When Louisiana began to open back up again after a hard lockdown this spring, Gov. John Bel Edwards touted two key antidotes to ensuring coronavirus did not spin out of control again: testing and contact tracing.
Things haven’t gone according to plan.
Baton Rouge, Lafayette, Lake Charles and several other cities are struggling to contain the virus. Hospital intensive care units are overwhelmed. School leaders don’t know whether they should open classrooms in the fall. And Louisiana has the highest per-capita rate of known coronavirus cases in the nation.
Contact tracers are supposed to speak with infected people as soon as they test positive, find out who they’ve been in contact with, and warn those people to self-quarantine. But that’s proved easier said than done: Early concerns about whether people would be unwilling to talk to contact tracers have been just one obstacle. Now, delays in test results are making it nearly impossible for contact tracers to do their work effectively.
In many cases, positive test results take as long as a week to return. By the time that happens, and contact tracers are able to get in touch with the person affected, the virus may have already left the sick person’s system and infected several new hosts. The state has spent $8 million on contact tracing since May 15, thanks to a $190 million federal grant for testing and tracing that’s supposed to last through 2023.
By then, state officials project they will have spent $48 million on contact tracing.
Though Louisiana now employs nearly 700 contact tracers, that group is still outnumbered by new daily cases, which have averaged 1,927 per day since July 20. When those people answer their phones, nearly three-fourths of them still aren’t providing the names of “close contacts” whom they may have infected.
As a result, it’s a pretty leaky system.
Take the case of Priscilla McCraney. She got a coronavirus test on July 19 in New Orleans after she spent time with family members who later tested positive. She said her only clue she might be sick came when she sniffed a candle at a Ross store and realized she couldn’t smell it.
Government contractors in Louisiana have been swamped with thousands of job applications for a federally-funded program to track and isolate n…
By the time her results came back positive on July 24, she felt fine again and had gotten her sense of smell back. She didn’t hear from a contact tracer until July 30 — 11 days after she got tested, and six days after she found out she was positive.
“Just imagine all the people like me who don’t have any symptoms or [have] just loss of smell and think it’s sinuses,” said McCraney, 36. “It’s really scary to think … if I go back to work and there’s somebody else that doesn’t have any symptoms, they’re spreading it all over again.”
By the time tracers reached her, McCraney’s infection was long gone, and it was way too late to warn people she had contact with that they might have been exposed.
“If someone isn’t tested until they show symptoms and you don’t get the result and begin to trace for seven, eight, nine days after that, there’s not a lot of benefit to tracing,” said John Barry, the New Orleans historian who wrote “The Great Influenza,” a bestseller about the 1918 flu pandemic.
As research for a coronavirus vaccine continues to ramp up worldwide, more and more clinical trials are coming to Louisiana.
Barry said slow test results, high numbers of positive cases and high rates of community spread all frustrate effective contact tracing. A tool developed by George Washington University says that, based on Louisiana’s current caseload, the state needs more than 12,000 contact tracers to do the job well.
Still, public health officials, contact tracers and Barry all say that having a contact tracing system that’s not keeping up is still better than having no system at all.
“In a situation like this, contact tracing is not as effective as it could be compared to a world where cases are lower and community spread is lower and easier to identify,” said Omar Khalid, chief of staff for Louisiana’s Office of Public Health. “You can’t use contact tracing as a silver bullet anytime, but especially when you’re seeing spread on this level … but we still think there’s value in it.”
More people answering phones, but not giving contacts
One bit of good news: More people are now talking to contact tracers than when the effort first started.
In early June, tracers were only reaching 48% of the people they called.
That number has improved dramatically, with contact tracers now reaching 69% of the people they target. Of those they’ve contacted, 27% have not answered or returned calls, while 4% have flatly declined to answer questions.
But while contact tracers are having better luck reaching people, they’re struggling to get them to cough up the information that they most need: 73% of people talking to tracers are not providing a list of close contacts.
Anyone who spent at least 15 minutes within 6 feet of the infected person within 48 hours of the person testing positive is considered a close contact.
They say lightning never strikes the same place twice.
“They’re saying there’s not any other person they’ve been in contact with shortly before they’ve become symptomatic,” Khalid said.
Those who have provided names have listed a total of 13,475 close contacts. So far, contact tracers have been able to reach 76% of them, with 5% declining to answer any questions.
