If you test positive for COVID-19 in New Jersey, you should eventually get a call from one of the state’s 3,500 contact tracers.
They will ask you how you are doing, give you information on how to quarantine and offer you any help you might need. Then, comes the big question: Will you turn over the names and contact information for anyone you spent 10 or 15 minutes with who might have been exposed to the virus?
At that point, about 78% of people contacted in New Jersey stop cooperating. They hang up. They clam up. They flat out refuse to turn over names, even though their identity will be kept secret.
After months of pouring time, money and resources into expanding New Jersey’s contact tracing operation, Gov. Phil Murphy and other state health officials have repeatedly expressed frustration at the lack of results.
“We have done everything we can to give our communities the tools to fight COVID. And yet, they hit walls because the people they are trained to help aren’t helping them or themselves,” Murphy said earlier this week, pleading with people to be more cooperative with contact tracers.
State officials have reason to be frustrated, experts say. With 78% of people blowing off contact tracers, New Jersey’s operation is struggling compared to other states.
“Unfortunately, that is substantially worse than most states,” said Steve Waters, the founder and chief executive officer of CONTRACE Public Health Corps, an organization that recruits contract tracers and serves as a consultant to tracing operations.
“For context, New York has around 35% not cooperating and Maryland is around 50%. North Dakota, largely seen as the example of what not to do, has around 80% not cooperating,” Waters said.
Other large states, including New York and Massachusetts, have had better success after quickly scaling up their contact tracing efforts and public relations campaigns to let people what to expect when a tracer calls.
Murphy said last week he and his chief of staff recently met with an unnamed company that said it might be able to improve New Jersey’s contact tracing “batting average.” He said he planned to send the proposal over to state Health Commissioner Judith Persichilli for review.
New Jersey health department officials did not respond to a request to comment on the state’s contact tracing numbers or what it is doing to try to improve them.
Why are New Jersey’s numbers so low?
It could be a combination of factors, including a lack of in-person outreach by tracers, few local public relations efforts to educate the public on the role of contact tracers, too many inexperienced tracers, a culture of shame over contracting the virus and a general mistrust of turning over personal information to the government, experts say.
As one of the earliest and hardest hit states in the pandemic, New Jersey may also be suffering from COVID-19 fatigue and a skepticism that passing out the names of friends and relatives will really do anything to curb the spread of the virus.
New Jersey also needs more diversity in its contact tracing corps, Waters said. New York City, which has received a lot of praise for its NYC Test and Trace Corps, has focused on hiring tracers who speak 40 languages, including a recent push for more people who speak Yiddish and Russian. It has also encouraged contact tracers to knock on doors when needed to help convince people to cooperate with turning over the names of their close contacts.
New Jersey, which has one of the highest immigrant populations in the country, has struggled to hire enough Spanish speaking tracers, Waters said.
“This is extremely important as the Hispanic community is one the hardest hit by COVID-19, and if the contact tracers can’t communicate with them, they obviously can’t share their contacts. Having contact tracers with the cultural literacy of the Hispanic community is also important to build the necessary level of trust so that the people they are calling feel comfortable sharing their contacts,” Waters said.
New Jersey should also be turning to non-government sources, including local sports stars and celebrities, to publicly speak about the benefits of contact tracing on social media and encourage people to cooperate, Waters said.
Other states have begun revamping their contact tracing operations:
-New Hampshire announced last month it will no longer try to call every person who tests positive in the state. “As community transmission increases, it becomes a less effective strategy,” Ben Chan, the state epidemiologist, said at a press conference. Instead, the state will narrow its contact tracing to only vulnerable populations, including children, the elderly, racial minorities and healthcare workers.
-In Wisconsin, some health departments have moved to a “crisis model” of contact tracing. Instead of trying to track down an infected person’s contacts, tracers simply call people who tests positive and give them instructions on quarantining. Then, the infected person is asked to call their close contacts themselves.
