Contact tracing — finding and notifying everyone who has had close contact with a person infected with the coronavirus — is key to stemming the pandemic. Once people learn they’ve spent time near someone who had the virus, they can get tested themselves and quarantine so they don’t infect others.
Bay Area county health departments ramped up in April and May to handle the laborious process, most of it armchair detective work by phone and email, not the high-tech surveillance some in Silicon Valley originally envisioned. But the recent surge in cases has made the task much harder, because there are more people to contact and because it takes longer to be tested and then get the results.
Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara counties all fall short of their goal of doing case investigations for 90% of the people who test positive, and then reaching out to 90% of the folks those people had close contact with while they were infectious.
Napa, Sonoma and Solano counties did not respond to requests for information.
When it comes to reaching contacts of the people who tested positive, the counties range from 70% to 80%, except for Contra Costa, which reaches only 26% of those who had contact with infected people, and Marin, which reached only 46% (its numbers are older). Still, those numbers are far better than those in New York and some other states.
“Obviously we want as many as possible because that’s where you get the most bang for your buck,” said Dr. George Rutherford, an infectious diseases expert at UCSF who spearheaded San Francisco’s contact-tracing program. But modeling shows that even reaching 43% of infected people’s contacts provides some disease suppression. “I think the spread would be worse without” contact tracing, even though it hasn’t reached its potential, he said.
Contra Costa County could not say why it is so far below the Bay Area norm, especially since it is closer than Alameda and San Mateo counties to meeting its contact tracing staff goal.
“We’ve been grappling with it,” said Erika Jenssen, deputy director of Contra Costa Health Services. “To do effective contact tracing, we need timely lab results for tests, adequate staffing and to partner with the community.”
She pointed to delayed test results as a major obstacle. While the median turnaround time in the county is four days, many results come in as late as 10 days after testing — by which time a person may not longer be infectious.
The case investigations — interviews with newly diagnosed people — shed light on how the virus has spread since shelter-in-place orders were eased.
“We are seeing more people who were at some kind of gathering; that’s a common source of exposure,” Jenssen said. Contra Costa County investigators found that 18% of those who tested positive had attended large gatherings in the previous 15 days, while 17% had been to in-person workplaces. About 20% had visited restaurants, supermarkets and other stores.
Even counties that have maintained fairly high contact tracing numbers say they struggle with the surge.
Thursday, July 9: 63 new cases today, no new deaths. Since the outbreak started: 1,985 cases, 108 hospitalized, 27 deaths.
Compare previous report, Wednesday July 8:Summary
Solano County reported 63 new cases today, total of 1,985 cases since the outbreak started. Over the last 7 days, Solano reported 509 new cases, an average of 73 per day.
No new deaths today, total of 27.
Hospitalizations – Solano is reporting 1 fewer currently hospitalized person since yesterday, for a total of 39, and held steady at 108 persons in the total number hospitalized since the outbreak started.
Active cases(“The total number of laboratory-confirmed cases of COVID-19 in Solano County residents who are still within 10 days of when their specimens were collected.”) – Solano reported39 more ACTIVE cases today, total of 409. This figure has been climbing steadily: a week ago Monday there were 70 active cases, increasing to a previous high of 369 on last week Thursday and today’s record high of 409. Only 40 of those active cases are hospitalized – a whole lot of infected people are out among us, hopefully quarantined. Seriously, is the County able to contact trace all of these?
ICU beds Available increased by 6% to 37%. Ventilators Available declined by 4% to 82%.
Testing – 556 residents were tested since yesterday, total of 35,680. We still have a long way to go: only 8% of Solano County’s 447,643 residents (2019) have been tested.
Details and Demographics tab
The County’s Public Health Dashboard includes a second tab (panel), “Details and Demographics” (shown here). Note that the Summary tab and this Details tab are both user interactive – hover over a chart (or tap) to get details. On this Details tab, most of the small charts have a small additional tab showing the rate per 100,000. Go there and explore the two tabs. (Expand a chart by clicking the small button in its upper right corner.)
By Age Group
Youth 17 and under – 3 new cases today, total of 192 cases, and no new hospitalizations, total only 2. Two weeks ago, there were only 87 cases among this age group – we’ve seen over 100 new cases in 14 days!I continue to be alarmed for Solano’s youth. Cases among Solano youth have increased in recent weeks to nearly 10% of the 1,985 total confirmed cases.
