She enjoys the work, but she had some concerns. The big one was that she felt like a public-health Sisyphus. “It’s literally too late to do contact tracing in Texas,” she said. That month, Texas had 15,000 new cases on some days. “How are you going to go back and find all those old contacts? You can’t really trace if everyone and their cousin has it.”
The countries where contact tracing has worked best set up their tracing systems before cases exploded, and as cases grew, they hired more tracers. The U.S. has not done this. In June, when states were in the throes of reopening, only seven states and Washington, D.C., met the Centers for Disease Control and Prevention’s recommendation of 30 contact tracers per 100,000 residents, according to an NPR analysis. According to the latest data from Test and Trace, an organization that grades states on their testing and tracing capabilities, only seven states are currently considered “fully prepared to test and trace.” States meet this threshold if they have a test-positivity rate of 3 percent or less, provide test results in two days or less, and employ five to 15 contact tracers per positive test. “When we started to see cases start to rise back up, hospitalizations start to increase, and then people are looking at contact tracing as this thing that’s going to stop that? Well, that’s just not what contact tracing is able to do at that point,” says Candice Chen, a health-policy professor at George Washington University.
What’s more, once a tracer asks Aunt Sally to isolate, ensuring that she actually does so can be hard, especially if she doesn’t get paid leave from work, or if she lives in a cramped apartment with lots of other people. In Iceland, the government set up a special quarantine hotel as an option for people to isolate away from their families. But few places in the U.S. have set up free hotels for isolation. Larry Wile, the medical director of a health department in southwest Michigan, told me that a nearby county had set up a COVID-19 motel, but abandoned the effort when its staff quit out of fear of getting infected. Now, Wile said, the best his tracers can do is tell infected people to stay away from their family members and wash their hands.
Testing Takes Too Long
In Iceland, Pálmason has been tested twice. Both times, he took the test at 10 a.m. and got his results by eight that evening. In the U.S., coronavirus tests are taking days to come back—largely because there are too many different kinds of tests and no national testing strategy—which further hampers contact tracers’ work. The infected are walking around for days, unwittingly infecting others. And people are naturally less likely to be able to rattle off the names of everyone they encountered five days ago, as opposed to whom they saw yesterday.