California And Texas Health Officials: Mistrust A Major Hurdle For Contact Tracers | WCAI

California And Texas Health Officials: Mistrust A Major Hurdle For Contact Tracers

Aug 10, 2020
Originally published on August 11, 2020 9:31 am

Contact tracing has been one of the key tools in the fight against the coronavirus. Now, as the virus has infected more than 5 million Americans, the U.S. has at least 41,122 contact tracers — but that's not even half what public health experts said would be needed to help contain the spread.

Contact tracers call each person who has tested positive and track down their contacts to inform them of their risk so they can quarantine. They also often connect people with services so they can safely isolate.

In addition to staffing shortages and testing bottlenecks, those who are on the job are running into other big challenges, including the difficulty of getting people to cooperate, health officials say.

Elya Franciscus, an epidemiologist with Harris County Public Health in Houston, estimates that about half of those contacted by her department's contact tracers are not fully cooperative.

In the Los Angeles area, a few businesses have proven problematic — with outsize effects, says Michael Osur, assistant director and chief health strategist of the Riverside County Department of Public Health.

Some businesses have even told staff that if they cooperate with health officials, they'll be terminated, Osur says.

In these excerpts from their interview on NPR's All Things Considered, Franciscus and Osur describe the misinformation that's fueled the lack of cooperation and what can be done.

Let's talk about the issue of trust. When you call people and say, tell me everybody you've had close contact with in the last few days, are they willing to share that information?

Michael Osur: They're willing to tell us about their family contacts, who lives in the house. But they're not willing to share their friends, who they saw, the stores they went to. And that's been a huge problem because much of our spread has been through those informal barbecues, get-togethers and other places these people have been that we are having a hard time tracking down.

Elya Franciscus: It's the same thing in Harris County. ... They'll say, oh, "I went to a party and there were 30 people, but I'm not going to give you their names." When we try to get into the nitty-gritty ... "what bar did you go to?" they won't tell us because then they're afraid we're going to shut that bar down.

Do you run into that sort of thing, one in 10 calls, half the calls? Can you quantify it?

Franciscus: I would say for Harris County is upwards of 50%. I would say half are very cooperative. Another 25% are semi-cooperative and the other 25% are absolutely unwilling to share anything. There's so much misinformation being put out right now. Our contact tracers are being called names; they're being cursed at, derogatory language is being used, because there [have] been seeds of mistrust thrown into the community. ... They think that the numbers are inflated. We've heard multiple people say that we're getting paid to make up results. So it's so difficult to combat all of this.

Osur: Most of the businesses will be very cooperative. But some of the businesses that hire the food processors or the farm workers, they are completely uncooperative and have told their staff who are positive if they cooperate with us, they'll be terminated. So we have two or three businesses that have had major outbreaks that we can't get into at all. And that's been a huge problem.

Do you think there's anything you can do to build more trust and make contact tracing more effective and make people more responsive?

Osur: We are hiring appropriate people to do the contact tracing — race, ethnicity, language. ... They're part of our community. And I think we've not done a good job saying that, "The tracers are you. They can help you be healthy and be safe."

Listen to the full interview at the audio link above.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

ARI SHAPIRO, HOST:

We've known for months that contact tracing is a key part of getting the coronavirus under control. Contact tracing is a two-step process - first, investigating people who've tested positive to find out who they've been around and then calling all their contacts to make sure they can safely isolate. CDC Director Robert Redfield stressed how important that process is back in April.

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ROBERT REDFIELD: The major thrust of how we're going to control and make sure that we continue to keep this nation open is early case recognition, isolation and contact tracing. That's the fundamentals of public health. That's what we're going to do.

SHAPIRO: Well, now as the virus has infected more than 5 million Americans, the U.S. only has about 41,000 contact tracers, not even half what public health experts said would be needed to help contain the spread of the virus. Those who are on the job are running into some big challenges, and we've invited two local health officials to talk about those challenges with us.

Elya Franciscus of Harris County Public Health in Houston, Texas, and Michael Osur of the Riverside County Department of Public Health in the Los Angeles area, thank you both for joining us.

ELYA FRANCISCUS: Thank you for having me, Ari.

MICHAEL OSUR: Thank you, Ari.

SHAPIRO: Both of your states had a steep increase in COVID-19 cases from June into July. The numbers are now going down a bit. How does the number of contact tracers that you have where you are compare to the number you need?

FRANCISCUS: So I can field this one first. We hired the correct number that we anticipated needing at the beginning of the incline. We did not anticipate it climbing so quickly and so steeply, and then we were not able to get as many as we needed to kind of overcome that hurdle.

SHAPIRO: So that's the outlook in Houston. What about in Southern California?

OSUR: In Riverside, Calif., in the county, we had 120 through May. And then when the numbers went - increased, we did a whole big influx of new hiring of temporary workers. And we've now, in the seven weeks, hired 360 contact tracers. The issue is case investigators because there are so many cases we need to interview first so the contact tracers can call people.

FRANCISCUS: And I'll echo that. That's an issue that we're having as well because there's a different level of skill sets needed to be an investigator. You're that initial point of contact for these confirmed cases. And there's just not enough. So then you bottleneck before you can get to...

SHAPIRO: Yeah.