Persons 18-49 years of age – 46 new cases today, total of 1,188 cases. This age group represents 60% of the 1,985 total cases, by far the highest percentage of all age groups. The County reported no new hospitalizations among this age group today, total of 28 hospitalized at one time, and 2 deaths.
Persons 50-64 years of age – 10 new cases today, total of 381 cases. This age group represents 19% of the 1,985 total cases. No new hospitalizations today, total of 36 hospitalized at one time. No new deaths, total of 3 deaths.
Persons 65 years or older – 4 new cases today, total of 223 cases. This age group represents 11% of the 1,985 total cases.
No new hospitalizations, total of 42 hospitalized since the outbreak began. No new deaths, total of 22 deaths. In this older age group, 19% of positive cases required hospitalization at one time, a substantially higher percentage than in the lower age groups. And this group accounts for 22 of the 27 deaths, or 81%.
Incidence Rate: Cases, Hospitalizations, Deaths
On the Race/Ethnicity chart (and also on the Age Group chart) there are “Rate” tabs. Today’s report shows Solano County with:
Solano County has 442 positive cases per population of 100,000, up from 428 yesterday (Compare this number with the City incidence rates, below.)
24 Solano hospitalizations per population of 100,000, same as yesterday.
6 Solano deaths per population of 100,000, same as yesterday.
Percent Positive Test Rates
Increasingly, national, state and county news reports are focusing on percent positive test rates. Five Bay Area counties report daily on their seven-day average percent positive test rate, but Solano County does not. This information is immediately important, as positive test rates in California and other southwestern states are increasing. I wrote and asked Dr. Matyas on June 24 to supply information as to Solano County’s “percent positive test rate.” He replied next day with thanks and wrote, “We are actively working to include these values on our County dashboard. I hope we can begin to report on them sometime next week.” That was nearly 2 weeks ago… (and I wrote to him again today, will keep you posted).
Vallejoadded 19 new cases today, total of 677.
Fairfield added 26 new cases today, total of 685. Fairfield has seen over 200 new cases over the last week, and now has more positive cases than anywhere in Solano County.
Vacaville added 8 new cases today, total of 308 cases.
Suisun City added 3 new cases today, total of 130 cases.
Benicia added 1 new case today, total of 40 cases. Benicia was extremely stable with only 2 new cases for the entire month of June. Now Benicia has seen 14 new cases in 10 days. The numbers are small in comparison to other Solano cities, but something’s definitely going on in Benicia!
Dixonadded 5 new case today, total of 116 cases. Dixon has also moved from stable to increasing over this last week.
Rio Vistaadded 1 new case, total of 21 cases.
Unincorporated areas – Although the County still still shows Unincorporated at <10 (less than 10), a little math tells the story: Solano’s unincorporated areas remained steady at 8 cases, those unaccounted for in the other City totals.
A “Rate” column shows the rate of positive COVID-19 cases (per 100,000 population) for each city. Benicia has the lowest rate, 145.1 cases per 100,000. Compare Solano cities’ incidence rates in the chart, and note that the CDC reports today’s rate in California at 732 per 100,000 (up from 702 yesterday).
Race / Ethnicity
The County report on race / ethnicity data includes case numbers, hospitalizations, deaths and Solano population statistics. There are also tabs showing a calculated rate per 100,000 by race/ethnicity for each of these boxes. This information is discouragingly similar to national reportsthat indicate worse outcomes among black and brown Americans. As of today:
White Americans are 39% of the population in Solano County, but only account for 23% of cases, 22% of hospitalizations and 19% of deaths.
Black Americans are 13% of Solano’s population, and account for 12% of cases, but 29% of hospitalizations, and 35% of deaths.
Latinx Americans are 26% of Solano’s population, but account for 37% of cases. They account for 25% of hospitalizations, and 23% of deaths.
Asian Americans are 14% of Solano’s population, and account for 10% of cases and 14% of hospitalizations, but 19% of deaths.
A batch of about 500 people will be deployed this week statewide for contact tracing, the public health practice that involves tracking down people who have come in contact with COVID-19 patients.
