Why States May Fall Short on Contact Tracing - Bio-Defense Network
May 2020

Why States May Fall Short on Contact Tracing

Shreya Kangovi writes for the Institute for Healthcare Improvement that the US National Governor’s Association and public health experts have recommended a multibillion dollar federal investment in contact tracing. This tool for preventing the spread of infectious diseases, they asserted, is necessary to ease the physical distancing measures imposed because of the COVID-19 pandemic and safely restart the economy.

Yet, unless contact tracing is conducted by trusted community members and coupled with social and economic supports, the US risks wasting precious time and money on an ineffective approach.

Imagine George, a 43-year-old restaurant worker from Southwest Philadelphia who supports his family. Now imagine a 22-year-old volunteer graduate student tracer from a different sociocultural background calling to explain that George was been exposed to COVID-19. George is hardly surprised by the fact of his exposure; he takes the bus every day and works in a crowded galley kitchen.

The tracer goes on to pedantically “educate” George about the need to self-isolate. George understands the importance of self-isolation, but he doesn’t know how he can possibly do it. Who will explain this to his boss? How is he is going to put food on the table? When George is compelled to break quarantine to return to work or buy groceries, he will become “the bad guy” and could even be fined. The result is victim-blaming and hardship for George and continued spread of COVID-19.

(NOTE: Bio-Defense Network recognizes the challenges faced by Contact Tracers who are not reflective of the community they are calling and is working to attract Tracers with a range of socioeconomic backgrounds and experiences.)

Circumstances like George’s call for a trusted individual who can advocate with employers, battle eviction notices, drop off food, and connect to the health care system.t

Fortunately, this type of person exists, and is called a community health worker. Community health workers are not just random do-gooders, but a bona fide workforce with an official Bureau of Labor classification. For the past 80 years, US community organizations, public health departments, and health systems have hired community health workers, trusted laypeople who come from within the communities they serve. Their job is to meet people where they are and support a broad range of social and health needs. Community health workers have a strong scientific and economic evidence base behind them, including the proven ability to save Medicaid $4,200 per beneficiary. If scaled to even 15 percent of Medicaid beneficiaries, this would save US taxpayers $47 billion per year.

Community health workers can form the backbone of nascent contact tracing efforts. They can provide social, economic, and preventive health support to individuals and families. They can link together surveillance, health care and public health systems. 

At a time of historic unemployment, community health workers can be hired, trained, and deployed in a matter of weeks, creating jobs for those from the hardest hit communities. By not just employing, but deploying this workforce, community health workers can be the key to opening and growing our economies.

Yet, we aren’t talking about them. The national conversation has focused on mobilizing an army of contact tracers made up of volunteers, furloughed nurses, or public health students. This strategy does not consider the daily realities of the communities these tracers intend to help and the assets that already exist within them.

As states and local health departments race to launch contact tracing initiatives, they need a more comprehensive workforce strategy that incorporates community health workers. For communities facing some of the biggest impact of COVID — i.e., racial and ethnic minorities, lower-income populations, etc. — community health workers can conduct contact tracing, and provide holistic support. In other communities, a surge army of volunteer tracers or even technology-based solutions may suffice.

Funding streams need to support this hybrid approach. My organization, the Penn Center for Community Health Workers, is leading a growing coalition of organizations, including the Institute for Healthcare Improvement, the American Public Health Association, the National Association of Community Health Workers, and NAACP that urges Congress and CMS to authorize sustainable funding for community health workers. Short-term backing for community health workers and surge contact tracers can come from a public health infrastructure fund and emergency supplemental funding, as is recommended by the Association of State and Territorial Health Officials. Longer-term funding for community health workers could come directly from the Centers for Medicare and Medicaid Services (CMS). A combination of workforce types and financing would help ensure a right-sized approach to sustaining a workforce that can save lives and livelihoods during the pandemic and the recovery that follows.

Health care “solutions” are often designed by and for privileged individuals, and thus tend to be overly simplistic and out of touch with reality. If the US is to contain COVID-19 and have a chance at safely lifting current restrictions, we need to design for people like George. Unless we protect and support individuals like him, COVID-19 and all its consequences will surge on.

Shreya Kangovi, MD, MS, is the founding Executive Director of the Penn Center for Community Health Workers, and an Associate Professor at the University of Pennsylvania Perelman School of Medicine.

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