Contact tracing bears a strong resemblance to programs aimed at improving community health. With states hiring temporary contact tracers, lawmakers should consider expanding the program to carry out both tasks.
Contact tracing involves interviewing every new COVID-19 patient and reaching out to everyone they’ve recently contacted so those people can be tested and possibly quarantined. To be successful, tracing programs also need to provide food and social service support for the people asked to stay isolated indoors. All this must be done in a supportive—not coercive—manner.
How different is that from population health management programs that canvas communities for people with undiagnosed chronic conditions like hypertension, asthma and diabetes? The goal there is to get people treatment and address the social conditions that made them sick in the first place.
Both programs require culturally sensitive teams with the professional skills needed to follow up and follow through. Both have their greatest impact on poor and minority communities, which have been disproportionately harmed by COVID-19 because of the high prevalence of preexisting medical conditions.
Throwing briefly trained recruits into a raging pandemic risks alienating the very people they hope to help. Sadly, it’s the best we’ve got given the nation’s utter lack of preparedness.
And when COVID-19 subsides, what will happen to what they learned on the job? Unless steps are taken to preserve that training, the U.S. will remain as unprepared for the next pandemic as it was for this one.
It makes far more sense to permanently employ a cadre of population health experts who can rapidly switch to pandemic response when the need arises. Over the last decade, cash-strapped state and local governments cut 56,000 public health positions. Epidemiologists project the U.S. now needs 150,000 to 300,000 contact tracers to reduce the virus’ spread and stamp out the pandemic.
Permanently retaining a sizable fraction of that workforce in the nation’s public health departments after the pandemic ends would preserve those skills, in effect serving as a fire department for future pandemics. And in the absence of those rare events, they could serve as community health workers taking on the nation’s enormous public health challenges.
The senseless murders of African Americans at the hands of rogue police and vigilantes, and the ensuing civic unrest, have brought home to average Americans the enduring discrimination against minority and low-income communities. They suffer most from the untreated chronic conditions and deaths of despair borne of economic deprivation and inequality. It’s way past time for Congress to listen to their voices and address these issues in a systematic way.
A recent report from the Public Health Leadership Forum estimated a mere $4.5 billion a year would fill the yawning gaps in the nation’s public health infrastructure that have been exposed by COVID-19. Hospitals, too, can play a role by expanding their population health management programs to cover their entire communities, not just “covered lives” for whom they’ve taken on financial risk.
As with everything COVID-19-related, the imminent expansion of contact tracing is generating fear and political opposition.
The concern, ably expressed by Peggy Noonan in a recent Wall Street Journal column, is that tracing will become “an onerous system that provokes resentment, spurs anxiety, and invites pushback.”
There’s no doubt contact tracing, poorly executed, has that potential. Americans’ deeply ingrained individualism, their distrust of government and the fear of an invasion of privacy guarantee there will be opposition. Look around. Far too many people still refuse to wear masks or observe social distancing.
But Americans also have a barn-raising tradition where communities turn to collective action to help those in need. The barn our healthcare system needs now is a contact-tracing program with adequate privacy protections that can serve as a springboard to improving population health.