Starting this week, the tracers will begin calling, texting and emailing those who may have been exposed to coronavirus, encouraging them to quarantine or recommending medical care, according to Gov. Gavin Newsom’s office. Meanwhile, Californians may notice new radio, television and billboard campaigns that aim to up awareness of contact tracing and urge people to pick up the phone. Tracers will be identified as part of the “CA COVID Team” — an effort led by the California Public Health Department — when texting or calling, and will not share health information with outside entities.
The tracers are the first batch toward a goal of 10,000 statewide, according to Newsom’s office. It’s not exactly clear how those tracers will work in tandem with local health departments’ own contact tracing programs.
Working with the University of California, San Francisco and Los Angeles, the state began developing an online training program earlier this month to get the tracers up to speed. Another 300 tracers will be trained this week, Newsom’s office said.
Governor asks Californians to answer the call to help keep our families and communities healthy and on the path to reopening
SACRAMENTO – In the ongoing efforts to mitigate the spread of COVID-19, Governor Gavin Newsom today launched California Connected, the state’s comprehensive contact tracing program and public awareness campaign. As part of California Connected, public health workers from communities across the state will connect with individuals who test positive for COVID-19 and work with them, and people they have been in close contact with, to ensure they have access to confidential testing, as well as medical care and other services to help prevent the spread of the virus.
The state’s program is led by the Administration in collaboration with the California Department of Public Health, local public health departments and the University of California, San Francisco (UCSF) and Los Angeles (UCLA), which have launched a robust online training academy to develop a culturally competent and skilled contact tracing workforce.
“We are all eager to get back to work and play, and that’s why we’re asking Californians to answer the call when they see their local public health department reaching out by phone, email or text,” said Governor Newsom. “That simple action of answering the call could save lives and help keep our families and communities healthy.”
To prevent the spread of this virus, public health workers will connect Californians with confidential testing. They may also recommend medical care,
and that individuals who could be infectious separate themselves from others in their home to protect those around them. Information provided to local public health departments is confidential under California law. Public health authorities will not share that information with outside entities. That information will be used for public health purposes only. Contact tracers will not ask for financial information, social security numbers or immigration status.
“A key step in stopping the spread of COVID-19 is quickly identifying and limiting new cases, across the diversity of our populations – and that’s exactly what this statewide program does,” said Dr. Sonia Angell, California Department of Public Health Director and State Health Officer. “We are bringing together the best minds in public health, academia and private industry to design a program that can help lower the risk for COVID-19 in all of our communities and keep us on the path to reopening.”
The California Connected public awareness campaign is getting off the ground this week with support from multiple private partners who have committed a total of $5.1 million in funding and in-kind resources to help educate all Californians, and underserved communities in particular. These partners include Jeff Skoll and his organizations (The Skoll Foundation, Participant, and Ending Pandemics), The California Health Care Foundation, The California Endowment, Twitter and Facebook, in addition to existing media partners engaged in the larger public awareness effort.
Beginning this week, Californians across the state will hear radio ads and see billboards, social media posts and videos in multiple languages encouraging them to answer the call to slow the spread of COVID-19. Public health workers across the state – identified on caller ID as the “CA COVID Team” – will call, text and email individuals who test positive for COVID-19 and people they may have unknowingly exposed to the virus.
The state plans to launch 10,000 contact tracers statewide as part of its plan to reopen California. More than 500 individuals have been trained under the new contact tracing program, and more than 300 are being trained this week.
To streamline and coordinate these efforts, Accenture, a leading global professional services company, is launching a data management platform developed by Salesforce and contact capabilities (phone calls, texts and emails) in collaboration with Amazon Web Service’s Amazon Connect. These organizations have already successfully implemented a large-scale contact tracing effort in Massachusetts.
A PSA from Director of the California Department of Public Health Dr. Sonia Angell can be found here. Watch the California Connected PSA in English here and in Spanish here. An infographic and other content can be found here.
[Editor: the link in the first paragraph to “the patient in her 40s” is a fascinating account by 10 UC Davis physicians, covering Solano County’s first-in-the-nation community transmitted case of COVID-19. The narrative covers everything from initial intake to the patient’s stable condition and discharge, along with x-rays and treatment timeline. – R.S.]
