The Massachusetts program that tracks down people who were exposed to COVID-19, one of the most ambitious state initiatives in the country, is wrapping up as health leaders shift priorities and precious dollars to vaccinating and testing residents amid another surge of new cases and rising hospitalizations.
With no more state-funded workers to help track new infections, local health departments, already stretched thin, have been advised by the state to only contact trace and investigate COVID cases found in group settings, where infections are more likely to spread rapidly, such as health care facilities, homeless shelters, nursing homes, day-care centers, and schools.
The directive has prompted sighs of relief from some weary local health directors but also concern about how to convey to their residents that COVID is spreading rapidly with the Omicron variant and should still be taken seriously.
“That’s a difficult needle to thread,” said Timothy McDonald, Needham’s health director. McDonald has opted to continue contacting all residents who test positive, and tracking their contacts into January, as he crafts a message to residents that explains the changes but still captures the urgency of taking precautions.
“We believe right now it would be very challenging to message that because people’s attention, right around the holidays, is hard to capture,” he said. “And with a new variant . . . is this the right time to do it?”
In April 2020, the state launched its Contact Tracing Collaborative, recruiting Boston-based Partners in Health to lead an initiative that, state data show, has helped more than 1.2 million people and connected thousands to food and other essentials so they could stay home and prevent more infections. The collaborative was made up of workers recruited and trained by Partners and local health department staff. But following a bumpy start, with Partners computers not connecting with health departments and cases falling through the cracks, some communities opted not to use the service, while others relied heavily on help from the Partners workers.
Contact tracing is a laborious, but essential, part of containing some highly contagious diseases. Tracers methodically track down anyone who has been in recent close contact with an individual who tested positive and, if the contact is vaccinated, advise them to monitor their symptoms. If they show signs of COVID infection, they are advised to stay home and get tested. More aggressive advice is given to those who are unvaccinated.
In the early months of the pandemic, with thousands of cases reported daily in Massachusetts, the task overwhelmed health departments, prompting the state to tap Partners in Health.
“At this point, most people in Massachusetts know what to do if they are infected,” said Phoebe Walker, director of Franklin County’s Cooperative Public Health Service, which includes 16 communities. “We think about what is the best use of our time to stop the spread of the disease, and it’s shifting our resources from contact tracing to more vaccination outreach.”
But in testimony Thursday to the Legislature’s Joint Committee on COVID-19 and Emergency Preparedness, Walker acknowleged that she and many of her colleagues are still trying to figure out how to safely make that shift.
“The public has not heard [about the shift] from the governor, which makes them really confused and angry when a public health nurse does not contact them,” Walker said. “So we need leadership to explain this change to the public in Massachusetts.”
Partners in Health workers took their last cases Nov. 30, and all of their work will be concluded by Friday, according to a statement from the Baker administration.
“To prepare for this transition, the administration has awarded over $15 million in federal and state resources to local boards of health to build local capacity for case investigations and contact tracing, and the Department of Public Health is preparing to award an additional $4 million to boards of health for these efforts,” the statement said.
The Partners-led program made more than 2.7 million calls to residents since April 2020, and the projected final bill for that work is $157.9 million, the state said.
Other states have also been winding down or trimming back their contact tracing, once a pillar of the pandemic response, said Crystal Watson, an assistant professor who specializes in public health preparedness at Johns Hopkins Center for Health Security.
“Contact tracing still has value because it helps people take the actions we want them to take and creates some accountability,” Watson said.
“Without that, it’s much easier to ignore the messages from public health about what steps to take in terms of isolation and quarantine,” she said.
Watson said there is concern that the fast-spreading Omicron may overwhelm many contact tracing efforts and reduce their usefulness because its incubation period, the time between when someone is exposed and shows symptoms, appears to be half what it is for earlier variants — two to three days, on average, rather than four to five.
“That makes it much harder to contact trace because others may be infected by then,” she said.
As the pandemic has dragged on, it’s been increasingly difficult to get honest answers from people when contact tracers call, said Sigalle Reiss, president of the Massachusetts Health Officers Association and Norwood’s health director.
“People clearly lie to you, and don’t tell you their close contacts, and it wasn’t as effective on the ground,” she said.
Reiss agrees with the state’s decision to pull back and focus remaining efforts on vulnerable people in group settings.
“With cases climbing so much, even if you just focus on high risk and institutional settings, it’s still sort of overwhelming work,” she said.
The state set few parameters for how cities and towns should restructure their tracing efforts, a flexibility Reiss said is helpful but also problematic because it may create confusion among the public when many of the state’s 350 communities take different approaches.
To help fill in some of the gaps, the Baker administration is counting on MassNotify, a service that lets users who test positive anonymously alert others through software on their cellphone that they may have been exposed to COVID-19. A person’s cellphone shares anonymous codes — but no identifying information — with other MassNotify users through the phone’s Bluetooth.
Since launching in June, MassNotify has been enabled by 1.74 million users, 25.2 percent of the state’s population, the administration said.
But some local health department directors say they will stick with contact tracing most cases, until it becomes overwhelming.
“We still feel it’s important to get in touch, to let them know how to take care of themselves and take care of people around them at high risk,” said Maura Valley, Tisbury’s health agent and the public health coordinator for the six communities on Martha’s Vineyard.
Cases are climbing rapidly on the Vineyard, and Valley said they are “triaging” now, prioritizing contact tracing for the people most vulnerable to serious complications from infection.
“We still see a lot of people disregarding [public health information],” Valley said. “So it doesn’t hurt for us to reinforce it, for as long as we are able to.”