West Virginia’s Contact Tracing Needs Illustrate ‘The Paradox In Public Health’
As West Virginia continues to reopen its economy, Gov. Jim Justice and public health officials have called for more personal protective equipment, more testing and a plan for contact tracing.
Contact tracing is an important part of making sure highly contagious diseases like the coronavirus don’t spread. The practice helps tell people whether they have come in contact with an infected person, which in turn, can help guide treatments and reduce further exposure.
But as local health departments have seen their budgets cut in recent years, many don’t have the staff to facilitate the sudden and increased need for contact tracing.
Dr. Sherri Young, who serves as the health officer and executive director for the Kanawha-Charleston Health Department, said her agency has employed extra people and drawn on help from the National Guard.
KCHD is one of the largest health departments in the state. But, according to the Department of Health and Human Resources, nearly half of West Virginia’s county health departments have fewer than five full-time employees.
“We've had help from the county employees, we've had our own internal staff retrained to do this contact tracing,” Young said. “So at any given point in time, we have about 10 to 15 staff dedicated directly to contact tracing.”
As Justice began to roll out the state’s plan to reopen, state health officer Dr. Cathy Slemp said she expects West Virginia will need about 270 to 300 people to conduct contact tracing, based on models that call for 15 contact tracers for every 100,000 residents.
But many local health departments in West Virginia don’t have enough resources to handle the existing needs within their communities. West Virginia University’s School of Public Health is partnering with the state DHHR to create a training program to get more contact tracers in place.
Dr. Christopher Martin is one of the professors leading the program, and he noted that guidance from the Centers for Disease Control and Prevention indicates that people don’t need experience in public health to learn how to do contact tracing.
He and others have created an online training that will take 14 to 16 hours. He says they’re targeting three broad groups: Students, including undergrad public health majors and graduate students in public health and related fields; licensed health professionals and students who need additional clinical hours to complete their degrees; and concerned citizens who want to volunteer.
“This is something that, anyone with the right interpersonal skill set and motivation, we can train them to do this,” Martin said.
The three-credit-hour course for public health students will begin on May 18.
“But that's not quick enough to meet the needs,” which is why they’re targeting the other groups, too, Martin said.
He said the volunteer interest has been huge.
“My inbox has been flooded with emails — but they're very edifying emails — from people in communities who say, ‘Look, I'm retired, or I'm available or I'm at home with kids and I want to do my part to help our state's response,” he said.
Martin said those who complete the training will be placed in the field with the National Guard members or local health department representatives for about 40 hours of practical experience.
But public health experts acknowledge some major challenges still exist.
Dr. Rahul Gupta currently serves as the senior vice president and chief health officer for the March of Dimes in Washington, D.C., and was formerly West Virginia’s public health commissioner under two administrations.
“I think what you're going to find for both the safety of the contact tracers — as well as those individuals who may be tracing — that a lot of this work will be done remotely,” Gupta said.
While contact tracing was commonplace in public health long before the coronavirus pandemic, the ability to do the work in person was critical, because picking up on non-verbal cues can make the process more complete, Gupta said.
“The challenge of remote work of course, is you are totally dependent on the other person, the other side's ability to pick up the phone,” Gupta said. “And they may not be in a position to pick up the phone — especially if they're at home alone and really sick or somewhere else. And so we may actually have a lot of unknowns rather than being able to track people down.”
With more than 180 cases reported in Kawawha County from at least 40 clusters Dr. Young with the Kanawha Charleston Health Department said the work of contact tracing will be time consuming and require a lot of resources.
“When you have to call their household contacts and see who they've been in contact with, where have they traveled and who did they work with, what was the last time they were in the office, what day did they get symptomatic — the contact tracing piece gets very in depth as far as what we need to know to help keep people around them safe,” Young explained.
Martin, of WVU, said gaps in resources like contact tracing come as no surprise.
“There's something that we call the paradox in public health, which is that we only care about public health after there have been failures of public health as we see before us now,” he said. “And the countries that have responded very effectively — when you look at those countries, what they have in common is a past failure.”
The DHHR said they are working with regional epidemiologists to deploy additional contact tracing staff to the counties that need it based on the number of cases and what existing staff are available.