Takeaway: We spoke with a State Health Department leader and got a good look at how states are ramping and managing testing and contact tracing

As the COVID-19 outbreak abates, the focus of state and local health departments turns to developing the proper infrastructure to contain future outbreaks. We spoke to a leader of a state health department which experienced a moderate level of disease (around 180/100,000 population versus a high in New York at around 1,700/100,000 and a low in Montana at around 33/100,000) to learn more about the testing and contact tracing infrastructure being augmented and developed by states. Peak day count of cases for this state was 1100 and currently reported confirmed are around 300. Despite the moderate level of disease, this state has deployed an aggressive testing program in conjunction with leaders in its Metro areas.

  • The State Health Department employs 50-70 contact tracers all the time to track down people who have come in contact with people who have tested positive for a reportable disease (HIV, Chlamydia, COVID-19, measles, etc.)
  • About 6-8 weeks ago as caseload climbed, they added another 50-70 people.
  • They put a call out to other state employees to be temporarily reassigned to the health department and have a pool of another 230 people to draw from.
  • Additionally, they can call on medical corp at National Guard and in the State's Medical Reserve Corp.
  • State feels it employs or has access to sufficient personnel to meet demand
  • They have approximately 300 people total actively working on contact tracing and the large metro regions have another 150-180 (consistent with Harvard study recommending 30/100k)
  • It is not difficult work; a contact tracer just needs to know their way around a spreadsheet and be able to speak clearly on the phone.
  • This state does not contact trace people living in congregate settings like nursing homes, assisted living centers and prisons. It is a mistake to estimate number of contact tracers needed without removing these populations from the caseload.
  • Cases are identified when a lab confirms a test result and enters the patient's demographic data into an automated reporting system. That information appears in state's database and contact tracing begins
  • The initial interview between the patient and contact tracer lasts about one hour. Patient is asked about past activity until three days prior to onset of symptoms. 
  • Follow-up calls are approximately 5 min each. 
  • Contacts of confirmed positive patient are asked to get tested and given information about testing sites
  • Rural contact tracers are only working about 2 hours a day due to low positive tests
  • Testing asymptomatic individuals is not a good use of resources and not clinically recommended
  • Estimates around 25% or less of the infected population is asymptomatic.
  • Antibody testing at the individual level is useless as we know little about the extent and duration of immunity; may be helpful on a population level to understand disease and attack characteristics

Emily Evans
Managing Director – Health Policy



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Thomas Tobin
Managing Director


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