If you’ve gotten COVID-19 in the past month, you may have gotten a notification from the Maryland Department of Health sent straight to your phone, linking you to information about next steps and guidance for isolation.
It’s not the same way the state would have been in contact with you if you had gotten COVID-19 a year and a half ago. Back then, contact tracers were responsible for calling each person who caught the virus and conducting an interview that sought to figure out to whom they may have spread the virus. Then, contact tracers would get in touch with those contacts to inform them they may have been exposed, in hopes of getting that person tested and, ideally, cutting the virus off before it could spread to anyone else.
But now, with new COVID-19 case rates recently surging to levels over 10 times higher than they were in the spring of 2020, when Maryland first began formally hiring contact tracers, it’s quickly become impossible for contact tracers to keep up with the more than 10,000 cases that have been reported most days from late December through early January.
Contact tracers went from being able to get in touch with 66% of new COVID-19-positive contacts per week from Dec. 5-12, to just over 11% the week of Jan. 2, according to data on the state’s coronavirus dashboard. Of the individuals whom contact tracers where able to reach the week of Jan. 2, about 78% completed an interview and about 34% gave the name of at least one contact.
Throughout the pandemic, contact tracing, along with rigorous testing, isolation, social distancing, masking and hygiene, has been an important measure for curbing the virus’s spread, according to Tolbert Nyenswah, a senior research associate at the Johns Hopkins Bloomberg School of Public Health and the former deputy minister of health of Liberia.
“Contact tracing is critical,” he said. “If we can limit contact (with) people who are infected, we can limit opportunities (for) the spread of the disease.”
But, he said, the state’s current contact tracing rate is well below what is effective. Contact tracers must be able to interview at least 80% of positive cases to help limit the spread of the virus.
It’s a matter of quantity; over the past month, the number of cases has risen substantially, but the number of contact tracers, and the number of calls they are able to make in a day, hasn’t increased at the same rate.
In fact, state and county health departments currently employ fewer contact tracers than they did at the pandemic’s previous height about a year ago, according to Marcia Pearlowitz, deputy director of MDH’s contact tracing unit.
Last winter, state and county health departments hired a significant number of contact tracers to accommodate the surge, with 1,500 total contact tracers working in Maryland in January 2021, 800 of whom were employed by the state. As vaccines rolled out and cases declined significantly in the spring and summer, however, the operation once again scaled back, to the point where only about 80 contact tracers were employed by the state.
Ahead of the current surge, the state began to once again hire contact tracers in anticipation of a surge around the holidays, but MDH didn’t predict that the state’s case count would so significantly surpass all its previous surges. As of Jan. 7, the department employed about 400 contact tracers — half of the amount employed at the same point last year — with another 120 slated to join in the coming weeks.
“We still don’t have as many staff as we did last winter, but our system has progressed since then as well. We have more automation and things that make some of the work we do more efficient,” Pearlowitz said. “It’s very hard to bring people on quickly.”
Individual counties do contact tracing as well, although whether a new positive case first goes to the MDH’s contact tracers or the counties contact tracers varies by jurisdiction.
Earlier in the pandemic, Anne Arundel County had as many as 55 contact tracers and new positive cases came directly to them, according to Allison Holly, the Anne Arundel County Department of Health’s program supervisor for epidemiology. But now, the county has nine contact tracers and takes on cases that the state’s contact tracers can’t get to.
“We’re not reaching every positive case in the state. It’s just not possible with the surge and the amount of contact tracers we have,” she said.
Both counties and the state have taken two major steps to continue contact tracing as best as possible amid unmanageable case counts. Firstly, they’ve relied on automation and digital tools to support their work.
One of the main functions of contact tracing throughout the pandemic has been to provide information to those who test positive about next steps — how long to isolate, how to get medical attention if needed, and more. Now, texts that are automatically sent to anyone over the age of 18 who tests positive for the virus help to give those individuals up-to-date information about isolating. Between Jan. 2 and Jan. 8, 80,789 such texts were sent out.
They’re also working to prioritize getting in touch with individuals — both those with positive cases and their close contacts — who are higher risk. This includes older people, unvaccinated people, and people who live or work in high-risk settings. The state and county health departments’ contact tracers previously prioritized higher-risk individuals during last winter’s surge, but throughout the pandemic contact tracing calls have mostly been made on a first-come, first-served basis.
“The main focus is … to mitigate as much spread as possible, in trying to reach out to the more higher-risk patients or residents that we have now. They’re the ones who, if they do have COVID, they would end up in the hospital,” Holly said.
According to Nyenswah, prioritization is important, but he advised contact tracers to focus on areas with high amounts of spread, like schools.
“You have to be adaptive in the approach and look at where there is huge transmissibility of the disease you’re dealing with,” he said.