On Monday, all of Florida will be in phase one of the state’s reopening plan. As the Sunshine State inches back from pandemic shutdowns, a vital part of that plan is isolating people who have the coronavirus and keeping it from spreading.
Contact tracing is integral to that process.
Contact tracing is like detective work, but in the public heath arena. Professional tracers gather information from people infected with a virus to figure out who else may have been exposed.
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A University of Florida research scientist, specializing in disease modeling, has some questions about the state’s contact tracing process. Dr. Tom Hladish is also a consultant to the state health department. He talked about the need for a transparent plan for contact tracing, and Florida's current coronavirus testing on the Florida Roundup with host Tom Hudson.
Here’s an excerpt from the conversation.
TOM HUDSON: Is it appropriate for Florida to reopen in the way that it is, in your estimation?
DR. TOM HLADISH: That's a tricky question. Asking an epidemiologist that, is a little bit like asking a doctor what's the right number of cigarettes to smoke.
I ask the question not to be tricky, doctor, just curious as to your opinion, because you have this knowledge that a lot of us don't.
Sure. So, as a human, I recognize that keeping the population locked down is not something we can just do indefinitely. It has great economic and psychological costs. I think that what we're doing right now is reasonable in terms of having a gradual and phased reopening.
My biggest concern is that we need to have adequate infrastructure in place to evaluate whether these changes are having an unacceptable impact and to know that quickly. One of the big challenges with COVID-19 is that it takes quite a while for us to be able to detect transmission when someone gets infected.
It takes about five days for them to develop symptoms, another couple of days for them to get sick enough to get tested. And then, in some cases, it can take up to a week to get test results back. So that means that when you change policy, you don't necessarily know the impact of that policy for another two weeks after that.
Let's focus on that infrastructure. The University of Florida’s Emerging Pathogens Institute model, that you've been part of, has said "robust testing, contact tracing, and household quarantining could offset a second pandemic." So, let's tackle that piece by piece. Dr. Hladish, is Florida robustly testing for COVID- 19 right now?
I think this is an open question about what the right number of tests is. I personally think that the amount of testing that we're doing right now may be sufficient. We need to be smart about how we're testing. We need to make sure that we're detecting transmission in populations that may not normally be very quick to seek health care.
We also need to be aggressive about tracing detection, keeping good data, tracing transmission, and keeping good data on the setting where it took place. So, for example, if you're reopening restaurants, there are some places outside of Florida where restaurants are required to keep a log of customers. And so that makes it possible to actually go back and say, OK, we know that someone who was at this restaurant became infected. We need to go and test the other people who were at the restaurant at the same time.
Is that good practice? Is that something that ought to be emulated here in Florida?
Absolutely. I think that approaches like that would be extremely valuable.
Let me focus on the contact tracing now, because that's another piece that you all have obviously referred to in your research — your colleagues at the Emerging Pathogens Institute have also focused on. To do contact tracing on, they've estimated in their modeling, 40 percent of the people who are found to be actively infected with symptoms. Is Florida putting in place infrastructure to accomplish that?
That's a good question. I don't know as well as I would like. I don't find the process to be completely transparent. I have asked about this and the process with the Department of Health. Yeah. It's not clear to me exactly how contact tracing is being executed right now.
So, the Department of Health, in its latest public statements, says that it has more than 1,000 contact tracers in the state. The National Association of County and City Health Officials suggests the number of people involved in contact tracing should be about 30 per 100,000. The math on that would then lead us to about 6,000 people doing contact tracing in Florida. But you're unaware in the position you're in, even as an advisor to the DOH, about its process around contact tracing. Is that correct?
I believe it is changing. And yes, unfortunately, it is not particularly transparent.