There’s not much ‘tracing’ in Florida’s COVID-19 contact tracing program

The state once had 4,400 people involved in calling those who test positive, but it leaves to patients the task of reaching out to their contacts.
Gov. Ron DeSantis, appearing in March at Palm Harbor University High School, told reporters in attendance that contact tracing doesn't work.
Gov. Ron DeSantis, appearing in March at Palm Harbor University High School, told reporters in attendance that contact tracing doesn't work. [ DOUGLAS R. CLIFFORD ]
Published Oct. 11, 2021|Updated Oct. 15, 2021

Contact tracing can break the chain of disease transmission, the Centers for Disease Control and Prevention says.

The White House calls contact tracing “one of the core state preparedness responsibilities” in the fight against the COVID-19 pandemic.

The prime minister of Australia credits diligent contact tracing with keeping the number of coronavirus deaths in his nation to just under 1,400.

But while Florida is spending tens of millions of dollars on contact tracing, it can’t say whether the program is helping slow the coronavirus.

The state Department of Health doesn’t know how many calls are being made by its contact tracers because it doesn’t keep track of them, a department spokesman told the Tampa Bay Times in the spring. The state has not responded to requests since then for more current information.

What’s more, Florida only does a portion of the job of contact tracing as it’s described in guidelines from the CDC.

Armed with a list of people who have tested positive, contact tracers should call them, inform them of the test results, get a list of people they’ve come in contact with, then reach out to warn those people, the CDC says.

In Florida, callers tell many infected people to reach out to their contacts themselves.

This graphic from the Florida Department of Health asks those infected with COVID-19 to notify their contacts on their own.
This graphic from the Florida Department of Health asks those infected with COVID-19 to notify their contacts on their own. [ Florida Department of Health ]

This practice raises two questions: Will patients be reluctant to acknowledge to others they have COVID-19 and make calls on their own? And does it conflict with advice from federal civil rights attorneys that callers should refrain from identifying the patient — all but impossible if it’s the patient making the calls?

It’s not clear whether contact tracers in Florida ever call anyone besides the patient. Job postings from the Department of Health for open positions make no reference to reaching out to a patient’s contacts, only to interviewing patients, making a list of their contacts and offering the patients information and recommendations.

Contact tracers in Florida tell patients to “alert people that you have been in close contact with while ill that you have tested positive” and “tell them to self-isolate for 14 days.” The state defines a “close contact” as anyone who was within 6 feet of an infected person for more than 15 minutes.

Gov. Ron DeSantis made it clear what he thinks of contact tracing in March, speaking to reporters at an appearance in Palm Harbor.

“I think we have to admit that contact tracing has just not worked, OK?” DeSantis said.

But contact tracing can work, said Thomas Hladish, a research scientist at the University of Florida’s Emerging Pathogens Institute who formerly worked as a software developer and epidemiologist with the state Department of Health.

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Related: Will Florida keep funding local coronavirus contact tracing? The state won't say.

It doesn’t work in Florida because the state failed to create a comprehensive strategy for contact tracing — a task he described as herculean.

“It’s like showing up to a house on fire with a squirt gun and saying water doesn’t put out fires,” Hladish said. “You didn’t do it right in the first place.”

Judie and Matt Faivre of Trinity waited for a contact tracer to call them after they came down with the coronavirus in September and quarantined for two weeks at home.

The couple, in their 70s, had been careful to limit their exposure to the virus because Matt has underlying health conditions. They always wear masks, even today, and got vaccinated in January. They figure they contracted the virus when Matt played with his band for the first time in a year one day and they attended a wake the next.

No contract tracer ever called.

“I was surprised,” Judy Faivre said. “My friend in New York City, her sister got COVID and was on the phone for two hours giving them all kinds of information.”

Even if they’re calling the patient only, contact tracers are overwhelmed by caseloads of 100 to 150 a day, said Dr. Douglas Holt, director of the state health office in Hillsborough County.

“Bottom line, contact tracing is not effective or designed (for) the level or the numbers of cases we’re seeing,” Holt said. “But that doesn’t stop us from trying to reach everyone as quickly as we can.”

Another challenge is trust. Caller ID will often tag contact tracers as “Florida Department of Health” but sometimes as “potential spam” since many of them work from remote locations, Holt said. Real scammers have also made people wary, so they hang up or are reluctant to answer questions.

Related: DeSantis says contact tracing didn't work. So why is Florida paying for this app?

At the start of the year, there were 4,400 people statewide involved in contact tracing, said Alberto Moscoso, a former spokesman with the Department of Health. The breakdown was 2,600 state employees and 1,800 contracted workers, including 412 public health students and 645 workers supplied by private health-and-human services contractor Maximus.

“The need for contact tracers is continually assessed and adjusted as needed depending on case counts,” Moscoso said.

Moscoso spoke to the Times in the spring and cited numbers from earlier this year. He has since left the agency. The state and its county branches did not respond to multiple requests for more recent numbers, nor did they respond to interview requests to further explain their efforts.

To stop the spread of the disease, communities would need 30 contact tracers for every 100,000 people, according to the National Association of County and City Health Officials. That means Florida, with a population of 21.5 million people, would need about 6,443 contact tracers — 2,000 more than it has.

It is unclear how many contact tracers are currently working for the state. Liz Halloran, a spokeswoman for Maximus, confirmed in an email that the company’s contract with Florida’s Department of Health ended more than six months ago, on March 31.

Related: Tracking coronavirus: Florida turns to students to help with contact tracing

One measure of calls made by contact tracers in Florida indicates they dropped off dramatically after the summer surge that followed the outbreak of the pandemic in March 2020.

In a report to the state, contractor Maximus said its contact tracers made 535,136 calls statewide in July 2020 but less than half that number the following month.

An earnings report Maximus sent to its shareholders in February 2020 placed the value of its contract with the Florida Department of Health at $73 million over six months. That’s on top of the $138 million DeSantis earmarked to support “not just contact tracing, but other personnel,” he said in a 2020 budget announcement.

Meantime, Florida — with a population of 21.5 million — recorded 1,719 deaths from coronavirus last week. That’s more than Australia, with 26 million people, has recorded since the outbreak of the virus 19 months ago.

CORRECTION: Thomas Hladish is a research scientist with the University of Florida. An earlier version of this story described his employment incorrectly.

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