Note: This is the second of a two-part look at the issues surrounding contact tracing in the states. You can read Part I, States Ramp Up Contact Tracing Amidst Privacy Concerns, here.  

As we reported last issue, governments around the world are increasingly turning to technology to help them in their COVID-19 contact tracing efforts. But with cell phone apps mired in issues of privacy and efficacy, most states are still relying on human tracers to help them slow the spread of the virus.

The task is a daunting one.

Contact tracing has been used to great effect for centuries in combatting the spread of infectious diseases. It is labor-intensive work that requires an infected person to reveal to health officials who they have been in contact with, and then for officials to contact those people directly.

The sheer number of people infected with or exposed to COVID-19 has states scrambling to hire enough tracers to tackle the job.

“We’ve never had something at this scale,” Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, told Stat last month. “And clearly we need a lot more people to take this on.”  

Estimates vary on how many tracers might be needed, ranging from 180,000 to as high as 300,000 across the nation.

In recent weeks states have announced major efforts to ramp up their number of contact tracers, led by California Gov. Gavin Newsom’s announced plan to grow the state’s contact tracing workforce from its current 950 to at least 10,000 by the end of June.

“We have hundreds and hundreds being trained every day,” Newsom said during a recent press conference. 

Newsom’s office is encouraging some of the state’s 23,000 state employees to volunteer to become tracers, but also indicated that some workers could be reassigned to the task if not enough offer to do so willingly.

But Newsom acknowledged that having enough warm bodies to make calls is only part of the challenge.

“It is important that we have a tracing corps that looks like the communities they are calling,” he told reporters.

That perspective has drawn praise from Anthony Wright, executive director of Health Access, a statewide health care advocacy coalition based in Sacramento.

“I think Gov. Newsom has been fairly eloquent on this issue,” Wright says. “If we are going to have a new crew of contact tracers whose job it is to ask people for fairly specific information about their lives, then those people are going to need to be grounded in the very different and diverse communities of California and mindful of the different concerns those community members might have about providing that information.”

Wright says this is particularly true when reaching out to the state’s expansive immigrant population.

“That is a conversation that requires building trust and sensitivity,” he says. “Our significant immigrant population has real reason to be concerned about the federal government, so tracers need to be exceedingly clear that this information is being collected by the state, and it will not and cannot be used for any other purpose.”

This is particularly critical in light of how hard the COVID-19 pandemic is hitting communities of color in proportion to the U.S. population as a whole.

According to data collected by the COVID-19 Racial Tracker, a volunteer project launched by The Atlantic, deaths among African Americans are out of proportion to their share of the population. In four states the rate is close to three times greater. In Wisconsin, for example, African Americans make up just 6 percent of the population but account for 27 percent of COVID-19 deaths. Nationally, black Americans account for approximately 13 percent of the population, but almost 24 percent of COVID-19 deaths.

It is equally rough for Latinos, who are infected with the virus at a higher rate than their share of the population in all but one of the 44 jurisdictions that report Hispanic ethnicity data (42 states plus Washington D.C.). The infection rate is over four times higher in eight of those states. Native Americans and Asian Americans have also been hit particularly hard.

But accurate data for how these communities have been impacted is also still not fully clear. There are major differences in how individual states collect that information, and how states as a whole differ in collection from the U.S. Centers for Disease Control. Some states in fact are not breaking any data down by race, while others have yet to release any data at all.

All of which makes the contact tracing effort both extremely critical and intensely challenging. But those challenges could be even greater in the wake of the intense protests that have taken place across the nation over the death of an African-American man at the hands of Minneapolis police.

Minnesota Public Safety Commissioner John Harrington told reporters during a press conference that police there would begin to contact-trace demonstrators arrested during those protests. Harrington said their goal was to root out white supremacist groups who had come to the protests to spark violence. But David Harvey, the executive director of the National Coalition of STD Directors, which represents contact tracers across the country, said that is going to make the jobs of tracers seeking COVID-19 information that much tougher.

“I am deeply worried about the impact of these wrong-headed comments,” Harvey told CNET. “Anything that interferes with the public health system where we’re trying to promote trust is damaging, particularly when you look at how COVID-19 is impacting communities of color.”

That lack of trust – fueled by the usual plethora of Internet and social media conspiracy theories – has even led to threats of violence against public health workers. When a contact tracer in the small eastern Washington community of Okanogan County connected with a resident who had tested positive for the virus, she found herself the target of a Facebook campaign that accused her of conducting surveillance and placing the family under house arrest, neither of which was true. The posts turned into death threats, forcing her to file a police report and install security cameras around her home.

States from California to New York are nevertheless pushing forward, all with an eye toward gaining enough trust from citizens to make the effort pay off.

California was partnered with University of California San Francisco to develop hiring criteria for intended new tracers “to communicate effectively with California’s highly diverse population.”

New Jersey Gov. Phil Murphy (D) announced a plan to add up to 1,000 new contact tracers to the approximately 900 already doing the job around the Garden State. In May, state Health Commissioner Judith Persichilli said that total could reach up to 5,000, and reiterated her own previous call for multilingual and culturally diverse candidates to apply for the positions.

New York City has already hired 1,700 new tracers, and Mayor Bill de Blasio (D) says the Big Apple is “ready to go to 5,000 to 10,000 [contact tracers] if that’s what will help us beat back the disease.” Gov. Andrew Cuomo (D) says the statewide total could reach 17,000.

How much any of this helps stem the tide of the pandemic remains to be determined. Some experts, including Marc Lipsitch, director of the Center for Communicable Disease Dynamics at Harvard University School of Public Health, are pessimistic. He recently told National Geographic magazine that even if the tracing programs manage to accurately trace 80 percent of the country’s cases – something he said would be “miraculous – the other 20 percent would continue to spread the disease around.

Even so, he says the effort is worthwhile.

“My view is it’s probably not going to work,” Lipsitch said. “But given the lack of alternatives, we have to try — and hopefully demonstrate that I’m wrong.”


Handful of States Pass COVID-19 Contact Tracing Measures

At least seven states have introduced bills or resolutions dealing with contract tracing of COVID-19, according to Governing and LexisNexis State Net. Four of those states have enacted or adopted such measures. Measures are still pending in four states, including six bills in New York addressing privacy issues among other things.