A true story of contact tracing in Arkansas:

An Arkansan had symptoms of Covid-19 and was tested in mid-June. He received a positive result 7 days later. He was contacted by a contact tracer 9 days after the results were returned, 16 days after the date of his test.

By this time, the man’s wife, who was advised by the contact tracer to quarantine, was already ill – as likely were any of his other contacts.

Contact tracing like this is pointless. It only has value if you reach the contacts before they spread the virus themselves.

A 7-day testing turnaround time already puts contact tracers woefully behind. Add more than a week to that, and the contacts of new cases have had 16 days to spread the disease and are likely themselves new cases on an ever-ballooning list of people waiting to be traced.

Arkansas is spending millions of dollars on contact tracing.

Hundreds of people are dedicating all of their time to an endeavor that is of little value if there aren’t 3 elements in place:

- Rapid testing turnaround times

- Sufficient staff to reach new cases within 48 hours of result

- Public compliance – answering the phone, providing accurate information about contacts, full isolation of those contacts

Let’s look at each of these.

Rapid testing turnaround times

Arkansas has little control over this. Even if the state invested millions in lab infrastructure and staff, it would be at the mercy of a supply chain for swabs and test kits that is unable to keep up with demand.

Sufficient staff to reach new cases within 48 hours of result

For an average of 573 daily new cases, Arkansas would need around 2,865 contact tracing staff to trace all new cases in 48 hours. Right now we are working with around 200.

The state is bringing on 700 contact tracers this month, but some of the 200 current staff will go back to work on other projects. Even with the new hires (costing $22 million), the state will be around 2,000 contact tracers short of having an effective program.

Public compliance

When I spoke with state epidemiologist Dr. Dillaha a few weeks ago, she admitted that compliance was a big issue. Many of those contacted are unwilling to isolate, and family members of contacts (who themselves become exposed) go about their normal lives.

Honesty is another hurdle. There may be reasons why someone doesn’t want to divulge certain contacts or where they've been.

It seems an impossible triumvirate to achieve – full compliance, a complete turnaround on testing, a 1,000% increase in contact tracing staff.

Dr. Fauci acknowledged a few days ago that contact tracing, which once seemed so promising, may not be our saving grace.

Here he is being quoted in the New York Times:

“What good is testing if the results take four days to come back and infectious people aren’t isolated in the interim? What good is testing if contact tracing doesn’t identify and warn exposed people quickly?”

Dr. Fauci acknowledged that the country was not adequately isolating people. But, he added, above a certain level of infection, “the core paradigm of identification, isolation and contact tracing just doesn’t work.”

Posted on the blog. https://arkansascovid.com/2020/07/a-story-of-contact-tracing-in-arkansas/