When Louisiana resumed reopening after a severe blockade this spring, Governor John Bel Edwards touted two key antidotes to ensure that the coronavirus did not escape control again: test and contact traceability.
Things did not go according to plan.
Baton Rouge, Lafayette, Lake Charles and several other cities are struggling to contain the virus. The hospital’s intensive care units are overwhelmed. School leaders don’t know if they should open classes in the fall. And Louisiana has the highest per capita rate of known coronavirus cases in the nation.
Tracers should talk to infected people as soon as they are positive, find out who they have been in contact with, and warn those people to self-quarantine. But that turned out to be easier said than done: the first concerns that people weren̵
In many cases, positive test results take up to a week to return. By the time they occur and the contact tracers are unable to make contact with the affected person, the virus may have already left the sick person’s system and infected several new hosts. The state has spent $ 8 million on the contact track since May 15, thanks to a federal grant of $ 190 million for testing and the track that is expected to last until 2023.
At that point, state officials predict that they will have spent $ 48 million on finding contacts.
Although Louisiana now employs nearly 700 contact detectors, that group is even more numerous than the new daily cases, which averaged 1,927 per day since July 20. When these people answer their phones, almost three quarters of them still don’t provide the names of “Close Contacts” that they may have infected.
As a result, it is a system that loses enough.
Take the case of Priscilla McCraney. He received a coronavirus test on July 19 in New Orleans after spending time with family members who later proved positive. He said his only clue that he might be ill came when he sniffed a candle in a Ross shop and realized he couldn’t smell it.
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When his results turned positive on July 24, he felt good again and had recovered his smell. She had no news from a contact tracer until 30-11 July after being tested and six days after finding out she was positive.
“Imagine all the people like me who don’t have any symptoms either [have] just loss of smell and think that they are breasts, “said McCraney, 36.” It is really scary to think … if I go back to work and there is someone else who has no symptoms, they are spreading it again. “
By the time the tracers reached her, McCraney’s infection had long since disappeared, and it was too late to warn the people she had contacts with that they might have been discovered.
“If someone isn’t tested until they show symptoms and you get the result and you start tracking for seven, eight, nine days later, there aren’t many benefits for the track,” said John Barry, New Orleans. historian who wrote “The Great Influence”, a bestseller on the 1918 flu pandemic.
As the search for a coronavirus vaccine continues to grow around the world, more and more clinical trials are coming to Louisiana.
Barry said slow test results, a large number of positive cases and high community rates spread all the frustrating traces of effective contact. A tool developed by George Washington University says that according to Louisiana’s current workload, the state needs over 12,000 tracers to do the job well.
However, public health officials, contact tracers and Barry all claim that having a contact tracking system that doesn’t keep up is even better than having no system.
“In a situation like this, the search for contacts is not as effective as it could be compared to a world in which cases are lower and the spread of the community is lower and easier to identify,” said Omar Khalid, chief staff of the Louisiana Public Health Office. “You can’t use contact tracking like a silver bullet at any time, but especially when you’re seeing the spread on this level … but we still think there is value.”
Most people answer phones, but don’t make contact
Some good news: more people are now talking to tracers than when the effort started.
At the beginning of June, the tracers reached only 48% of the people who called.
That number has improved dramatically, with contact tracers now reaching 69% of the people they turn to. Of those who contacted, 27% did not answer or answer calls, while 4% categorically refused to answer questions.
But while contact tracers are having more luck reaching people, they are struggling to get them to cough up the information they need most: 73% of people talking to tracers don’t provide a list of close contacts.
Anyone who has spent at least 15 minutes within 6 feet of the infected person within 48 hours of the positive person is considered close contact.
They say lightning never strikes twice in the same place.
“They are saying that there is no other person they have been in contact with just before they become symptomatic,” said Khalid.
Those who provided names listed a total of 13,475 close contacts. So far, the contact tracers have been able to reach 76%, a drop of 5% to answer any questions.
Despite the challenges, Khalid said there is no point in giving up on the track of contacts when cases begin to overwhelm the state’s ability to keep up. If they did, health officials would lose useful information where the outbreaks came from, how people are recovering and more, he said. Barry noted that it is also important to have the infrastructure for tracking contacts for when cases come back.
The Department of Health refused to make all contact tracers available for an interview. But a Louisiana contact tracer who attended a Reddit “Ask Me Anything” forum on July 20 said the job appeared to be drinking from a fire hose.
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“In June, when there were only 500 cases per day, it looked like we were doing something useful,” wrote the tracer. “Now with over 2000 cases per day, it seems that what we are doing is not of great help. I think the most important thing we do is collect data for state epidemiologists as they use what we give them to make their decisions about the virus. “
The contact trace existed in Louisiana long before the pandemic, and was used to trace the spread of diseases such as mumps and tuberculosis. At the start of the pandemic, a small state team tried to keep up. Since then, hundreds of others have joined the effort.
Emily Rawls, 30, from New Orleans, was one of the team’s top targets: she spoke to tracers in mid-March after testing positive for coronavirus. But she said the contacts she appointed told her that they had never heard of the state.
Khalid said that at some point in the spring, it became clear that the spread of the virus in New Orleans was too large and the department’s resources were too sparse. This is when the state brought four private companies to help: called Plus and Hub Enterprises based on Lafayette, Coast Professional based in West Monroe and Hammerman and Gainer based in Kenner.
“They are the Louisianans who call Louisianans”
These contractors claim to have adapted their way of working in hopes of reaching more people and making them feel more comfortable.
The contact tracers used to call without warning and few people answered. Now, they usually write messages first, to say that a contact tracker will call and beg people to reply.
Contact trackers have also learned more about advising people they call, many of whom face difficulties while battling the virus and the anxiety around it, said Barbara Lamont, president of Calls Plus. She said the tracers speak often people through mental health crises and try to connect people to useful resources, such as suicide hotlines.
Another lesson, Lamont said, is that health officials and members of the public interpret the phrase “contacts” differently. Louisiana’s close families don’t necessarily think of relatives as “contacts,” he said.
“They think of the contacts as strangers and are reluctant to give you the mother and brother,” said Lamont.
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Coast Professional, Inc. added 200 workers in a month, totaling 300, to try to keep up with the workload, said Brooke Singletary, vice president of business development.
Hub Enterprises has doubled its contact tracking staff to nearly 400 since its work with the state began in mid-May. The staff works from 8:00 to 20:00 Monday to Saturday and from noon to 20:00 on Sunday.
Hub vice president Robin Buchanan said his company also added 40 employees – in addition to the nearly 400 who track contacts – to answer calls from people who return messages from contact trackers.
Buchanan urged people to learn phone numbers: call trackers call from (877) 766-2130 and write from 225-396-5389.
Louisiana has become the 12th state to exceed 100,000 confirmed cases of coronavirus.
“It’s the Louisianans they call Louisianans,” said Buchanan. “He’s your neighbor, the person down the street – we’re just trying to get the information we need to protect people and warn them that it’s been exposed.”
Sometimes, everything works quite well. Matthew Nichols of Metairie, 47, was tested for coronavirus, received a positive result, and heard from a contact tracer within five days in late June.
He said contact detectors quickly followed his wife and received daily messages from contact detectors who checked in later.
But this is not always the case.
Soranny Martinez, 31, from New Orleans, was tested for coronavirus in early July and found she was positive a few days later. He did another test just over a week later to make sure the virus was gone.
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It wasn’t until after taking the second test that he heard from a contact tracer. About the only part of the system that worked as it should have been: the contact tracers immediately called her mother after they called her.
“I would have guessed they would have called me sooner,” said Martinez.