The state’s public health office is on the brink of launching a new contact tracing program that aims to quickly track down Georgians who may have been exposed to the coronavirus.
The effort, which officials say will involve hundreds of trained state employees and volunteers, is one of the cornerstones of Gov. Brian Kemp's effort to reopen the economy. The Kemp administration has faced criticism for his decision to ease some business restrictions in a few days. It's hoping that contact tracing and expanded testing will help contain the spread of the virus and allow Georgians to gradually return to everyday life.
“This has really shifted to become our priority focus in the weeks ahead,” Public Health Commissioner Kathleen Toomey said Monday. “This is the way we’re going to stop the virus.”
Contact tracing, mixed with diagnostic testing, is a widely used public health tool. The state has long used it to track tuberculosis and sexually transmitted diseases.
The work is time-sensitive and requires some detective work. Tracers reach out to people who test positive for an infectious pathogen, offer help and inquire about their recent close contacts. Those contacts are then notified and put under quarantine. If they test positive the process repeats for their contacts.
Contact tracing has been listed by the White House as a core responsibility for states looking to lift coronavirus restrictions.
Independent public health experts question whether Georgia has the resources ready to respond to new outbreaks that could occur as Georgia eases social restrictions. The state may need thousands of contact tracers, they say.
Georgia in recent weeks has expanded testing. Experts estimate it’s still not enough and Georgia might need to double or even quadruple the number of tests for COVID-19 it’s performing each day.
Georgia’s chronic underfunding of public health has hindered its response to the pandemic, said Allison Chamberlain, acting director of the Center for Public Health Preparedness and Research at Emory University.
The incubation period for this coronavirus is a few days, meaning public health officials have little time to trace the steps of infected people before those who are exposed become contagious.
“We need to do this very fast,” Chamberlain said.
The coronavirus represents a challenge on a far larger scale than previous public health crises, Toomey said. Georgia has more than 20,000 confirmed cases and many more people are believed to be infected but have not been tested due to shortages.
“It’s literally going to take a village for us to work together to do this,” Toomey said of contact tracing.
Scaling up
State officials have provided little detail about what the contact tracing program will look like, when it will be operating and how much the Kemp administration is planning to spend on it. A Georgia Department of Public Health spokeswoman said more details will be available in the coming days.
DPH’s epidemiologists will serve as “incident commanders,” Toomey said, and are putting together training videos that will be shown to staff in the state’s 18 public health districts, which will be on the front lines of carrying out the work.
Toomey said she envisions recruiting additional workers from other state agencies and students from Georgia's medical and public health schools. There are also discussions about folding in the National Guard, which has already been mobilized to audit sanitation and test for coronavirus cases at assisted-living facilities.
The contact tracing work will be a major undertaking for the state, but it represents a mere fraction of what some public health experts say is needed to keep proper tabs on the virus.
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The state of Massachusetts alone has plans to hire nearly 1,000 contact tracers. China deployed more than 1,800 teams of at least five epidemiologists to work in Wuhan, where the virus first emerged, according to the World Health Organization.
Dr. Harry J. Heiman, a professor at Georgia State University School of Public Health, said Georgia might need thousands of tracers. He said he was encouraged DPH is reaching out to the colleges to recruit people. But it also will take time to staff all 18 public health districts and train workers.
Georgia and other states locked down their economies because they lacked the testing and contact tracing capacity to quickly isolate infected people and contain the virus.
Heiman said the state needs to be thinking about how to test and contact trace by neighborhood in every corner of the state.
The hardest hit Georgia residents – largely minority and poor populations – often lack robust health coverage and reliable transportation to reach testing sites, Heiman said. That’s where testing paired with contact tracing is critical.
“That means not just drive-through centers,” Heiman said. “We have significant portions of communities who don’t have cars. The barrier of entry for testing can’t be cars.”
Tom Frieden, the former head of Atlanta's Centers for Disease Control and Prevention, said an "army" of 300,000 contact tracers is needed nationally. The Association of State and Territorial Health Officials, the trade group representing the nation's public health agencies, and the Johns Hopkins Center for Health Security recently recommended 100,000 paid or volunteer workers. Based on those figures, Georgia would need to hire some 1,600 people at a potential cost of more than $50 million to follow this approach, the AJC previously reported.
CDC Director Robert Redfield told The Washington Post Tuesday that the Atlanta-based federal agency has plans to hire at least 650 additional people to aid state-level contact tracing and other efforts. He suggested that Census Bureau workers and volunteers from AmeriCorps and the Peace Corps could also be tapped for such work.
Portal in the works
Traditionally, contact tracing is done in person and over the phone, but DPH said a web portal is being developed for Georgia that will “eventually enable us to rapidly expand contact tracing efforts across the state to help prevent the spread of COVID-19.”
DPH declined to share additional details. The AJC reported Tuesday that the portal being produced by a company called MTX Group in coordination with Google.
On Monday, Kemp described the project as “a self-reporting app” in which DPH, with patient consent, “can use enhanced contact monitoring and tracing.”
Rival tech giants Apple and Google announced earlier this month they were jointly developing contact tracing technology for their Android and iOS smart phone operating systems that would alert users if they’ve been near someone who has tested positive for the virus.
People would opt in for the alerts, and those infected would need to report their cases into the system, but the venture has raised concerns from some privacy advocates who worry the data could be used for surveillance or sold to advertisers.
“There needs to be clear restrictions on how this (data) can be used and … discarded when the pandemic is over,” said Andrea Young, executive director of the ACLU of Georgia.
Staff writer Greg Bluestein contributed to this article.
What is contact tracing?
Trained workers reach out to people who test positive for an infectious pathogen like the coronavirus, offer help and inquire about their recent close contacts. Those contacts are then notified and put under quarantine, and if they test positive the process repeats for their contacts.
