The Maine Center for Disease Control and Prevention plans to double its number of coronavirus trackers over the next week, using a combination of retired state epidemiologists and new hires to boost its staff of so-called “disease detectives” from 15 to 30.

The ability to identify and counsel people who have been exposed to someone who has tested positive for COVID-19, a process known as “contact tracing,” is one of the key measures of a state’s readiness to start relaxing social distancing requirements, according to newly released White House guidelines.

“They have been the quiet heroes of this entire outbreak,” said CDC Director Nirav Shah about Maine’s disease detectives earlier this month. “Since day one, they’ve been out there talking to people to learn their stories and put together these really complicated timelines to get a better sense of who … infected whom.”

But will even 30 tracers be enough? A former director of the U.S. Centers for Disease Control and Prevention, Tom Frieden, says the United States needs at least 300,000 contact tracers before it can begin to safely relax social distancing requirements for its 331 million citizens.

“Contact tracing, enormously important,” said Frieden, who served as head of CDC from 2009 to 2017  under President Obama. “We need an army of contact tracers in every community of the U.S. to be ready to find every contact and warn them to care for themselves and stop spreading it to others.”

Even with the planned expansion, Maine’s staffing would fall short of the 310 trackers that Frieden’s 1-to-1,000 ratio suggests a state the size of Maine, with 1.3 million people, needs to win what he calls “World War C” and shut down any future outbreaks that pop up as restrictions are relaxed.

Other public health groups, including a national association of state health officials, agree on the need for more tracers, but want Congress to fund the hiring of one-third the number Frieden recommends. Even that suggests Maine would need 100 tracers, but these groups say individual states should decide how many they need.

Not even a month ago, Maine CDC used a group of eight to 10 staff epidemiologists to track the spread of communicable diseases and mosquito and tick-borne illnesses. But the arrival of the pandemic prompted the office to “repurpose” five public health nurses to beef up its tracing efforts, Shah said.

That team has been working seven days a week – with 10 contact tracers working on an average day – to identify and counsel close contacts of those testing positive for COVID-19. But the new federal guidelines issued Thursday call for even more, prompting Maine to double its tracking workforce.

“Rather than looking to national models, it’s more a matter of setting a reasonable expectation for what a small state like Maine can do in a week,” said Robert Long, CDC spokesman. “This pandemic forces us to reassess what we’re doing every day to best match resources with needs.”

Beginning next week, retired Maine CDC epidemiologists will start returning to work for a few months on a contract basis, Shah said. The state will also begin hiring new people “skilled in the ways of medicine and epidemiology” to be trained as trackers, he said.

Before a government can even consider loosening its pandemic restrictions, Frieden said, a state should, among other things, be able to talk to at least 90 percent of the close contacts of any patient who has tested positive and within 12 hours test those contacts who are showing symptoms.

The number of confirmed COVID-19 cases in Maine is still going up. On Friday, Maine was reporting 827 confirmed positives and 29 deaths, which means the state is still trying to contain the virus, making it too early to know when it will be ready for reopening, Shah said.

State officials are reviewing the White House guidelines, and generally consider them to be a good starting place, Shah said. Maine is also likely to adopt a phased-in reopening, tailored by region, demographics and industry, according to a statement issued by Gov. Janet Mills.

“It provides a skeleton,” Shah said of the guidelines. “Like all skeletons, it needs more meat on the bones.”

Maine CDC on Friday could not provide detailed information about its contact tracing methods, or how much it has cost in the past or how it will fund its planned expansion, saying that arm of the office was busy reviewing the new federal protocols and doing actual consultations.

Last month’s $2 trillion stimulus package established a $150 billion Coronavirus Relief Fund to help states deal with the pandemic, and also gives $4.3 billion to the CDC to fund pandemic response work. It’s not earmarked for epidemiology, but states could use some of the money to hire contact tracers.

Governments across the nation, from Massachusetts to California, are ramping up contract tracing efforts. In San Francisco, nurses, medical students and librarians are being trained. The same is happening across New England, with every state now considering expansions of their contact tracing efforts.

Earlier this month, Massachusetts announced it would collaborate with a public health nonprofit in Boston to deploy 1,000 contact tracers earning $27 an hour to track and contain the virus there. The price tag? An estimated $44 million, according to the nonprofit.

Even Rhode Island, with a population of about a million, has 100 people doing nothing but contact tracing. The governor there has even asked residents to keep a daily log of whom they come into contact with in case they become infected, to make it easier for contact tracers to do their job.

Even if money was not a problem, there is no established public health benchmark for how many contact tracers are needed to track the coronavirus now or to shut down hotspots that may pop up as restrictions are relaxed, said Josh Michaud, associate director of global health policy for the Kaiser Family Foundation.

At the high end, Frieden is calling for a 1-to-1,000 ratio, but the John Hopkins Bloomberg School of Public Health and the Association of State and Territorial Health Officials have asked Congress to fund a third of that number, or 100,000 tracers, as part of a $3.6 billion emergency funding effort, Michaud said.

One thing they do agree on? The 2,200 trackers on hand nationally before the pandemic falls woefully short, he said.

“We have a massive shortage,” Michaud said. “Different jurisdictions have different needs, but the point is that most if not all levels of governments here or anywhere around the world are not where they need to be in terms of having enough contact tracers. Until we do, reopening is a huge risk.”

 

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