Public health officials revealed the scope of their expanded contact-tracing program at a Board of Supervisors meeting this week, during which Health Officer Sara Cody said her staff must be prepared to manage up to 75 cases a day after the economy is reopened and people return to work or school.
The added staff and associated services could cost $50 million or more, said county officials.
The Santa Clara County plans underscore the massive undertaking facing the state as public health officials prepare to ease social-distancing restrictions and anticipate a jump in new coronavirus cases. Contact tracing is one of the linchpins of safely reopening — it’s meant to quickly break chains of infection and prevent new cases from spiraling into outbreaks.
But it’s labor-intensive work, requiring hours of phone interviews and daily check-ins for all infected people and their contacts. Gov. Gavin Newsom has said he’d like to add 20,000 people to the state’s contact-tracing programs to keep on top of the outbreak. Nationwide, public health experts have said the U.S. will need hundreds of thousands of contact tracers.
“This is core to the public health effort to control spread of communicable disease. And we’re going to need to do it at a scale we’ve never done before,” Cody told county supervisors on Tuesday. “This is going to be a very, very, very large body of work. We’ll look for as much external support as we can. But this is going to be a very large and expensive scope of work.”
Santa Clara and five other Bay Area counties last week extended a regional stay-home order through the end of May, with the understanding that they won’t reopen until several key metrics have been met to protect the public from future outbreaks.
One of those metrics is a robust enough contact-tracing program to investigate at least 90% of cases and at least 90% of their close contacts. Few, if any, of the counties are meeting that goal.
Santa Clara County, like almost all California counties, has relied on a relatively small staff of contact tracers in the past to investigate communicable diseases like measles, HIV and tuberculosis. But the coronavirus presents an enormous new challenge because of the number of people infected and how easily it spreads from person to person.
The Public Health Department was able to keep up with investigating coronavirus cases in Santa Clara County until early March. But as the virus began spreading widely — and new infections exploded from five or 10 a day to 50 or more — it became impossible to do contact tracing on every case.
Case counts have fallen off since the Bay Area began sheltering in place seven weeks ago, and Santa Clara County public health officials say they are starting to do contact tracing on all new infections again. The department has fewer than 50 staff members doing that work now, and is able to investigate up to 25 cases a day. The county had about 2,300 cases as of Wednesday.
But once the shelter-in-place orders are lifted, cases will climb — and so will their contacts. At the moment, each case is associated with only two or three close contacts, since almost everyone is staying home and avoiding social interactions. When people return to their regular activities, each case could have up to 40 close contacts, public health officials said.
Cody told the Board of Supervisors that she wants to be prepared to investigate up to 75 cases and their contacts every day.
“Hopefully not more than that,” she said.
That will require a staff of 1,000, about 680 of whom would be contact tracers, Cody said. The staff will need to be flexible, expanding and contracting as cases wax and wane, but during peak times, hundreds of tracers might be working 24 hours a day, seven days a week.
The county won’t necessarily need all of that staff hired before it eases shelter-in-place restrictions, but Cody did not say this week how many people she expected to have by the end of the month.
“Our goal is to onboard as fast as we can without face-planting,” she said. “We can’t do this fast enough. Even in a week or two, our team will be significantly expanded.”
Cody said they will hire tracers from a variety of sources: public health and other county departments, for example. Some may come from city and school district staffs. The county also is working with Heluna Health, a Los Angeles nonprofit that provides staff and support services to public health and other agencies.
She also said they will depend on volunteers to help keep costs under control. Public health officials said they already are getting calls from people eager to help, and they expect to put together a formal application process.
County officials said they plan to develop their own workforce and not rely on a state training program to fill their ranks. Newsom announced a state partnership with UCSF and UCLA this week to train up to 3,000 people a week.
“This is all foundational so we can more quickly move to modify our stay-at-home order,” Newsom said Monday.
The state training program was piloted with the San Francisco Department of Public Health, which has roughly tripled its contact-tracing staff over the past two weeks, to about 150 tracers. Tracers get about 20 hours of training, most of it online.
“You’re talking about doubling or tripling the size of the public health staff,” said George Rutherford, an infectious disease expert at UCSF who is principal investigator of the state training program.
Rutherford noted that many counties have dramatically scaled back their contact-tracing staffs over the past several decades, partly due to vaccination efforts that nearly wiped out many infectious diseases that once were widespread. He said he hoped public health departments would try to maintain larger programs once this pandemic is over.
“The public health departments have been whittled down over the years. But these threats aren’t going away,” he said. “I’m hopeful that we’ll be able to get a new dawn in public health, as people understand that these are the kinds of numbers we need.”
At the very least, Rutherford said, the contact tracers hired now may be well suited to help again once a vaccine is developed. That may be the next massive public health undertaking — immunizing tens of millions of Americans.
Erin Allday is a San Francisco Chronicle staff writer. Email: [email protected]