Contact Tracing is an Urgent Task. So Why Is the State Failing at It?

Back a month ago, I wrote a commentary in the Chicago Tribune in which I criticized the governor’s complete lack of communication (and seeming lack of plans) regarding contact tracing, despite the mandate that to move to Phase 3 contact tracing must be implemented, and to move to Phase 4, contact tracing must be fully scaled-up (90% of new diagnoses).

In the meantime, the governor has shifted to statements that contact tracing is already underway at local Departments of Public Health, and has shifted to speaking of a 60% objective (e.g., on May 18 and May 29) as well as a doublespeak rewriting of objectives as reaching 90% of the 60% target (I can no longer find this cite), and relabeling the entire project as “‘a goal’ rather than a requirement” (according to a May 26 Tribune report).  However, the Restore Illinois official requirement remains unchanged.

I’ve become resigned to the fact that this is how politics works, that rather than announcing a change that involves an admission of failure and invites demands for other changes, it’s simply memory-holed.  And my anger has shifted from the lack of communication to the lack of urgency in the actions of the governor, the mayor, and the Cook County Board President.

With respect to the last of these, an article on June 11 at the Chicago Tribune was the first reporting on the Cook County Department of Public Health’s actions —  even when I looked just a few days prior there was no information available on the DPH website; now, the website announces that

CCDPH anticipates starting our first group of contact tracers by early August. Contact tracers will be brought on in groups of 50-100. CCDPH will have a full team by the fall.

Again, remember that this is supposed to be in place in order to move to Phase 4, which is otherwise being targeted for just two weeks from now.

Why is this taking so long?

In part, it appears to be the fault of the Illinois Department of Public Health taking nearly three months to allocate funding from the CARES Act, which passed in March.  But it appears, from the Tribune reporting of Preckwinkle’s statements, that the delay is because the county simply does not recognize the urgency of getting the program in place as soon as possible, and is instead using the program to promote social justice objectives even at the cost of delayed implementation.

Preckwinkle said the efforts, funded with a grant from the Illinois Department of Public Health, would focus extensively on disproportionately affected groups that have “experienced systemic racism,” including African Americans and Latinos, both in terms of tracing and hiring of new contact tracers. The program also will be bilingual so hundreds of thousands of Spanish-speaking residents are not left out.

“This grant is so important for those who have been most impacted by COVID-19,” said Dr. Kiran Joshi, one of two senior medical officers running the county Department of Public Health, who said blacks in the county have been affected at three times the rate of whites and Latinos at four times the rate. “We intend to hire suburban Cook County residents for these jobs who are culturally competent, multilingual and have great communication skills.”

The county, however, will take several months to ramp up the program, even though many social-distancing restrictions have been lifted by the state and there’s concern that a future surge could occur soon because of recent crowded conditions during protests over the Minneapolis police killing of George Floyd.

Now, I well understand the importance of hiring tracers who can gain the trust of the tracees, because a program in which individuals are contacted but refuse assistance to enable them to isolate and refuse to provide information about their contacts because they don’t trust the tracer and can’t be persuaded that the greater good of their community warrants these actions, is fairly useless.  But Preckwinkle’s statement goes beyond this acknowledgement to a desire to use the program to advance broader social goals.  And that’s wrong — the top priority should be speed, regardless of whether goals of equal opportunity or extra assistance to underrepresented groups must be sacrificed.

In fact, like it or not, it is likely that a focus should be on disproportionately less affected communities, as the low-hanging fruit, with far more payoff in terms of the effectiveness of the effort.  It seems to me even more the case state-wide, that nipping in the bud an incipient outbreak in a community that’s otherwise been uneffected would be more successful than the greater challenge of dense urban areas with a pre-existing substantial prevalence.

And it’s not just suburban Cook County — in Chicago itself, the process of hiring contact tracers is set to take much longer than it should, due to a process of first identifying an organization with which to contract out the primary organization of the effort, and then distributing funds to

at least 30 neighborhood-based organizations located within, or primarily serving residents of, communities of high economic hardship

which would work at

recruiting, hiring and supporting a workforce of 600 contact tracers, supervisors and referral coordinators to support an operation that has the capacity to trace 4,500 new contacts per day

with an objective of hiring 150 by August 1, and 300 by September 15.

And, again, quite apart from the appropriateness of prioritizing workers from low-income communities for city jobs, in general, contact tracing is not just a city jobs program.  It is an urgent task.  The work of hiring tracers should have been started months ago, not months in the future.

What’s more, even this plan is being criticized by Chicago activists, who want the hiring to be done within the Chicago Department of Public Health itself, rather than being outsourced, and who are treating this as a matter of shoring up governmental institutions.

Also joining the group were current and former union officials who have an interest in seeing the ranks of public workers expand. They included Tony Johnston, president of the Cook County College Teachers Union, who said city community colleges should be training new contact tracers, and Matt Brandon, former secretary-treasurer of International Service Employees Union Local 73 and current president of Communities Organized to Win.

Contact tracing is not a jobs program.  It is not a stimulus program.  It is not an economic rebuilding program for poor communities.  It is certainly not a program for building up a unionized workforce.  And city, county, and state government officials who treat it as such, rather than ramping up tracing as quickly as possible, during this limited window of opportunity of lowered infection rates due to lockdowns and warmer weather, are failing the people they serve.