In addition to a rapid ramp-up of testing for the coronavirus, Minnesota will need a seriously scaled-up corps of people to retrace the steps — and personal contacts — of those who are infected before the state can begin to return to something approaching normalcy.
They’re called “contact tracers,” and state plans estimate they’ll need 750 of them. Which is a lot more than they have now.
But increases have already begun. On Tuesday, there were 92; on Wednesday, 110.
The state’s plan calls for the remaining personnel to be conscripted from the ranks of state employees, state health officials said Wednesday.
The timeline for when and how to accomplish the rapid reassignment was still being developed Wednesday, said Kris Ehresmann, the head of epidemiology for the Minnesota Department of Health who essentially serves as commandant for the statewide public health response.
The pressure to recruit and train contact tracers is being felt across the nation as states in some regions push past their initial peaks while others, including Minnesota, find themselves having lowered the curve and built up enough hospital capacity to start planning for the next stage.
TEST-TRACE-ISOLATE
Contact tracing is an essential element in the epidemiological playbook. Gov. Tim Walz has made it clear that he’s pulling out that playbook as he looks to ease the economy back to life in the midst of what will be a six-week stay-at-home order.
On Monday, Walz said before large sectors of the workforce can return to their jobs, the state needs to be able to test 5,000 people a day for the virus. It’s an ambitious objective, and he said he’s not certain it can be reached before May 4, when the stay-at-home order and several others, including the closure of schools, are set to expire.
Then on Tuesday, Dr. William Morice, chair of the Department of Laboratory Medicine and Pathology at Mayo Clinic, said he believed the Rochester institution was poised to meet that challenge.
But that’s not mission accomplished.
The full strategy for a society to operate in the midst of an epidemic is balanced on three legs of a stool: testing, tracing and isolating.
The first step — testing — is needed to see who’s infected — an especially important aspect of responding to the novel coronavirus because people with no symptoms are believed to be major spreaders of the virus. The infected are isolated at home or in a hospital or other facility so they don’t spread it while their bodies are fighting it off.
The second step is tracing — the task of figuring out everyone who might have been exposed by the infected person. It’s a laborious process that traditionally involves public health workers, clipboard and shoe leather, or a lot of time on the telephone. Contact tracers interview the infected person and ask where he or she went and with whom they came into contact over the previous days.
The current standard for coronavirus exposure is being within 6 feet of someone for at least 10 minutes. Everyone who fits that bill — all those contacts — are then told to self-quarantine, or isolate themselves, for two weeks, or, if they become ill, until they recover.
Without isolation, those who were exposed — and thus might be infected — can infect others and create new outbreaks. Without contact tracing, there’s no way to know who should isolate.
“It is going to be critical,” Robert Redfield, head of the federal Centers for Disease Control and Prevention, told National Public Radio in a recent interview. “We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission — so it is going to be very aggressive, what I call ‘block and tackle,’ ‘block and tackle.’ ”
Contact tracing is frequently used to track sexually transmitted diseases and infections. It was widely employed in 2014 to monitor travelers returning from West Africa to ensure Ebola never spread here. And, most relevant to the current situation, contact tracing was essential in containing and suppressing the 2003 outbreak of SARS, which is also a coronavirus, albeit a much less contagious one.
NATIONAL CALL TO TRACE
Once an infectious disease is spreading unchecked in a population — as the coronavirus currently is in America despite a nation essentially under lockdown — the task of getting it under control requires formidable force.
In Wuhan, China, a region with a population of 11 million, upward of 9,000 contact tracers were deployed to regain control. The same ratio would call for Minnesota to assemble a force of more than 4,600. However, American health officials appear to think that type of army isn’t needed here.
Massachusetts recently announced plans to recruit 1,000 contact tracers. Ehresmann said that, using the same math as Massachusetts officials, Minnesota would need about 750, although she allowed that the figure was merely an estimate.
“The number of contact tracers we would need really depends on the number of molecular tests run (the percent that are positive),” she said in an email Wednesday. “And we would not necessarily be hiring as there are a number of state employees that could be redirected to this effort.”
Under his emergency powers, Walz can reassign just about any state employee to just about any necessary task.
WILL IT BE ENOUGH?
While laborious, contact tracing doesn’t require expertise. Someone might be able to be trained in a single day, according to Anita Cicero, deputy director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health and a lead author of “A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the U.S.”
However, in the report, Cicero argues that the dastardly features of the coronavirus — notably its relatively long period of contagiousness without symptoms — and its widespread circulation in America, as well as the fact that universal testing is nowhere near available, mean that the Massachusetts standard won’t be enough.
“A contact tracing effort of this unprecedented scale and of this critical and historical importance to the functioning and reopening of society has never before been envisioned or required,” she wrote, concluding: “it would make sense to at least start by adding an extra 100,000 contact tracers across the United States.”
That would translate to about 1,500 in Minnesota.
AN APP FOR THAT?
In lieu of manpower, technology might have a role. Contact tracing-friendly smartphone apps, which trace movements of people and use Bluetooth to record close contacts, are being deployed widely in Southeast Asia. Last week, North Dakota Gov. Doug Burgum highlighted Care19, an app that stores 21 days of one’s movements, so that if you fall ill, it’s easy to know where you’ve been.
It’s unclear if Minnesota will push such ideas.
“We are constantly evaluating and reassessing our resource needs and making plans as needed,” Minnesota Department of Health spokesman Doug Schultz said Wednesday.