-Virginia announced last week it would move to a new model of contact tracing that prioritizes certain cases. People diagnosed with COVID-19 in the past six days and the people in their households will get calls, along with newly diagnosed people who live in work in nursing homes and those with severe illnesses. Anyone linked to a known outbreak or cluster will also move to the top of the list.
New Jersey isn’t alone in struggling with contact tracing. Philadelphia said it has also been having problems connecting with residents. Only about 25% of those called by contact tracers were even answering the phone last month, city officials said.
In South Florida, local officials said “snowbirds” and other people visiting for the winter were also being especially uncooperative with contact tracers because they were unwilling to talk about where they traveled and who they came in contact with before testing positive.
As of last week, New Jersey had contact information for 97% of people who tested positive, but attempts were made to contact only 77%, according to the state dashboard. About 22% of people did not “take the call,” meaning they didn’t answer the phone, their contact information was wrong or the person was hospitalized or had died.
About 56% of people who tested positive ended up connecting with the contact tracers. Of those, 3% refused to speak at all and 78% refused to provide contacts for people who they may have exposed.
Of the people who were identified as contacts who may have been exposed to the virus, about half were successfully reached by contact tracers and 23% had coronavirus symptoms.
New Jersey has been working hard to expand its contact tracing workforce, but the state started with a lot of strikes against it, experts say. The state’s decentralized patchwork of local and county health departments made it difficult to get a unified contact tracing operation up and running quickly. The state was also slower than other states last spring in getting a plan together to hire more contact tracers.
New Jersey has had to rapidly hire and train new contact tracers as coronavirus cases continue to rise in one of the most densely populated areas in the nation.
As of last week, New Jersey had 3,313 contact tracers, including more than 200 who were in their first week on the job. The state said it has met its hiring goal in every county except Bergen.
There are currently about 37 contact tracers for every 100,000 people in New Jersey’s population, according to the state’s COVID-19 dashboard.
That simply isn’t enough for a state where the daily positivity rate has passed 10%, according to TestAndTrace, a volunteer organization that compiles data about contact tracing.
The group gives New Jersey relatively low marks in its ranking of contact tracing operations and says a state of its size needs at least 12,000 more contact tracers. New Jersey is one of more than 30 states that gets a 0 on the group’s 0 to 5 scale ranking testing and tracing systems.
Other states, including New York, Massachusetts and Washington, D.C., get higher marks in the TestAndTrace ranking for having more contact tracers per capita in states with lower percentages of people testing positive.
As the second wave of the virus continue to hit New Jersey, it may be time for New Jersey to follow other states and radically rethink the contact tracing concept, public health experts say. With thousands of people testing positive every day, contact tracing may be too little, too late.
“Contact tracing should have been applied at an elevated level during this summer, when infection spread was less rampant, to prevent us from getting to where we are today,” said Perry Halkitis, dean of the Rutgers School of Public Health.
Asking 3,300 contact tracers to track thousands of new cases each day may be impossible, even if New Jerseyans were more cooperative.
“In the current condition of disease spread, contact tracing, while still helpful, has less preventive utility, and is even more difficult to undertake given the steep acceleration of infections,” Halkitis said.
New Jersey’s contact tracing effort has been costly. Over the summer, state officials said they hired the Massachusetts company Public Consulting Group, or PCG, $23.5 million for a three-month contract to hire, manage and pay 1,200 contact tracers.
The state also made a $16.3 million deal with the Rutgers School of Public Health earlier in the year to recruit, train and pay 1,000 contact tracers. An additional $1.9 million was spent to obtain the CommCare database system contact tracers use to track their work.
But Waters, the founder of CONTRACE Public Health Corps, encouraged New Jersey not to completely give up. On a personal level, contact tracing is a success if even one person is informed they were exposed to the virus and gets tested, limiting its spread.
“Contact tracing doesn’t need to have 100% participation to be effective. And any number of people being warned so they can take steps to protect themselves, their loved ones and their communities, is better than none,” Waters said.
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