Few states invested more effort in tracking down people who may have been exposed to COVID-19 than Massachusetts. More than 4,500 workers have been hired to do the labor-intensive job, costing the state $130.4 million by the end of this June.
A year since its launch, the staff recruited by Boston-based Partners in Health has made at least 2 million calls, helped more than 186,000 people quarantine, and connected thousands to food and other essentials so they could stay home and prevent further infections.
But now, as the effort winds down, some public health officials are questioning whether the money was well spent.
They say that the Baker administration’s decision to hire an outside nonprofit group to run the program deprived them of the chance to bolster many sagging local departments to tackle COVID-19 and future crises. And now that Partners in Health is laying off staff, local health departments are losing the benefit of that extra help.
“These are temporary patches on a system that obviously needs addressing,” said Sigalle Reiss, president of the Massachusetts Health Officers Association and Norwood’s health director. “We haven’t improved the local public health structure, so we’re back to where we were before the pandemic.”
Reiss acknowledged that help from Partners in Health was vital early on when the first wave of the pandemic broke in Massachusetts. But she said some of the money should also have been used to “build something more sustainable” to prepare local departments to take over the job.
And some cities and towns chose not to work extensively with Partners in Health in part because a clunky state computer system created delays for local officials to hand off cases.
Tracers were “reaching a person potentially two days after we would, and that felt like too much potential for an infection to spread,” said Phoebe Walker, director of Franklin County’s Cooperative Public Health Service, which includes 15 communities.
But Baker administration officials say the ambitious contact tracing program has been a success. Since last April, state figures show, the Partners in Health program handled the contact tracing for about 60 percent of the total COVID cases.
“The diligent effort of thousands of tracers over the past year has helped curtail the scope of infections and provide assistance and guidance to those infected,” a Baker administration spokesman said in a statement.
Contact tracing is a decidedly unglamorous, but essential, part of containing some highly contagious diseases. Tracers methodically track down anyone who has been in recent close contact with people who test positive and advise them to self-quarantine and get tested. In the early months of the pandemic, with thousands of cases reported daily in Massachusetts, the task overwhelmed local health departments.
The Massachusetts program, known as the Community Tracing Collaborative, quickly became one of the largest such efforts nationally, using more tracers per population than all but a handful of other states, according to data from Johns Hopkins Bloomberg School of Public Health.
The tracing collaborative acts as ready support to any city or town that needs help — ultimately, 339 of the state’s 351 municipalities used their services, between 150 and 200 of them regularly.
John Welch, director of Partners in Health’s program in Massachusetts, said the tracers’ work went beyond identifying infected people to potentially helping slow transmission. By connecting people to food and other essentials, the program made it easier for people to remain isolated.
“Connecting caring to what feels like a very mechanical activity of making phone calls and collecting data is how to find success,” Welch said.
Crystal Watson, an assistant professor at the Bloomberg School of Public Health who has surveyed many states’ programs, said the Massachusetts initiative is among several in the Northeast that succeeded in reaching a large percentage of those infected. State data show the tracers reached more than 486,000 people over the course of the program — 82 percent of everyone they called.
Contact tracing initiatives vary greatly across the country, making comparisons difficult. Massachusetts’ program is unique. Though Partners in Health contracted its consulting and training services in other states, Massachusetts is the only place where the nonprofit employed and managed a contingent of tracers and support staff.
Still, a comparison with Virginia, which used slightly more contact tracing staff per population than Massachusetts, suggests this state’s program was more expensive. Virginia spent $48.6 million through 2020 on contact tracing, including the cost of hiring new contact tracers, according to the Virginia state health department. In Massachusetts over the same period, Partners in Health was awarded a $54 million contract through last December, a state spokesman said.
In hard-hit New Bedford, the Partners in Health program has been a life saver, said Damon Chaplin, the city’s health director. Chaplin, his two part-time public health nurses, and several more city employees were working day and night a year ago and still weren’t keeping up with the swift-moving virus.
“It was,” he said, “a beast.”
The collaborative has handled about 80 percent of New Bedford’s contact tracing, Chaplin said, and that’s allowed him and his nurses to attend to other department duties and vaccinations as well as tackling some of the harder-to-reach tracing calls.
“Communities like New Bedford, we have limited resources,” Chaplin said “There is no additional funding coming from the state to support local public health.”
But the program also has had its share of hiccups.
As recently as Jan. 28, Welch sent an e-mail to workers saying that during the winter surge in cases, local health departments and the state health department alerted Partners in Health that “there were frequent errors in the information [the collaborative’s] teammates shared,” about isolation and quarantine requirements when calling residents. Partners in Health had hired a lot of employees in December, just as federal and state regulators were changing quarantine guidance, perhaps fueling the errors.
In response, Partners in Health rolled out more mandatory training.
Nearly half of the state’s municipalities did not regularly use the Partners in Health contact tracers. Some said they worried about their residents falling through the cracks during spikes in cases.
“When [the state contract tracers] got overwhelmed, they would drop down into triage mode, which was, ‘We’ll call you twice and then we give up,’” said Walker, the health director from Franklin County. “That made me uncomfortable.”
Now, state officials are concerned that Massachusetts not drop its guard on contact tracing, especially with the number of cases rising again. In recent weeks, Partners in Health laid off 200 workers as infection levels started to decline in Massachusetts. The state’s contract with the nonprofit runs through June, but a Baker administration spokesman said it may be extended through September if caseloads warrant.
Watson, the Johns Hopkins assistant professor, worries that states may wind down contact tracing initiatives too soon.
“Compared to COVID-19 testing, it’s still receiving less attention and the number of tests performed everyday has dropped precipitously,” Watson said. “I do worry we will let our guard down and not respond quickly enough if we do see another surge.”