Coronavirus detectives: Here’s how counties try to track everyone exposed
Back in February, the woman was the first in the nation known to be infected without traveling or being around someone who was sick. But she was too ill to answer questions about where she’d been and whom she had talked to, worked with and touched.
Dozens of public health investigators from local, state and federal agencies fanned out like detectives, questioning the family members who had visited her and the hospitals that had orchestrated her care — even staking out the store where she worked. Their mission: to piece together a list of people who could have been exposed to the virus.
In the end, the list totaled more than 300 people spanning six California counties, Matyas estimated. Four — including three healthcare workers — tested positive, each prompting their own investigation.
This process, called contact tracing, is a critical element in containing the spread of the novel coronavirus. But the ability of California’s 61 county and city public health departments varies greatly as they struggle to keep pace with rising numbers of patients.
“What we had to do was clear from the beginning,” Matyas said. “But actually being able to do it was very hard.”
Some local health departments, like Madera County’s, have managed to trace the contacts of every person who tests positive for the coronavirus. Others, like the city of Long Beach and Placer County, are so overburdened that they are only trying to trace contacts that could put vulnerable people at risk, such as healthcare workers or people in nursing homes.
To handle the pandemic, the nation will need 30 contact tracers for every 100,000 Americans, according to the National Association of County and City Health Officials. But no California city or county has anywhere near that many. Under that formula, for example, Long Beach would need 140 investigators, seven to nine times more than it has now.
North of Sacramento, Placer County, with a population of almost 400,000, would need 120 tracers.
“It certainly illustrates the point that 18 — which is our expanded capacity, which is more than our baseline of six — is woefully inadequate,” said Aimee Sisson, Placer County’s public health director.
Contact tracing will become even more important as the state starts reopening parts of its economy. The concern is that more human interaction could cause flare-ups, especially since people can spread the virus before feeling ill and limited testing leaves people unaware they’re infectious.
“We need to make sure that there is capacity in every county to do adequate contact tracing. That’s part of containing the disease,” said Kat DeBurgh, executive director of the Health Officers Association of California. “Are we ready today? No. When will we be ready? I don’t know.”
Gov. Gavin Newsom addressed the concern about inadequate contact tracing on Wednesday, announcing plans to train 10,000 people to help local health departments. “The good news is we believe we have the capacity to build an army of tracers,” Newsom said, although he did not say when they’d be ready to deploy.
Jeffrey Martin, a professor of epidemiology and biostatistics at the University of California, San Francisco, said that fighting an epidemic is like fighting a wildfire: The state can’t afford to mess up containment.
“[It’s] important to track all of those people down to extinguish all the embers in that brushfire,” Martin said. “If we don’t do it right, and if the brush fires are not extinguished, you’d have to be a magical, wishful thinker, to think that there would not be a raging wildfire.”
Some counties keep up, others can’t
The San Joaquin Valley county of Madera typically has two to three people keeping tabs on tuberculosis and sexually transmitted infections in its population of roughly 157,000 people.
Then, the coronavirus hit — and the initial cluster encompassed about 200 patients and potential contacts, said Madera County public health director Sara Bosse. Thirty-six people have tested positive.
Still, by teaming with the sheriff’s department and probation investigators, the county has managed to keep up contact tracing, isolation and quarantine for everyone potentially exposed.
Madera is unusual in that investigators, typically in plain clothes, visit patients and their contacts in person — sort of. They drop off packets of information as well as a letter excusing work absences to employers. Then they get back into their cars, and answer questions face-to-face through the window, over the phone.
“Then they can explain to them what’s going on,” Bosse said. “We understand that people are experiencing a lot of anxiety and it’s difficult for people to hear this news that they might have been exposed.”
For now, the spread of the virus seems to be slowing.“We’re really hopeful that it’s at least in part due to the active contact tracing that we’ve implemented,” Bosse said.
In Riverside County, cases are coming in faster than the county’s 30-plus person team can investigate them, according to Barbara Cole, branch chief of disease control for the county’s public health department. The county has 3,084 confirmed cases.
It can take multiple phone calls to build enough trust to reconstruct someone’s string of contacts, Cole said.
“It’s about trying to establish a rapport, stressing how we’re going to protect their confidentiality,” she said. “The majority of people, they’re concerned about their friends and their family.”
