A surge of COVID-19 cases in the Hampton Roads region is putting a strain on the area’s contact tracing workforce, Virginia Health Commissioner Dr. Norman Oliver said during a Wednesday news briefing.
“In the Virginia Beach area, for example, we’ve had to supplement the contact tracing with help from other local health districts,” he added. Oliver described the growing need as a “challenge” the Virginia Department of Health is prepared to meet. But it also underscores ongoing concerns from public health experts that a continued rise in COVID-19 cases could make the virus increasingly difficult to contain.
One UVA epidemiologist recently likened the ongoing pandemic to “bailing water out of a boat.” The department currently has 1,547 case investigators and contact tracers — the health workers responsible for uncovering the sources of new infections and notifying Virginians who were potentially exposed. Those include 470 existing VDH employees and 713 contractors, plus an additional 186 employees and 178 new contractors working specifically in Fairfax and Arlington.
The expanded workforce equates to roughly 18 workers per 100,000 Virginians, which meets the goals set by the department earlier in the pandemic, according to spokesman Truman Braslaw. But recent case growth complicates things. The National Association of County and City Health Officials recommends a baseline of 15 health professionals per 100,000 population in a non-emergency situation. For COVID-19, the recommendation doubles. Currently, the Fitzhugh Mullan Institute for Health Workforce Equity at The George Washington University estimates that Virginia should have nearly 6,500 contact tracers — roughly 76 per 100,000 residents — to keep up with its average number of new cases.
That’s because the number of potential contacts grows exponentially with new cases. The Fitzhugh Mullan Institute’s analysis assumes that each worker is calling 10 contacts per case, which could be conservative depending on where the disease is contracted. Oliver said that many of the state’s new cases have been traced back to crowded bars and other “social events and gatherings where social distancing is not practiced and masks are not being worn” (though VDH “does not have reportable data” on exactly how many cases in July were linked to bars and restaurants, according to Braslaw).
“It becomes more complicated in that if someone’s been in a large crowd, a large gathering, you have to try to identify those people with whom they’ve really been in close contact,” Oliver added. “If they’re in a crowded bar, that becomes a little more challenging.”
Delayed test results are another obstacle. VDH is currently reporting that it reaches 84.5 percent of contacts within 24 hours (of those who respond to the department’s contact tracing workers), and 74.3 percent of new cases. But Oliver and Virginia Health Secretary Dr. Daniel Carey have also acknowledged that some Virginians are waiting up to 10 days or more for test results, which can delay the identification of new infections — and expand the pool of potential exposures.
“If we find out about the case 10 days after they’ve been infected — if the person has not been good about quarantining themselves while awaiting their test results, then we obviously have a lot more contacts that we have to follow up on,” Oliver said. “It increases the amount of work we have to do.”
VDH, with assistance from the Centers for Disease Control and Prevention, is in the process of establishing regional surge teams as part of a “statewide containment center,” Braslaw wrote in an email on Wednesday. “The plan is to have individuals in each region who can do case investigation and contact tracing as well as five regional training coordinators who can train and onboard,” he added. Those teams can respond in-person to outbreaks within their region and virtually to new clusters in other parts of the state.
But public health experts have emphasized that one of the best ways to preserve the state’s existing contact tracing workforce is to control the number of new cases. In some areas of the Hampton Roads region, the percentage of COVID-19 tests that return positive has soared above 10 percent, a sign that community transmission is growing. Gov. Ralph Northam recently emphasized that case growth in four of the state’s five geographic regions is currently stable — a statement that Dr. Taison Bell, an infectious disease expert at the University of Virginia, described as “factually accurate” but not necessarily reflective of signs of trouble at the local level.
“I think the governor has tried to walk a balance between informing the public and making sure people are keeping their guard up,” he said. “But almost every health district has an area that’s a hotspot, or an outbreak at a long-term care facility, or something of the sort, so you always have to make sure that message gets across, too. We never want to give people false assurances.”
Several rural districts, including Pittsylvania-Danville and Mount Rogers, also have percent positivity rates above 10 percent. Dr. Deborah Birx, one of the Trump administration’s top coronavirus advisers, visited Virginia yesterday and described a concerning growth of COVID-19 in rural counties across the South — a trend that some experts fear will strain already-limited health resources.