The director of the Palm Beach County health department made a startling public statement Tuesday: After Nov. 30, Florida will stop funding local efforts to trace new coronavirus infections.
“We want to keep the contact tracing effective. We want to maintain those people that we have,” Alina Alonso said at a local county commission meeting. “Definitely a big concern for the entire state.”
Contact tracing is a time-intensive investigative process used to get in touch with people who have come into contact with someone who has tested positive for COVID-19. It’s been held up by Florida Surgeon General Scott Rivkees as “a way that we actually stop the cycle of transmission.”
But Tuesday’s pronouncement from Alonso, the top health official in Florida’s third-largest county, raised questions about the future of the state’s contact tracing program — questions the state was not willing to fully answer.
When asked whether the state would keep funding local contact tracing efforts after Nov. 30, spokesman for the Florida Division of Emergency Management said officials will “work with” county health departments to make sure contact tracing efforts are funded. The spokesman, Jason Mahon, noted that local health funding comes from state, county and federal programs.
The Palm Beach County department of health did not immediately respond to an email and phone call asking for comment.
State has eased COVID-19 restrictions
If Florida does stop paying for local contact tracing after Nov. 30, it would follow a pattern of behavior on the part of state leaders since the summer surge in cases began to fade in early September.
Since then, Florida stopped mandating and paying for the testing of staff at nursing homes and assisted living facilities. Gov. Ron DeSantis has allowed most businesses — including bars — to reopen fully, with no restrictions. And last week, the state eased restrictions on people visiting long-term care facilities.
Few of the state’s policies have forbidden local governments or individual businesses from taking precautions. Many businesses across the state are still limiting indoor service; the federal government has started to pay for the testing of nursing home staff. County health departments will continue to perform contact tracing, Mahon said.
But most all of the state’s recent actions have transferred responsibility for preventing outbreaks from state government officials to localities and individuals.
When DeSantis announced reopening, he pointed to improving indicators — fewer cases, hospitalizations and lower positivity rates. But in the past week, Florida has seen cases and hospitalizations rise, a nationwide pattern pointing to another possible surge.
That means now isn’t the time to pull back on contact tracing efforts, said Dr. Mary Jo Trepka, the chair of Florida International University’s Department of Epidemiology.
Trepka said with Florida open and little social distancing in place, contact tracing is one of the few strategies left to control the virus, along with testing and asking people to do their part.
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“If you start cutting that program now it’s going to be very hard to restart again, and it is a really important part of controlling COVID,” Trepka said.
Has Florida contact tracing been effective?
In late May, the state began to contract its tracing efforts out to a company, Maximus, which said in an email that it currently has 1,100 people working to trace new infections. To date, the state has paid that firm between $65 million and $70 million, a Maximus spokeswoman said.
Hundreds of Florida’s contact tracers have also come from medical schools, including the University of Florida. Representatives from the Department of Health started recruiting students in the spring. But in mid-July, they stopped calling, said Dr. Michael Lauzardo, director of UF’s in-house contact tracing program.
He isn’t sure why.
Specifics of the agreement with Maximus have been “obscured” by the state, Lauzardo added. Contact tracing “became a very nebulous kind of process” when the company came in.
Potential funding cuts would further weaken local health departments' efforts, Lauzardo said. Municipalities would have to draw from their own budgets to continue pursuing this vital public health work, he said. The threat of a funding shortfall is all the greater as governments run out of the money they got through the federal Coronavirus Aid, Relief, and Economic Security Act, passed in March.
Even with state funding, contact tracing efforts have fallen short in Florida all along, Lauzardo said — in the face of evidence that the practice helps slow the spread of disease.
“We are in an age where people don’t listen to experts and where policy is divorced from expertise,” he said. “When you don’t look at the data and the science, there’s a price to pay.”
Lauzardo called contact tracing “a basic public health function,” comparing it to access to clean drinking water. Pushing its financial burden onto localities is as absurd as asking individual neighborhoods to purify their own water so the city or county doesn’t have to, he said.
“There is no debate among any public health experts anywhere that contact tracing is not worth doing,” he said. “There’s a huge amount of value in it and it’s not something to be given up on. That’s a fatalistic and cowardly way to look at this.”
Hiring and training contact tracers takes weeks, Trepka said. During Florida’s summer surge, casework swamped the department of health as they rushed to get contact tracers in place.
A survey from NPR and Johns Hopkins University estimates Florida needs about 8,761 contact tracers but has 4,400 working.
Little else is known about the state’s contact tracing program. The state doesn’t readily report the size of its contact tracing workforce, how many cases they’ve attempted to reach and how many they reached successfully. When asked questions about these figures, Mahon did not respond.
Some reports have highlighted that Florida’s contact tracing efforts hit road blocks along the way — including calls being flagged as spam, according to the Miami Herald, and many of those infected going without ever receiving a call, according to CNN.
A herd immunity strategy?
From the beginning of the pandemic, public health experts have emphasized testing, tracing and distancing. But with fewer safeguards remaining, personal responsibility could become more important.
To some health experts, that begs the question: Could herd immunity make a difference?
To reach a level of herd immunity, anywhere from about 8,000 to 14,000 more people would have to die in Miami-Dade County alone, Trepka said.
And that would be for a strategy scientists aren’t confident in. They don’t know for sure how long coronavirus immunity lasts, and, in multiple documented cases, people infected with the coronavirus became re-infected with another strain.
“We don’t even know that if we go through that whole sacrifice if people would be immune on a long term basis or not,” Trepka said. Later, she added, “Until we have a vaccine, we have essentially social distancing, contact tracing, mask wearing, hand washing, and that’s about it.”
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