SAN JOSE — Santa Clara County has struggled to find staff to build out a 1,000-person workforce to perform contact tracing, a key indicator for reopening more parts of the economy.
By this point, the county had aimed to have about 700 tracers in place to track down the close contacts of people who test positive for COVID-19. But three weeks after the county executive voiced that goal, the health department has just 50 contact tracers, amounting to about 2.6 tracers per 100,000 residents, with the capability to go through about 25 cases a day.
Attracting contact tracers have proved difficult, county CEO Jeff Smith admitted in an interview, noting that the county is asking cities to contribute to the workforce and recruiting its own “nonessential” workers currently on administrative leave.
“It’s turned out to be a lot harder than I expected, because the cities were really unable to identify a large group, and we’ve been calling and communicating with our employees and haven’t received a lot of ‘yes’ answers,” he said.
“I’m still pretty confident we’ll get there,” Smith added, “but it wasn’t as fast as I expected.”
Other Bay Area counties are faring slightly better when it comes to contact tracing, but most are still far from achieving the 15 tracers per 100,000 residents that Gov. Gavin Newsom has set as a benchmark for reopening. Of the six counties that signed on to local shelter in place orders, only San Francisco — which kicked off a tracing program in mid-April thanks to a partnership with University of California, San Francisco — has hit the mark with about 16 tracers per 100,000 people. As of Friday, Contra Costa County had about six tracers per 100,000 residents; while Alameda and San Mateo counties had about 4.5 and four per 100,000, respectively. Marin County officials did not respond to a request for comment.
Contact tracing — which involves finding close contacts of individuals who have tested positive for the virus and encouraging them to quarantine — is a fundamental tool to stop the chain of COVID-19 transmission, epidemiologists say. For every exposed person that tracers reach and convince to stay home or seek medical care, exponential infections are prevented, said Dr. George Rutherford, an epidemiologist with UCSF who oversees San Francisco’s contact tracing program.
“Contact tracing is important because as soon as we get away from the shelter-in-place, it becomes a first line of defense — or really a second line of defense — against coronavirus transmission,” Rutherford said. “It’s a more surgical approach than shelter-in-place.”
San Francisco Health Department’s “extremely close” relationship with UCSF helped get its tracing program off the ground much earlier than in neighboring counties, Rutherford said, allowing the county to rapidly build up a staff of about 150 tracers recruited from other public agencies like the city attorney’s office and library system, as well as from the university.
In Santa Clara County, some potential tracers have turned down the job because of misconceptions that they’d have to go out into the field and be exposed to COVID-19, Smith said. Others are unsure whether they can make the six to 12-month commitment that the county has asked for.
To clear up the confusion, the county has recently intensified recruiting efforts among existing staff, and last week called for hundreds of volunteers to build up the local contact tracing workforce. County officials may also eventually consider creating new paid positions for the work, Smith said, and has since dropped the time commitment to three months.
Smith noted that given the levels of testing in the county, the 50 tracers currently working are not overburdened with cases and there’s no “backlog” of positive tests to trace. This week, the county will begin training an additional 75 volunteers as tracers, Smith said. The timeline for hiring 700 staffers has been pushed out to mid-July, he added, at which point testing capacity will also have increased.
Still, other county officials have been left frustrated by the yawning gap between the projected hiring numbers and the current progress. Without a written financial and hiring plan in hand, for example, Supervisor Susan Ellenberg said she cannot be confident that the county is “doing everything” it can to safely exit shelter-in-place.
“It took us a long time, relatively speaking, to ramp up to where we need to be on testing,” Ellenberg said. “It looks like we’re following that same path on tracing.”
As of last week, Santa Clara County had conducted about 266 tests for every 10,000 residents, compared to 515 tests per 10,000 in San Francisco County, 285 per 10,000 residents in San Mateo County, 230 per 10,000 in Alameda County and 204 per 10,000 in Contra Costa County. Low testing rates have been a particular point of exasperation in San Jose, where at least two testing sites have operated below capacity for weeks and efforts to reach residents in the heavily Latinx and Vietnamese neighborhoods in East San Jose were hindered by language and technology barriers.
Either way, Smith argued, meeting reopening benchmarks related to testing, contact tracing and personal protective equipment won’t allow the county to pull back restrictions in one fell swoop.
“The number that was picked was not magic,” Smith said of the contact tracing goal. “In a fluid situation, you have to have goals, but they’re not triggers.”
In response to questions about contact tracing during a committee meeting Tuesday morning, Health Officer Dr. Sara Cody said that her team “has been working almost twenty-four-seven for almost four months to do what we need to do to protect the public.”
“Our goal is to stay ahead,” Cody said. “So far, we’ve been able to do that … we don’t need to bring on a huge staff before that happens.”
Earlier this month, when asked for a timeline to get contact tracing off the ground, Cody said the team would be “significantly expanded” within about a few weeks.
“The reason that we are going so hard on trying to amp up and scale up testing and case and contact investigations is so that we can begin to pivot — rather than do this blanket approach where we’re basically dropping fire retardants and having everyone shelter in place,” Cody told the Board of Supervisors on May 5. “But we need to feel confident that we’re doing it safely.”
