North Carolina now has 1,500 COVID-19 contact tracers. Study says state needs 7,100.
As the COVID-19 caseload continues to grow in North Carolina, the state lacks the contact tracing resources to track the virus’ spread, according to a George Washington University analysis.
To trace the new cases reported over the last two weeks, North Carolina would need 7,100 people working on tracing efforts, the analysis found. The N.C. Department of Health and Human Services reported Wednesday that 1,500 people are conducting contact tracing efforts at local health departments across the state.
North Carolina has reported an average of 1,200 new positive COVID-19 tests each day over the last week, The News & Observer has reported. DHHS Secretary Mandy Cohen said last week that she believes this is the first wave of the virus accelerating in North Carolina rather than the start of a second wave. Over the last two weeks, the state has routinely hit new highs for patients hospitalized with COVID-19.
During a Wednesday appearance before the N.C. House Health Committee, Cohen said the climbing caseload is stretching contact tracing resources.
“Early on, when we didn’t have a lot of cases, we were sort of able to keep up, but now that we are accelerating and have a thousand new cases a day, obviously we need more tracers,” Cohen said.
As part of the Carolina Community Tracing Collaborative, DHHS has partnered with Community Care of North Carolina to hire 309 new contact tracers since April. According to a DHHS spokeswoman, the department plans to hire as many as 141 additional staff to help with the effort.
Even with the additional staff, North Carolina’s tracing resources fall well short of where the George Washington study says they need to be in order to meet the current caseload.
Tracing is an important part of health officials’ COVID-19 efforts. By informing people who may have been exposed to the virus to consider testing and isolation, local health departments hope to potentially contain the spread of the disease.
DHHS needs support from members of the General Assembly, Cohen said, both in terms of finances and as liaisons between the state and local health departments.
The state has surged resources to nine counties with high caseloads or rate of spread, including Durham, Johnston and Wake in the Triangle area. Those additional resources include four additional contact tracers to supplement an eight-member “core team” in Johnston County and 10 additional contact tracers for Wake County.
Kimetha Fulwood, a Johnston County health-education specialist and contact tracer, said the Johnston County team tries to trace cases the same day they are reported but it sometimes takes 48 hours. An average daily caseload is between 30 and 60 now, but on one day spiked to 77 cases per tracer.
“We’re not able to get cases and sit on them until it’s convenient,” Fulwood said. “We’re talking about preventing the spread of the virus and people need to know immediately. Our team is working seven days a week. No one leaves at 5 p.m. anymore.”
National Public Radio found that 37 states, including North Carolina, do not have enough contact tracers to address their current caseload. An additional six states, including South Carolina, only have enough when reserve staff are taken into consideration.
Cohen said Wednesday that her staff has worked with local health departments and hospitals to build testing and tracing capacity since the virus reached North Carolina in March.
“This is where we have to start drawing on (that) capacity that we’ve been building and then surging even further where we’re seeing some of those issues,” Cohen said, adding that the state is still trying to build additional testing and tracing capacity.
George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity has built a tool that can be used to estimate how many people are needed to track the virus’ spread at the national, state and county levels.
The George Washington team assumes that each case will require 10 contacts when social distancing is in place. DHHS officials previously told The News & Observer they estimate each case will need five contacts, but that some cases can have as many as 30.
If the inputs are changed to five contacts per case, North Carolina’s estimated need for contact tracers falls from 7,100 to 3,910 — still significantly more than are working statewide.
Nationally, health experts and officials have said that they anticipate needing to make additional contacts per case as restrictions are lifted. According to the Massachusetts Community Tracing Collaborative, for instance, positive cases require less than five contacts under stay-at-home orders and about 10 per case without such an order.
Gov. Roy Cooper lifted North Carolina’s stay-at-home order on May 22.
Other assumptions in the George Washington study include a baseline of 15 contact tracers per 100,000 people. It also assumes that case investigators, the people who interview COVID-positive people to find out who they have been in contact with, can conduct six of those interviews daily.
Contact tracers, the staff members who let people know that they may have been in contact with a COVID-positive person, are estimated in the George Washington tool to be able to make 12 initial contacts each day and 32 follow-up calls with people who have already been informed they are at risk.
In Wake County, for instance, an average day sees 20 to 30 health department staff doing case investigation each day along with the 10 DHHS staff supplied through the contact tracing collaborative. The county has also trained 110 librarians to do contact tracing, and half of those are working each day as part of a rotation.
Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security, told NPR, “I think it’s amazing that the workforce scale-up has gone this far in such a short period of time. But I’m also — at the same time — concerned, because we’re seeing these increases in case numbers in a lot of different states.”
Reporter Luke DeCock contributed to this story.
This reporting is financially supported by Report for America/GroundTruth Project and The North Carolina Local News Lab Fund, a component fund of the North Carolina Community Foundation. The News & Observer maintains full editorial control of the work. To support the future of this reporting, subscribe or donate.
This story was originally published June 18, 2020 at 12:37 PM with the headline "North Carolina now has 1,500 COVID-19 contact tracers. Study says state needs 7,100.."