Readers are now likely familiar with the public health term “contact tracing.”
In case you missed it, contact tracing is the investigative process through which the spread of infectious disease between individuals is tracked and contained in a community. Those who are identified as infected are interviewed regarding where they spent time and with whom they interacted.
The ongoing process — contacts beget additional contacts to interview and potentially isolate — is resource-intensive and typically requires formal, public health training and/or experience.
Contact tracing is a fundamental component of effective return-to-work strategies during infectious disease outbreaks. However, as the ongoing pandemic has made clear, public health services departments do not have adequate capacity. As noted in recent weeks, an “army of contact tracers” is required to successfully slow the spread of SARS-CoV-2, or COVID-19.
Public health is not well-staffed or funded
In a recent letter to congressional leaders published by NPR, a group of public health experts and former, federal health officials argued that to safely reopen the economy, the contact tracing workforce needs to increase by 180,000, which will require $12 billion in funding.
The task would be challenging for industries that are well-staffed and funded; unfortunately, governmental public health agencies are not.
In 2000, there were an estimated 448,254 salaried positions in the U.S. public health workforce. By 2014, there were fewer than 300,000 public health workers in government agencies, fewer than 200,000 of which work at the state and local levels.
Ignoring any additional workforce losses, the governmental public health workforce would need to swell by 60% to meet the projected need for contact tracers.
What happens if we can’t track cases?
If the estimated 180,000 contact tracers were allocated according to population, Arizona — a state of 7.2 million people, accounting for roughly 2.2% of the U.S. population — would need nearly 4,000.
Though data is limited on the ability of state and local public health departments to recruit, train and deploy thousands of contact tracers in a short period of time, it seems reasonable that we should not place this kind of burden on an already strained system.
The Medical Reserve Corps, which functions to strengthen and respond to public health emergencies (a sort of public health national guard) is crucial, but during a pandemic, might also be strained. In Arizona, for example, there are approximately 1,600 Medical Reserve Corps volunteers across 13 units, roughly 700 of which are medical/public-health professionals.
We have talked ad nauseum about “flattening the curve” to avoid overwhelming the health-care system, but less about the upstream effects of an overwhelmed public health system. If we are unable to successfully identify cases, track/isolate and slow the transmission of the virus within our community, the downstream effects (i.e. those who end up sick and hospitalized) will be amplified.
The dwindling funding of governmental public health organizations has been compounded by a shift in the makeup of the broader, public health workforce.
We can’t rely solely on public health to do this
Not only is the new generation of the public health workforce younger, more diverse, and potentially less likely to have graduate degrees, they are more likely to pursue employment in the private sector.
Nonetheless, public health still attracts individuals who are pursuing formal training and are well-positioned to assist in contact tracing efforts.
Though only a portion of public health graduates pursue full-time careers in the public sector (traditionally the boots-on-the-ground frontline workers), all are equipped to be trained as contact tracers and deployed very quickly. Given the finite capacity of governmental public health agencies, we should consider including private partners in the public health arena to aid in the effort.
The challenges outlined here suggest that we should expand our thinking and harness the available capacity across the entire field of public health.
Developing more public/private partnerships would help fill temporary staffing needs as well as encourage ongoing collaborations.
As the COVID-19 pandemic has laid bare, having the ability to temporarily expand or contract the public health operating capacity in the event of an infectious disease outbreak would prevent delays in response times and help slow the spread of pathogens in our community.
Kyle Freese, MPH, PhD, is an epidemiologist with STChealth, a public health intelligence company in downtown Phoenix. Reach him at email@example.com; on Twitter, @Epi_DrFreese.
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