As New Hampshire starts to ease restrictions put in place to curb the coronavirus pandemic, the practice of contact tracing is expected to become more important.
“It’s the cornerstone for any kind of safe reopening,” said Semra Aytur, an associate professor of health and management policy at the University of New Hampshire.
Aytur said countries that have been successful containing the spread of COVID-19, the disease caused by the virus, did it partly through the early adoption of aggressive contact tracing. Contact tracing is when a public health professional investigates an individual case of an illness, talking to the infected person to determine where and when they contracted the illness, and who they have been in contact with before and after they were tested.
“It’s not even a new or necessarily sophisticated process,” Aytur said. “The whole notion behind it is human relationships.”
Contact tracing has been done for decades with other diseases, Aytur said.
Jake Leon, director of communications for the N.H. Department of Health and Human Services, said the state Bureau of Infectious Disease Control routinely engaged in contact tracing prior to the COVID-19 pandemic.
“This is right in their playbook,” Leon said. “We have outbreaks of infectious diseases throughout the year.”
Typically, the Bureau of Infectious Disease Control is dealing with outbreaks like norovirus or measles, not a global pandemic. However, the principles of contact tracing remain the same.
“It’s like the other diseases, but on a magnitude we haven’t seen before,” Leon said.
Contact tracing was used early this year when the goal was to contain coronavirus by identifying where it was being contracted. As it became apparent that COVID-19 was spreading throughout the state, the goal changed somewhat, Leon said.
“It was no longer about where there was a risk of exposure, because that was everywhere,” Leon said.
Contact tracing continues, though, as the state works to identify people who test positive and those they’ve been in contact with, to get them to isolate, Leon said.
Leon said once a positive test comes back, someone from the Bureau of Infectious Disease Control contacts the patient, usually within a day, to investigate where and when they might have contracted the illness. State epidemiologist Dr. Benjamin Chan has said this means the patient is interviewed about activities during the time they were infectious, and the department sets about tracking down people who might have been exposed to the virus by that patient. Those people are asked to self-quarantine for 14 days so they do not spread the virus.
The process is effective, if time-intensive.
“Contact investigations average about an hour each, notification calls average about 15 minutes, and the staff can complete seven to eight monitoring calls per hour,” Leon said in an email.
Leon said as the outbreak has changed over the past few months, the contact tracing team has kept up with it. Initially the Bureau of Infectious Disease Control worked on it alone, then added help from other DHHS teams, and then the bureau started hiring furloughed nurses and other medical professionals, as well as using N.H. National Guard soldiers. The bureau is now partnering with ConvenientMD to conduct contact tracing as well. The state has between 100 and 125 contact tracers right now, which is enough for the number of cases New Hampshire is experiencing, Leon said.
“However, we continue to pursue staffing contracts for short and longer term needs. In the short term, additional staffing would allow us to ramp up contact tracing efforts should the need arise,” Leon said in an email.
The contract with Convenient MD hasn’t yet been submitted to the Executive Council for approval, he said. The contract will have a set term which will be used as a ramp down for contract tracing. When that contract winds down and the other state employees and volunteers return to their normal positions, the state will continue to make sure the Infectious Disease staff are able to keep up with the needed contact tracing work, according to Leon.
Leon did not provide a pay scale for contact tracers in New Hampshire. A recent contact tracer job posting in Concord listed a pay range of $13-18 per hour. Massachusetts is bringing on at least 1,000 contact tracers, as its state Department of Public Health is partnering with the private firm Partners in Health to hire and train the workers. Partners in Health is starting contact tracers at $27 an hour for work that does not require medical experience. Potential contact tracers need the ability to interact with people, and basic computer skills for the position.
Some New Hampshire cities like Nashua and Manchester do their own contact tracing, in coordination with the state teams. Bobbie Bagley, Nashua’s director of public health, said she has public health nurses, other city employees, and teams of volunteers, like school nurses, contributing to the effort. Twelve to 18 people are contact tracing in Nashua.
“It’s time-consuming,” Bagley said.
The teams go out and make contact with people who test positive and their families in order to identify people at risk, and encourage people to self-isolate if needed, Bagley said.
New Hampshire’s efforts may not be enough as the state reopens in the coming weeks. Jeanelle Boyer, a professor of health science and researcher at Keene State College, said the state will need to ramp up the number of people doing the work.
“We still need more resources, and we need more people who are capable of doing it,” Boyer said. “There’s a need to take the scale up a notch, or several notches.”
Boyer said it is time to consider a smartphone app people can download to gather data used to help with contact tracing. Leon declined to comment on whether the state is considering that approach.
Leon said the state remains ready to add contact tracers as needed, based on the data. If there is a surge in positive cases as the summer progresses, the state will add contact tracers.
“We’re trying to maintain flexibility, to expand quickly as needed,” Leon said.
Aytur said it is important to have consistent training programs to get people ready to be contact tracers, but that a good training program can be deployed fairly rapidly to have people out doing the work in short order. The key skills for contact tracers don’t necessarily require medical training. The ability to put people at ease is vital.
“It’s really about being able to talk to people, ask them questions about their health, and getting them to trust you,” Aytur said.
Resources are coming together to get contact tracers trained, such as the recent free online course offered by Johns Hopkins University. The training in New Hampshire is led by the Bureau of Infectious Disease Control staff.
Aytur said people should know contact tracers are members of their communities, and their work will go a long way to helping build that trust.
“[It] might help people trust more if they are more open about the process and who the contact tracers are,” Aytur said. “That worked with Ebola.”