In the Northern California county of Solano, Matyas quickly realized that tracing and quarantining all contacts would be impossible for every case. To date, 186 people have tested positive in the county.
Instead, the county focuses on tracking the risk to vulnerable populations, including people who are older, have underlying medical conditions, or live without shelter.
Solano County’s communicable disease team, which has shrunk to its original staff of six, first interviews anyone who tests positive about where they work and who they came in contact with. That in some cases is a long list: people who visit their homes, coworkers who sit close or share food.
Then a member of the team calls all of the contacts. The idea is to identify and isolate people who are feeling ill or whose jobs put them at risk of infecting others in nursing homes, hospitals, or homeless shelters.
“We no longer pretend that we can do any kind of active quarantine,” Matyas said. “There’s no bandwidth to check on them to see if they’re doing it.”
Long Beach and Sacramento and Placer counties also are only tracing the virus’s spread through vulnerable populations.
“Instead of asking every place you went to, every person you came into contact with, we say, ‘Have you been in contact with vulnerable populations?’” said Sisson in Placer County. “We just have too many cases for that full interview.” In the county, which is home to the first person to die of the novel coronavirus in California, 133 people have tested positive.
In Long Beach, every case initially was tracked. But then people kept getting sick, and most of the deaths are in long-term care facilities
As people sheltered in place, contact tracing didn’t have to be as extensive. “Now we’re to the point where we have more than 400 cases, and we’re really focusing on our healthcare worker cases, and our cases in our long-term care facilities,” said Emily Holman, communicable disease controller for the city’s health department.
Tracing contacts of people in long-term care facilities is different than in the community at large. Instead of focusing on reconstructing a web of contacts, the aim is to rapidly identify and separate infected and potentially exposed people from healthy people. Speed is key, so if someone’s symptomatic, they’re treated as a case even with no test results.
“Every minute in those facilities can be crucial and could prevent an exposure,” Holman said.
Former CDC Director Tom Frieden called for an army of more than 300,000 contact tracers in an interview with STAT. And current CDC head Robert Redfield announced plans to hire 650 more public health personnel, including to help with contact tracing, the Washington Post reported.
The Bay Area’s Alameda County also has ramped up from just seven staff investigating cases of communicable disease to 60 people assigned to the novel coronavirus — including 18 who follow up with contacts. As the epidemic progresses, “we anticipate deploying as many as 300 staff for contact tracing,” said Nicholas Moss, acting director of Alameda County’s Public Health Department.
Sacramento County is working to expand its six-person team to 30 by recruiting from other departments and training medical students to work with people who are homeless.
“We’re hoping that based on the modeling that’s occurring, that we will be ready — and actually, we’re hoping that there won’t be another wave,” said Public Health Officer Olivia Kasirye.
Is there an app for that?
Some counties are looking to technological help. San Francisco, for instance, is training its contact tracers to use a platform that Grant Colfax, director of public health, called “an integral part of our efforts going forward.”
“We want to make sure that any technological tool we employ where people’s health information is going to be input, that there are adequate safeguards for privacy,” Moss said. Plus, the app has to be easy to use, and it has to cough back up the data needed to keep tabs on the virus’s spread.
Eric Sergienko, Mariposa County’s health officer, worries that if each local health department ends up using different software, it might be hard to trace contacts that cross county lines.
That’s where Sergienko hopes the state steps in and standardizes the platform California’s counties use. “What can the state do for us? Just by finding the best one,” he said.
State Health and Human Services Secretary Mark Ghaly said that California will need 10,000 more contact tracers as it modifies its stay at home order. Between 2,000 and 3,000 people could test positive per day. And each of them could have ten contacts, he said.
California might not have needed to push quite so hard to ramp up during the crisis if it had funded enough public health workers to begin with. “We’ve been seeking increased funding for years,” said Kat DeBurgh, executive director of the Health Officers Association of California.
More trained health workers could be important in fending off the next pandemic.
“By having these trained contact tracing public health workers, we can actually prevent infections, prevent the severe disease from happening in the first place,” said Lee Riley, a professor of epidemiology and infectious diseases at the University of California, Berkeley’s School of Public Health.
“But right now, everything that we’ve been doing is just reactive to what’s already happened.”