Despite the challenges, Khalid said it makes no sense to give up on contact tracing when cases begin to overwhelm the state’s ability to keep up. If they did, health officials would lose useful information about where outbreaks are stemming from, how people are recovering and more, he said. Barry noted it’s also important to have the infrastructure for contact tracing in place for when cases come back down.
The Department of Health declined to make any contact tracers available for an interview. But a Louisiana contact tracer who participated in a Reddit “Ask Me Anything” forum on July 20 said the job felt like drinking from a fire hose.
The largest hospital in Louisiana, Our Lady of the Lake Regional Medical Center in Baton Rouge, is down to a single available intensive care b…
“Back in June when there were only 500ish cases a day, it felt like we were doing something worthwhile,” the tracer wrote. “Now with 2000+ cases a day, it feels like what we are doing isn’t helping that much. I think the most important thing we do is data collection for the state’s epidemiologists as they are using what we give them to make their decisions on the virus.”
Contact tracing existed in Louisiana since long before the pandemic, and has been used to track the spread of diseases like mumps and tuberculosis. In the early days of the pandemic, a small state team tried to keep up. Since then, hundreds of others have joined the effort.
Emily Rawls, 30, of New Orleans, was among the team’s first targets: She talked to contact tracers in mid-March after she tested positive for coronavirus. But she said the contacts she named told her they never heard from the state.
Khalid said that at a certain point in the spring, it became clear the spread of the virus in New Orleans was too broad and the department’s resources were spread too thin. That’s when the state brought in four private companies to help: Lafayette-based Calls Plus and Hub Enterprises, West Monroe-based Coast Professional and Kenner-based Hammerman and Gainer.
‘It’s Louisianans calling Louisianans’
Those contractors say they’ve adjusted the way that they work in hopes of reaching more people and making them feel more comfortable.
Contact tracers used to call with no advance warning, and few people answered. Now, they usually text first, to say a contact tracer will be calling, and imploring people to answer.
Contact tracers have also learned more about how to counsel the people they call — many of whom are going through difficulties as they battle the virus and the anxiety surrounding it, said Barbara Lamont, president of Calls Plus. She said tracers are often talking people through mental health crises, and they try to connect people to helpful resources, like suicide hotlines.
Another lesson, Lamont said, is that health officials and members of the public interpret the phrase “contacts” differently. Tight-knit families in Louisiana don’t necessarily think of kin as “contacts,” she said.
“They think of contacts as strangers, and they’re reluctant to give you their mother and brother,” Lamont said.
When Dr. Lindsey Jackson arrived last month to work a stint at a New Orleans field hospital, she expected hundreds of coronavirus patients wou…
Coast Professional, Inc. has added 200 workers in a month, for a total of 300, to try to keep up with the workload, said Brooke Singletary, vice president of business development.
Hub Enterprises doubled its contact tracing staff to nearly 400 since its work with the state began in mid-May. Staffers are working from 8 a.m. to 8 p.m. Monday through Saturday, and from noon to 8 p.m. on Sundays.
Hub’s vice president, Robin Buchanan, said her company has also added 40 employees — on top of the nearly 400 doing contact tracing — to take calls from people returning messages from contact tracers.
Buchanan urged people to learn the phone numbers: contact tracers call from (877) 766-2130 and they text from 225-396-5389.
Louisiana became the 12th state to surpass 100,000 confirmed coronavirus cases.
“It’s Louisianans calling Louisianans,” Buchanan said. “It’s your neighbor, the person down the street — we’re just trying to get the information we need to protect people and to give proper notice that they’ve been exposed.”
Sometimes, it all works pretty well. Matthew Nichols of Metairie, 47, got tested for coronavirus, received his positive result and heard from a contact tracer all within the span of five days in late June.
He said contact tracers quickly followed up with his wife, and he received daily messages from contact tracers checking in afterward.
But that’s not always the case.
Soranny Martinez, 31, of New Orleans, got tested for coronavirus in early July and found out she was positive a few days later. She got another test a little over a week later to ensure the virus was gone.
A 31-year-old woman checked in to a New Orleans hospital this spring after five days of fever, cough and stomach pain. Hospital workers stuck …
It wasn’t until after she took the second test that she heard from a contact tracer. About the only part of the system that worked as it should have: Contact tracers immediately called her mom after they got off the phone with her.
“I would have guessed they would have called me earlier,” Martinez said.