’t include staff from the Philadelphia public health department, where “a considerable number” of people are working on contact tracing, he said.
But Salsberg said the workforce still appears insufficient for areas of Pennsylvania with relatively contained outbreaks — especially since those areas may see a spike in cases as businesses begin to reopen.
“When you’re looking to open up communities, that’s when you need to do this,” Salsberg said. “If you send people out into the public, you want to be able to test them and take them out of circulation if they are positive.”
Pennsylvania officials say contact tracing capacity is one factor they consider when allowing counties to reopen.
But Salsberg’s research suggests the state’s current workforce will be stretched thin when 13 more counties enter the “yellow phase” of Pennsylvania’s gradual reopening plan on Friday.
Those 13 counties alone will require a combined 170 contact tracers, his team’s data show.
Levine said Monday that the state is working to increase its contact tracing capacity, but did not describe in detail any current strategies to augment its workforce.
The state’s official plan says the effort will rely on its corps of 150 public health nurses and an unspecified number of volunteers.
Gov. Tom Wolf has also issued a broad outline for a statewide, civilian-powered contact tracing program that he hopes to have in place this fall. But Salsberg said “there’s no reason not to get [that effort] going as soon as possible,” given that state lawmakers are pushing for an even more accelerated timeline to reopen businesses.
An effective program – one that quickly identifies and isolates people who are likely to be carrying the disease – can even spare spare Pennsylvania the sweeping stay-at-home orders that have been in effect for the last two months.
But programs like that require manpower, Salsberg said. And other experts say they’re most effective when paired with widespread testing, which has remained elusive in Pennsylvania and much of the United States.
While testing has expanded in Pennsylvania since the early days of the pandemic, it remains far below the levels that researchers say is necessary to safely reopen the economy.
Pennsylvania officials aim to administer 8,500 tests per day across the state so they can reach 2 percent of the state’s population each month. But data from the state Department of Health show that the state has yet to hit that benchmark halfway into May.
Nationwide shortages of testing materials and protective equipment for medical workers have forced the Health Department to restrict tests to symptomatic patients. Experienced contact tracers say that’s not ideal for tracking a disease like COVID-19, which is easily transmitted by pre-symptomatic or asymptomatic patients.
“The way it’s supposed to work is … when you find people who have been exposed, you test them instantly,” Chris Sciamanna, professor of medicine and public health sciences at Penn State College of Medicine, told reporters last week. “We have not had the capacity to do that broadly.”
Sciamanna said testing shortages have hampered contact tracing in South-Central Pennsylvania, where he and Du lead an independent team of medical students that track Penn State COVID-19 patients and their contacts.
Though testing stagnated in Pennsylvania early this month, there are signs that diagnostic tests could soon be more widely available.
The drug store chain Rite-Aid, which is headquartered in suburban Harrisburg, announced plans last week to administer 10,000 tests per day across more than 70 testing sites nationwide, including 15 locations in Pennsylvania.
Their testing criteria also allows asymptomatic patients to sign up for tests.
State data also show that the rate of testing in Pennsylvania has accelerated after a weeks-long slump. The state completed an average of roughly 6,915 tests per day over the last week — the highest rate in almost a month.
Salberg said he’s sympathetic to political leaders feeling the financial ruin of the COVID-19 pandemic, which has led nearly 2 million Pennsylvanians to claim unemployment benefits and leached hundreds of millions from the state’s revenue streams.
But he said officials are being shortsighted when they proffer plans to reopen businesses but can’t yet ensure widespread testing and tracing.
“It’s the only way out, to be honest,” Salsberg said. “This is an investment that more than pays for itself by slowing the spread of the disease.”