‘Less need’ to investigate every case of Covid-19 as contact tracing responsibility shifts to cities
Now that city and town health departments are taking back responsibility for investigating cases of Covid-19 and tracking their contacts, state officials say local workers can scale back their efforts after Jan. 1 by not investigating every Covid-19 case and instead singling out infections in certain settings, such as clusters of infections. Even sooner, local workers can start making only one call on a case, with no followup after reaching the person. The policies, which are optional, will apply until the end of this year.
Asked whether Cambridge will take the options, Cambridge Public Health Department spokesperson Dawn Baxter said last week that the city is still deciding what to do. Cambridge and “its regional partners” in contact tracing, Chelsea, Revere and Winthrop, “are working to finalize protocols for case investigation and contact tracing” after Nov. 30, Baxter said.
That’s when the Community Tracing Collaborative, set up by the state to help communities do the laborious job of contact tracing, stops accepting cases from city and town health boards and departments. The organization had been created in April 2020 as a combination of the state health department and the medical charity Partners in Health. The collaborative will end its existence Dec. 31.
Case investigation and contact tracing is a long-recognized tool for controlling infectious diseases by connecting with infected residents, identifying their contacts and encouraging them to get tested, isolate or quarantine if necessary. Massachusetts earned praise as one of the first states to support expanded contact tracing in the pandemic. Now things are different, state officials told local health workers at a weekly meeting Nov. 9. Vaccines and free tests are widely available, treatments have been developed and the rate of new cases is lower than in March 2020, according to notes from a slideshow posted online.
“With many Covid transmissions occurring more commonly in households, social gatherings and workplaces, there is less need to investigate every case of Covid-19 and to speak with every contact,” according to slides presented at the meeting. After Jan. 1, communities and the state may “prioritize certain settings” for investigation and contact tracing and divide up responsibility, such as reserving cases in “disease clusters” for locals and cases in nursing homes and shelters for the state, the meeting notes say. The notes didn’t say whether case investigators and contact tracers can continue making only the initial call per case and contact.
Asked why the state is giving local boards of health and departments that option until the end of this year and whether it will continue after Jan. 1, Department of Public Health spokesperson Omar Cabrera said the state is asking local tracers “to provide a contact number [to people who are isolating or quarantining] in case of needs.” This would replace the practice of having workers call several times during isolation or quarantine, as often as daily.
Covid times have changed
Cabrera said that when the Community Tracing Collaborative was created “there was limited testing capability, minimal therapeutic interventions and no vaccines. Today, Massachusetts is a national leader in vaccine administration and free testing, and [has] the second-lowest Covid hospitalization rate and case positivity rates in the nation.”
Cabrera said more than 1 million Covid cases and contacts “have been identified for follow-up conducted by local health departments” and the collaborative. To prepare for the collaborative’s end, the state gave $15 million in state and federal funds “to local boards of health to build capacity for local investigations and contact tracing” and is preparing to award another $4 million, he said. The state says the collaborative has handled about 65 percent of cases.
When the collaborative stops helping Cambridge, state grants will help fund additional staff for the regional case investigation and contact tracing program involving the city and its three partners. It’s not known how fast that will happen. Meanwhile, the number and percentage of “unknown” cases in Cambridge – defined as people who could not be reached by tracers or were lost to follow-up – has been rising this fall, according to the Cambridge Public Health Department Covid-19 data center.
Local departments have responsibility
Hannah Emily Landsberg, associate director of Boston University Student Health Services and head of BU’s case investigation and contact tracing program, agreed with the state that “at this stage of the pandemic we have a clear understanding of where transmission is occurring,” though she added that means that health officials can now “focus outreach on notifying and informing close contacts.”
Commenting on returning responsibility for contact tracing to communities, Landsberg said that local departments are “in the best position to quickly identify and notify individuals about outbreaks, as they know their residents and towns best.” Besides getting additional funding from the state, local departments also can tap volunteers from the Academic Public Health Corps and state Department of Public Health epidemiologists, among other contact tracing aids, she said.
“These resources, in combination with the information gathered by the Community Tracing Collaborative this past year around patterns, higher risk populations and mitigation strategies has strengthened cities and towns’ ability to effectively manage Covid-19,” Landsberg said.