As states loosen up on social distancing rules, people aren't the only thing that will go back to work—so will the coronavirus. Dropping restrictions will allow the pathogen to move more freely through the population, possibly causing a second wave of illness that threatens to overwhelm hospital resources and drive death rates higher.
The key to avoid lurching from one lockdown to another, experts say, is contact tracing. When a patient tests positive to COVID-19, health care workers would reach out to all the people who might have been exposed before the patient became ill and advise them to self-quarantine. The idea is to extinguish small pockets of new cases before they explode into big outbreaks like the ones that steamrolled New York City and New Orleans last month.
Governors, in an effort to balance the need to let people go back to work and keep them safe from a pandemic virus that continues to circulate, have begun putting contact-tracing programs in place. Massachusetts has hired 1,000 people for its program, which started in early April, and many states have recently announced plans to follow suit.
Piecemeal efforts, however, may not be sufficient. What's needed is a mobilization of the health care workforce that reflects the wartime-footing the nation now finds itself in in battling the pandemic, says Crystal Watson, senior scholar and assistant professor at Johns Hopkins Center for Health Security.
To avoid a resurgence, Watson and a team of health care policy experts have concluded, the states will need about 100,000 health care workers to do the gum-shoe work of contact tracing, at a cost of about $3.6 billion. They have taken their plan to congressional leaders in hope of a financing bill.
"We need funding," she says. "We need a call to action. We need to rally around this initiative. And we need guidance and technical support from agencies like the CDC, for state and local health departments who are going to be doing this work. I haven't seen those things put in place yet and that's what we need to really make this effective."
Newsweek spoke with Watson about how the plan would work and why it's needed.
Newsweek: Your plan calls for a big operation to be put into place quickly.
Watson: This is unprecedented. It's going to be an initiative, if we can get it going, like no other we've ever had in this country for public health. This would be an incredible expansion of the workforce for public health.
During the Ebola epidemic, Liberian officials hired about a thousand people to do contact tracing. In the end, it was fairly successful, because by the time the department of defense brought in their mobile hospitals and set everything up, the cases had pretty much diminished because of those public health efforts. There are other countries that are doing this already for the COVID-19 pandemic.
How would it work?
If you get sick with COVID-19, you would expect to have a call from a contact tracer from the health department to talk to you about your illness and ask you who you were in contact with during the course of your illness, and possibly even a few days before, since [the virus] can transmit pre-symptomatically. The contact tracer would then reach out to your friends and family and even more random contacts that you may have had out in public.
Who would be enlisted to do the work?
Not just public health and health care professionals. It would potentially mean reaching out to people who are retired, people who have expertise in public health that are maybe not in those jobs right now. It would be an opportunity to bring them in as part of the workforce. I've had so many emails from people with an interest in contributing to this. I think there's this feeling around the country that they want to be able to give back and to do something that can help control this pandemic.
Can technology help as a workforce multiplier?
Technology [such as smartphones and apps] potentially can help us identify who might have been in your close vicinity when you went to the grocery store and had mild symptoms, and maybe didn't even understand that you were sick. That can help public health see who those people are, but then also notify them and follow up with them.
What about privacy?
The desire to keep people totally anonymous is understandable. We don't want unauthorized sharing of potentially sensitive information about people. But we need to make sure that any applications that are helping with contact tracing are accessible and usable by public health to actually find people, notify them and take steps that they need to help control the spread. Public health does contact tracing with very sensitive information all the time and this is what they're used to doing.
How many tests per day would we need for contact tracing?
At least 2 million a week. But it's hard to put a firm number on it, and it's going to change as the epidemic changes in different parts of the country, because the less spread we have, the fewer tests we'll actually need. It's a moving target.
Right now, the White House has said we're doing something like a million tests per week. Even though we have all those tests, they're not being used to their greatest extent. There are lots of bottlenecks—limits on the numbers of swabs and reagents. There may be excess capacity in some places but problems that are preventing them from being used. One problem we're running into now, though, is that the testing isn't fast enough. Even if someone gets a test, they may wait for days before we get the results. We have to act faster than that.
How quickly do we need this program?
What I find very frustrating right now is that there's a lot of appetite, particularly in Congress and at the federal level, to open things up and provide as much money as possible to help people who've lost their jobs and small businesses, which is absolutely important. But so far, we're not willing to allocate a fraction of the amount of money that is being dedicated to economic issues to actual public health and managing this pandemic, without which we are going to be in big trouble.
What do you mean by "big trouble"?
If we open everything up without restrictions and without the capacity to test and isolate cases and contact-trace and put people in quarantine in their homes, we're going to see a large resurgence of the virus, possibly much worse than we have seen already.
If we open things up without protections in place, without capabilities to manage the virus, then it will burn through our population. We'll see many, many more deaths. The death rate might skyrocket because hospitals will become overwhelmed.
That's what we've seen in other parts of the world, when we let this get out of control. Hospitals cannot care for the people who need care in the way that they need it and many more people die.
Sorry. It's pretty stark.
How much higher are death rates when emergency rooms are overwhelmed?
In some locations that have managed this well, the mortality rate could be under 1 percent. In Sweden, where they have not had the same kind of social distancing measures in place, the last figure I saw was that the crude mortality rate was 9 percent. In the north of Italy, where hospitals were very overwhelmed, mortality sometimes reaches double digits.
Is your report getting traction in Washington?
Congress is debating the next package of emergency funding. We've had a lot of discussion.
