The state’s silence about any long-term plan to map the spread of the virus through contact tracing — a measure most public health officials agree is an essential tool to help parts of the economy safely reopen — has frustrated some elected officials.
By Ben Conarck, Daniel Chang and Douglas Hanks
While some states preparing to reopen their economies have hired armies of people to trace novel coronavirus infections, Florida won’t say if it has a long-term plan to keep the virus at bay through contact tracing — a labor-intensive method of tracking down newly infected people and their close contacts in an effort to isolate them and stop the disease from spreading.
Contact tracing is considered by public health experts as a critical part of suppressing a possible second wave of COVID-19, but at a news conference Wednesday, Florida Surgeon General Scott Rivkees offered little detail on the state’s efforts despite saying that “this is a way that we actually stop the cycle of transmission.”
Standing with Gov. Ron DeSantis at the Hard Rock Stadium coronavirus testing site in Miami Gardens, he described the efforts only in the broadest terms: “This is something we have in place. We’ve been doing it from the very beginning and are continuing to expand.”
What that expansion consists of remains a mystery. The health department Rivkees oversees has not described its plans or even explained its process for contact tracing, despite repeated questions.
The number of people the state has working on contact tracing remains unclear. A spokesperson for the department said the agency has hired hundreds of additional staff members, including epidemiologists and students, but health officials and the participating schools won’t answer questions about how many infections they have traced, and how many new infections have been isolated as a result.
After the Miami Herald initially published this story online Wednesday — and after two weeks of mostly unanswered questions about contact tracing plans — the department provided a new number of contact tracers, saying in an email that “more than 1,000 individuals, including students, epidemiologists and other staff from across the department are currently involved in contact tracing.” The email said the state’s newly announced staffing number is “meeting the current operational demand.” The state didn’t explain how it nearly doubled the size of the staff from the number the agency provided a week earlier.
Michael Lauzardo, a pulmonary disease specialist and chief of the University of Florida College of Medicine’s division of infectious diseases, said it’s hard for states to hire and train enough people to trace every case. But he said that accurately tracing even a fraction of cases can help.
“Even if you get 20 percent of them right,” he said, “you can have a significant blunting effect.”
Contact tracing efforts in hard-hit South Florida are slightly clearer than the state’s. Health officials in Miami-Dade County said they have 175 employees performing the critical work, including 16 students.
In Broward County, contact tracing efforts are unknown: Broward’s health department didn’t respond at all to a question about how many employees are contact tracing there. However, a college student who had been employed by that health department to contact trace until mid-April said there were about two dozen employees plus 10 students doing the work in his office when he left the job.
The state’s silence about any long-term plan to map the spread of the virus through contact tracing — a measure most public health officials agree is an essential tool to help parts of the economy safely reopen — has frustrated some Miami-Dade elected officials. Commissioner Dennis Moss said the county can only do so much to supplement a state effort that hasn’t matched the crush of COVID-19 cases in the county that has more known infections than anywhere else in Florida.
“We’re willing to help in any way we can, but that’s the Department of Health’s responsibility,” he said. ‘We’re talking about it on the county level because we haven’t seen enough movement.”
Miami-Dade also is exploring a technological answer by considering joining the Massachusetts Institute of Technology’s Safe Paths initiative, which uses cellphone apps to warn people when they’ve come in close contact with somebody who tested positive for COVID-19.
Mayor Carlos Gimenez has discussed the possibility during briefings with county commissioners, participants said. The Safe Paths app would use a cell phone user’s location history to see who they’ve crossed paths with and whether that exposed them to anyone infected.
Commissioner Daniella Levine Cava said she supports bringing Safe Paths to Miami-Dade, but added that the county needs to adhere to the White House guidelines that call contact tracing one of the “core state preparedness responsibilities.”
“You’ve got people who say they’re going to adhere to these guidelines, then they kind of waive their hands and talk about reopening,” said Levine Cava, a candidate for mayor in 2020 to succeed a term-limited Gimenez. “We’re not meeting the thresholds. And we need to be honest with the public about that.”
Why not here?
Florida has confirmed about 17,000 more COVID-19 cases than Ohio so far, but when it comes to assembling the infrastructure needed to perform contact tracing, the Buckeye State seems to be outstripping Florida, announcing plans to hire 2,000 people to do the work.
Other states, including Massachusetts, California and New York, have announced plans to hire and recruit thousands of new workers and volunteers to do the tracing.
Florida is using its existing epidemiologists — 300 staff members — plus 223 new hires and additional college students to track down the contacts of residents who have tested positive for COVID-19, said Alberto Moscoso, communications director for the Department of Health.
The governor mentioned contact tracing when announcing the state’s reopening plans last week, but DeSantis has not laid out a comprehensive plan for addressing future outbreaks. The Centers for Disease Control warns that the U.S. could see a second wave of the novel coronavirus, particularly in states such as Florida that have begun to reopen businesses and lift stay-at-home orders.
Contact tracing is key, experts say, because it gives health departments the ability to quickly identify and contain an outbreak. Epidemiologists at Johns Hopkins Center for Health Security estimate that each infected person can, on average, infect two to three others, which means one case can turn into more than 59,000 cases in 10 rounds of infections and incubation.
There are efforts to establish a contact tracing force at the national level. A bipartisan group of former government health officials also released a letter last week calling for a national contact tracing workforce of 180,000 people. Other experts predict the nation will need 100,000 to 300,000 people to perform contact tracing until a vaccine is developed, which could take until 2021.
The National Association of County and City Health Officials says states need about 30 contact tracers per 100,000 people during the COVID-19 pandemic. Florida would need to have more than 6,400 contact tracers to meet that need.
In the long term, Florida must demonstrate that it can keep people safe from future outbreaks, said Roderick King, a physician and CEO of the Florida Institute for Health Innovation, a nonprofit that advocates for public health.
“Contact tracing, as well as testing, has got to be vitally important to be able to both build public confidence that it’s safe to come out,” he said, “and to be able to have a sense of the scope and spread, or at least the decrease in the scope and spread of the virus.”
“Those two pieces, what you’re doing is building an infrastructure that you can use for next year,” King said.
Angel Algarin, the student who helped health officials contact trace in Broward County through mid-April, said his job was to call newly diagnosed patients, ask about symptom history and recent close contacts, and then reaching out to those persons to find out if they ask had experienced illness.
Algarin, who attends Florida International University’s Stempel College of Public Health and Social Work, said the work made him feel as though he was part of a team trying to stop the coronavirus pandemic.
“We have our health providers — front line doctors and nurses,” he said. “The public health people are the second line of defense. We’re trying to help more people from becoming sick.”