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As states reopen, contact tracing efforts hobbled by obstacles

Public health agencies are ramping up tracing in the face of inadequate resources, a need for more people with skills suited for the job and a growing backlash of misinformation.
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In Texas, where gyms and offices this week joined the list of businesses that can reopen at limited capacity, only half of the 4,000 contact tracers needed by the state have been hired so far.

In Illinois' Cook County, there are about 30 contact tracers for the 2.5 million people who live outside of Chicago — far fewer than the 750 that officials are hoping for should funding become available in the next couple of weeks. Last week, the county racked up the most confirmed coronavirus infections in the nation.

And in Washington, which has managed to hire and train more than 1,300 contact tracers, state health officials last Friday had to issue a statement to dispel "rumors" circulating online about its tracing efforts.

As public health officials point to contact tracing as a key component for tracking the spread of the coronavirus and preventing a flare-up of cases amid the wave of reopenings, some agencies are wrestling with a lack of necessary resources from the federal government, a need for more qualified workers and a growing backlash of misinformation.

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Making matters worse are the absence of a cohesive national plan and coherent communication from the White House about the importance of contact tracing, said Jeremy Konyndyk, a senior policy fellow at the Center for Global Development who coordinated the United States' humanitarian response to the 2014 Ebola outbreak in West Africa.

"It's a massive messaging failure from this administration," he said.

Contact tracing is a time-consuming process that has been used for decades to combat the spread of illnesses, including Ebola and SARS. It involves calling people who are confirmed ill by their local health departments, asking them for their recent contacts and reaching out to those people to determine if they feel sick, need testing and must self-isolate. The goal is for public health agencies to pinpoint where outbreaks are occurring in a community and to stop further transmission of a disease like COVID-19, the illness caused by the novel coronavirus.

Konyndyk added that the country is "not as ready as we could have been" if the government had started preparing the public for the idea of tracing and the effort involved while most people were still isolating at home. "But the federal government chose not to own the issue," he said.

Contact tracing is part of the White House's reopening guidelines that were unveiled in mid-April, advising states to have the "ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results."

Later that month, President Donald Trump said during a news briefing that "we've gotten good at tracing" — a claim that health experts disputed as failing to recognize the nation's underfunded patchwork of contact tracing systems that are now being haphazardly rolled out during the pandemic.

Konyndyk said there are swaths of the country where partial and phased reopenings make sense because data has shown lower rates of new coronavirus cases, but lockdowns and stay-at-home orders shouldn't be fully lifted without states and communities having the capabilities to adequately test and trace.

Without those, Konyndyk added, "it's incredibly reckless."

In recent weeks, lawmakers in Washington have been pressing for increased federal funding and a national plan to help the Centers for Disease Control and Prevention assist public health agencies in hiring, training and deploying contact tracers.

One measure set forth by two Democrats, Sen. Elizabeth Warren of Massachusetts and Rep. Andy Levin of Michigan, proposes a "containment corps" in which the Department of Labor would fund state and local workforce agencies, which would in turn help unemployed individuals find jobs as contact tracers and other related roles.

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The House on Friday narrowly passed a $3 trillion coronavirus relief package crafted by Democrats, and includes $75 billion for developing and implementing a national system for testing and contact tracing. Trump, however, has already threatened to veto the bill in its current form if it passes the Senate.

Some workforce advocates say the bill, coupled with the roughly $2 trillion relief package passed in March, is essential, though it fails to take into consideration the scale and the scope of the crisis. Public health experts have estimated the U.S. will need between 100,000 to 300,000 people with the skills for contact tracing.

"This isn't just for three to six months either, but the next several years," said Andy Van Kleunen, CEO of the National Skills Coalition, a nonprofit advocacy group for improved skills training.

Van Kleunen said state and local health agencies' current use of volunteers, other government employees and some 40,000 National Guard members who've helped with COVID-19 testing and tracing have been important in these earlier months of containing the virus. But agencies can't rely on them to be part of a long-term workforce for a pandemic that has no end date in sight.

He added that the creation of a national standard for how to train and conduct contact tracing, which can be a collaboration between industry and government leaders, can help to ensure all public health agencies have the resources and the ability to do meaningful tracing.

"Until we come up with a national strategy, some states will do an effective job of this and some states will not," he said.

New York has partnered with the Johns Hopkins Bloomberg School of Public Health, which is offering a free six-hour course for people who want to be hired as a contact tracer in the state. New York is anticipating needing anywhere from 6,400 to 17,000 tracers statewide based on the projected number of cases and a standard of 30 professionals for every 100,000 people.

An analysis by NPR in late April found that only seven states — Alaska, California, Illinois, Michigan, Nebraska, New York and North Dakota — and Washington, D.C., are positioned to surpass that 30-worker threshold.

But even as states scramble to secure enough contact tracers, there are other obstacles that persist.

Ohio, which this week will allow for indoor restaurants and bars to reopen with social distancing measures in effect, has suggested hiring upwards of 2,000 contact tracers in the state. But Gov. Mike DeWine's push for residents to support contact tracing efforts was met on social media by skepticism, accusations of fear-mongering, conspiracy theories and unfounded complaints that people's private information will be shared with companies. (Participation in contact tracing is voluntary, and health officials stress that information such as Social Security numbers and bank data are not being collected.)

Tara C. Smith, a professor of epidemiology at Kent State University, said her concern is that the state has not effectively communicated with the public about how contact tracing will work, and if those being contacted will be forced to quarantine and what protections they'll have from job or pay loss if they must suddenly take off from work for a suggested 14-day quarantine period.

"I haven't seen a lot of clarity from states regarding 'what comes next' in controlling the virus that detail the specifics of contact tracing — how it's done and what to expect from people who are exposed to a case, especially," she said.

The Ohio Department of Health did not immediately respond to a request for comment.

Social media, meanwhile, remains a breeding ground for misinformation about contact tracing, and one Facebook post that went viral last week falsely claimed that the House's latest relief bill "is about controlling/tracking population, not about coronavirus."

"There's a lot of sound and fury from some small groups that we saw over wanting to reopen economies that I suspect we'll see with contact tracing," Konyndyk said. "But I think the vast majority will recognize its legitimacy."

Contact tracers who spoke with NBC News said that for the most part, people have been cooperative, and while some are initially hesitant about whom they're divulging information to, they realize the gravity of the situation.

"I haven't had too much of pushback with that," said Moyosola Babatunde, a contact tracing volunteer in Tarrant County, Texas, who received her master's degree in public health from the University of North Texas Health Science Center in Fort Worth. But calls "are difficult. You really are getting people to trust you and you're expecting them to share certain things. Not every call is going to go the way you need it to go."

Language can be a barrier, too. While Tarrant County has a translating service available to contact tracers, Babatunde said, in one case someone required a Swahili speaker.

Daniela Figueroa, another Tarrant County volunteer and a graduate of the University of North Texas Health Science Center's health administration program, said her Spanish-language skills have come in handy when she makes calls. In Tarrant County, home to Fort Worth, Latinos make up 30 percent of the population but have the highest rate of coronavirus cases of any race, county health data shows.

But getting someone to pick up the phone can be hard if they don't recognize the number or are in the throes of coronavirus symptoms, Figueroa said. She leaves a message asking them to call back — and sometimes, they do.

"Most people are willing to help the cause," she said.