FRANCISCUS: ...Even, the contact tracing piece.

SHAPIRO: For contact tracing to work, people need quick test results. It doesn't do much good to get in touch with close contacts if it takes a week or more for people to find out they have the disease. We should note that California's public health director has just resigned as the state works through a huge backlog of unprocessed tests. Are test results where you are coming in fast enough for contact tracing to work?

FRANCISCUS: So that was a huge issue for us in Harris County for a long time. And we were using commercial labs. But everyone is using commercial labs, so they were quickly becoming overwhelmed. And it was taking up to three weeks for us to get a result, which...

SHAPIRO: Three weeks.

FRANCISCUS: Three weeks - so by the time we were calling people, not only was it no longer helpful in terms of public health infection control, they were upset with us for it taking so long and even less likely to cooperate.

SHAPIRO: Of course.

FRANCISCUS: So we actually now - we've partnered with a local research university. And they're giving us a turnaround time of 48 hours for our test results.

SHAPIRO: Michael, what are things like in Riverside County?

OSUR: Yeah. So originally, we had two- to three-day turnaround with the commercial labs. That expanded to seven to nine days. It's now five to seven for the negatives, but we are seeing two to three days on the positives. But there's still another day delay while it goes through the state system, so I would say we're reaching people about Day 7, which for contacts, that may not be so bad. But yes, when it was nine days, it was not helpful at all.

SHAPIRO: Yeah. Let's talk about the issue of trust. When you call people and say, tell me everybody you've had close contact with in the last few days, are they willing to share that information?

OSUR: They're willing to tell us about their family contacts, who lives in the house, but they're not willing to share their friends, who they saw, the stores they went to. And that's been a huge problem because much of our spread has been through those informal barbecues, get-togethers and other places that these people have been that we are having a hard time tracking down.

FRANCISCUS: Yeah. It's the same thing in Harris County. We actually had to - and we created a software system because our regular system could not handle the number of COVID-19 cases that we were getting. And we actually had to add a button that said, unwilling to share contacts, or, unknown batch of contacts.

SHAPIRO: Wow.

FRANCISCUS: Like, they'll say, oh, I went to a party, and there were 30 people. But I'm not going to give you their names. When we try to get into the nitty-gritty, like, you know, oh, you went to a bar; what bar did you go to? They won't tell us because then they're afraid we're going to shut that bar down.

SHAPIRO: Do you run into that sort of thing, like, with 1 in 10 calls, half the calls? I mean, can you quantify it?

FRANCISCUS: I would say for Harris County, it's upwards of 50%. I would say half are very cooperative.

SHAPIRO: Wow.

FRANCISCUS: Another 25% are semi-cooperative, and the other 25 are absolutely unwilling to share anything. There's so much misinformation being put out right now. So our contact tracers are being - they're being called names. They're being cursed at. Derogatory language is being used because there's been these seeds of mistrust thrown into the community. So when we call, nothing we say can establish that trust where they'll be willing to share information with us.

SHAPIRO: Wow.

FRANCISCUS: They think that the numbers are inflated. We've heard multiple people say that we're getting paid to make up results. So it's so difficult to combat all of this information, this mistrust that's being put out there.

SHAPIRO: Wow.

OSUR: So we're finding - looking at businesses, most of the businesses will be very cooperative. But some of the businesses that hire the food processors or the farm workers - they are completely uncooperative and have told their staff who are positive, if they cooperate with us, they'll be terminated. So we have two or three businesses that have had major outbreaks that we can't get into at all, and that's been a huge problem.

SHAPIRO: Do you think there is anything you can do to build more trust and make contact tracing more effective and make people more responsive?

OSUR: We are hiring appropriate people to do the contact tracing, both race, ethnicity, language. And we have not done a great job of saying, hey, our contact tracers come from the community. The 360 new tracers we've hired were people that didn't have jobs before. They're part of our community. And I think we've not done a good job saying that the tracers are you. They can help you be healthy and be safe. And I - we've not done a great job getting that message out.

SHAPIRO: You know, back in the spring, when everyone was talking about how important contact tracing would be to solving this problem, did either of you expect that it would be this tough?

OSUR: We always said that this was the first wave, and the first wave never ended. And when mid-May came along with Mother's Day, Memorial Day, Father's Day, we tried to get the word out that this has not gone away, that we still needed to wear masks and keep distancing. But things opened up. People didn't listen. And now it's - we've lost all control that was possible in April and early May. Now we have to put that genie back in the bottle.

FRANCISCUS: Yeah - similar to Harris County. I mean, we do use contact tracing, but it's one tool among many that public health workers utilize. So when so much onus was being placed on the importance of contact tracing, we did agree, but we knew that it was going to have to be a multifaceted approach. It was going to have to be used in conjunction with, you know, shutting down businesses, shutting down restaurants, social distancing, mask-wearing. So whenever those measures only lasted a month and they expected contact tracing to basically fill in all those gaps, that was never going to be successful.

SHAPIRO: That's Elya Franciscus, an epidemiologist with Harris County Public Health in Houston, Texas, and Michael Osur, assistant director and chief health strategist at the Riverside County Department of Public Health in California.

Thanks to both of you.

FRANCISCUS: Thank you, Ari.

OSUR: Thank you, Ari.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.