Virginia to Hire 1,000 Contact Tracers. What Will Their Priorities Be?

by James A. Bacon

Virginia is committing $58 million in federal emergency aid to expand contact tracing of people testing positive for the COVID-19 virus, reports the Richmond Times-Dispatch. The epidemic-fighting tool will be all the more necessary as Virginia eases its Vulcan Death Grip on Virginia’s economy and people begin moving around more freely.

“As we interact more, there will be more opportunity for [positive cases] to infect others,” Virginia State health Commissioner Norman Oliver told the Senate Finance & Appropriations Committee yesterday.

The state health department already uses contact tracing to prevent the spread of sexually transmittable diseases, tuberculosis and other communicable diseases. “This is what local health departments do every day,” Oliver told the committee. Hiring 200 communicable disease investigators and 1,000 contact tracers will cost an estimated $7 million to $8 million a month. 

The RTD article did not say how the activities of the contact tracers would be prioritized, presumably because Oliver did not tell the committee. Twelve hundred people sounds like a lot — and maybe it’s more than enough to handle the job. But consider that the number of new COVID-19 cases every day has ranged between 700 and 1,300 over the past couple of weeks. Roughly speaking, that’s one new case per contact tracer per day.

Some cases will be easy to handle. Patient X might have caught the disease while hunkering down at home. The contact tracer might have to track down no more than two or three family members with whom the patient had come into contact. Patient Y might be more complicated if he had, say, gone grocery shopping at the Kroger, bought some light bulbs at the hardware store, and picked up some medications at the CVS. The task gets way more complicated if Patient X has spent time with co-workers in the office or socialized with friends, all of whom must be contacted.

As an side, does the contact-tracing protocol require all of these contacts to be tested? Whatever the answer to that question, one can see that contact tracing for the corona virus is a labor-intensive task. It’s one thing to contact a person’s sexual partners — often a small number of readily identified individuals — in the effort to quash an outbreak of syphilis. It’s another to contact everyone a COVID-19 patient has come into contact with over the past week.

The point is this: The Virginia Department of Health may not be able to follow up on every positive COVID-19 test. In that case, there are two possible courses of action: (1) Treat all cases the same, dealing with them on a first-come, first-serve basis until a huge backlog builds up, or (2) set priorities. It would be wise to develop a list of priorities before a backlog occurs.

Hopefully, the department has thought through its contact-tracing protocols for COVID-9. Some logical questions:

Should the VDH prioritize contact tracing in nursing homes and correctional facilities? Clearly, those are locations where the virus has the potential to run out of control. Or, conversely, are the quarters so confined and access to the facilities so controlled that nothing useful is gained by ascertaining whom a particular COVID-19 patient came into contact with?

Should VDH prioritize regions like Northern Virginia where the virus has penetrated most deeply into the population, on the logic that such regions are where the need to slow the spread is the greatest?

Conversely, should the department focus on areas like Western Virginia where the virus has not made deep in roads in the hope of snuffing it out?

I have another thought: Use the contact tracers to identify and categorize the circumstances in which the virus spread. What percentage of the population likely contracted the disease at home? From family members? From friends? While running errands to the grocery store or drug store? In restaurants (should they ever reopen)? In the workplace? In trains, buses, airplanes and other forms of public transit? At the beach? While jogging outdoors? While pushing elevator buttons or opening door handles? In many cases, we may never know the answer. But in some cases, perhaps, we will. Such information would be of tremendous value in crafting public policies to combat the virus — and in informing the public where the greatest risks are.

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