The failure to stage the tracing workforce harks back to U.S. officials’ inability to build up adequate testing in the early days of the pandemic.

Severe shortages of public health workers to track disease spread helped fuel coronavirus spikes in states like Florida, Texas and Arizona and could make it harder to stamp out new hot spots.

Florida Gov. Ron DeSantis has about 10 percent of the 15,000 workers needed to contain the outbreak in his state, according to one widely cited simulatorand plans to hire just 600 more. Texas Gov. Greg Abbott has 3,000 of the 4,000 tracers he said he wanted to hire in late April. And Arizona Gov. Doug Ducey called up 300 National Guard members to fill the surveillance gap, more than a month after he lifted his stay-at-home order.

The failure to stage the tracing workforce harks back to U.S. officials’ inability to build up adequate testing in the early days of the pandemic and is increasing the likelihood that states will be forced to shut down their economies again to stop serious disease spread.

“This [tracing] situation is a disaster,” Rep. Greg Stanton (D-Ariz.), whose Phoenix-area district is being swamped with new cases, wrote in a letter to officials in Maricopa County and Ducey on Thursday. “From late March until early June, those who may have been exposed to an infected patient received no outreach at all from public health officials.”

Ashish Jha, faculty director of Harvard’s Global Health Institute, said there’s been little real interest in building the testing, tracing and isolation needed to contain the coronavirus, making the model difficult to apply as rolling outbreaks cross the nation. States “don’t have anywhere near the testing and tracing capacity needed to really get this disease under control,” Jha said.

Public health officials two months ago estimated it would take at least 100,000 contact tracers to safely reopen the country. But CDC Director Robert Redfield told Congress last week that fewer than 30,000 have been hired so far to interview infected people, identify those with whom they’ve come into contact and persuade those people to self-quarantine.

Redfield told NPR in April that the country could not safely reopen until it scaled up contact tracing, warning, “We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission.”

The shortfall is being felt in places like North Carolina, another state that’s paused reopenings due to a surge in new cases, which has about 1,500 contact tracers. Health secretary Mandy Cohen told state lawmakers last Wednesday that their program is stretched thin and on Friday selected its first vendor to expand the workforce.

“State economies reopened too soon, and state and local public health departments did not have enough time to get their programs fully implemented,” said David Harvey, executive director of National Coalition of STD Directors, which is advising many states on contact tracing. “Now, they’re continuing to race against the clock to get contact tracing in place, and there’s nowhere near enough people to do the work. It’s really scary.”

Ducey on Thursday defended his efforts, saying Arizona did enhance its contact tracing capability during April’s stay-at-home order. But the spike in daily infections — which have quadrupled since mid-May — overwhelmed the state.

Maricopa County officials say there had been no delay in investigations until recently, when cases soared.

Critics say the failing stems from a lack of direction from the Trump administration, which has left reopening decisions to states and released guidance on contact tracing weeks after state efforts were launched. That’s left sizable state-to-state disparities in readiness.

“President Trump’s refusal to focus on testing and contact tracing and the general absence of any leadership led to disastrous failures in the early days of the COVID-19 pandemic,” Senate Minority Leader Chuck Schumer said in a statement to POLITICO.

Democratic lawmakers are pushing the Trump administration to quickly distribute $8 billion Congress approved weeks ago to fortify contact tracing programs. While the administration has already released $11 billion for state testing and tracing, Democrats say further delay on the remaining funds has left states inadequately prepared to deal with new spikes in infections.

Reports from the front lines bear that out.

Jennifer Kertanis, the director of the Farmington Valley Health District in Canton, Conn., told POLITICO her department only received $40,000 in federal aid and was told that would have to do until next March.

“We’ve already pretty much spent all of that money on equipment to allow staff to work safely from home and on overtime,” she said. “We have not had the money to hire anybody. We’ve been training the existing staff that we have had and shuffling duties around. We’ve been using pen and paper and Excel spreadsheets because we’ve never had the resources to invest.”

Lawmakers in the Black, Hispanic and Asian Pacific American caucuses last week grilled Redfield over the lack of federal leadership on contact tracing. He said the CDC is currently reviewing plans states developed. But several lawmakers pointed out that states were already using these plans and that assistance from the agency is too little, too late.

Rep. Judy Chu (D-Calif.) told POLITICO she found the information “really worrisome.”

“Are they really leaving it up to the states to have a contact tracer plan? Who’s going to enforce a contact tracer plan?” she said. “As we know, the states vary so much in terms of whether they take COVID-19 seriously.”

The CDC did not respond to multiple requests for comment and did not say when the agency will give feedback on states’ plans.

Despite ongoing challenges with funding, logistics and federal support, some states have built successful programs.

Hawaii, which is now seeing only a handful of new infections, increased its contact tracing staff in the last month from around 80 to more than 300 — and more than 1,400 have signed up to be trained if needed.

Gov. David Ige told POLITICO that the state, learning from past outbreaks including SARS, has been able to track every positive case so far, and that the vast majority of individuals have been willing to share information about their contacts.

“People don’t want to get their friends and neighbors sick,” he said.

Oregon also has a robust program that is currently contacting more than 90 percent of new infections within 24 hours.

But elsewhere, officials are still putting together their tracing programs months after stay-at-home orders were lifted — and training new hires as spikes threaten to overwhelm local health systems. Even those states that have hired hundreds or thousands of people have struggled to find new infections quickly and elicit useful information.

In New York City, which opened restaurants on Monday, contact tracers last week received phone numbers for about 85 percent of newly infected people, but less than half of those people provided information on their recent contacts.

New Jersey, one of the hardest hit states, has brought on almost no new contact tracers since the pandemic began. The state has roughly 900 and needs somewhere between 2,500 and 4,000, Democratic Gov. Phil Murphy said Wednesday. The state’s digital platform to track the program is only running in two counties, so statewide data on how successful the program has been so far is not yet available.

Houston, the latest epicenter, is still working to hire and train 150 contact tracers by July 1.

Kirstin Short, chief of the Epidemiology Bureau at the Houston Health Department, told POLITICO that not only has her team struggled to handle the volume of cases, but it’s been a challenge to convince the Covid-positive people they reach to share information about those they may have exposed.

“Now that they know they’re sick, they might have some guilt over what they did in terms of going out and socializing,” she said.

Meanwhile, tracking apps once billed as a key tool in reopenings have largely flopped both in the U.S. and abroad. Among the barriers are low smartphone and Wi-Fi access among low-income communities and the elderly — two groups at the highest risk from the virus — poor information sharing between states and widespread distrust of big tech and government surveillance.

North Dakota, for instance, is pushing two different apps that purport to alert users when they were around someone who tested positive, but so far, only four percent of the population has downloaded it — far too little to be a useful public health tool.

Alexander Miamen, a contact tracer in Boston since March, said technology can play a role but it will only be successful if it’s supplemented by well-trained health workers who understand the people they are contacting.

“A high-tech app cannot express empathy,” he said. “One of the most vulnerable times in anyone’s life is when they are ill.”

This blog originally appeared at Politico on June 28, 2020. Reprinted with permission.

About the Author: Dan Goldberg is a health care reporter for POLITICO Pro covering health care politics and policy in the states. He previously covered New York State health care for POLITICO New York.

About the Author: Alice Ollstein is a health care reporter for POLITICO Pro, covering the Capitol Hill beat. Prior to joining POLITICO, she covered federal policy and politics for Talking Points Memo.