By the time public health officer Bela Matyas learned that the novel coronavirus was spreading in Solano County, a patient in her 40s was already on a ventilator.
Back in February, the patient was the first in the nation known to be infected without traveling or being around someone who was sick. But she was too ill to answer questions about where she’d been and who she had talked to, worked with or touched.
Dozens of public health investigators from local, state and federal agencies fanned out like detectives, questioning the family members who had visited her and the hospitals that had orchestrated her care — even staking out the store where she worked. Their mission: to piece together a list of people who could have been exposed to the virus.
In the end, the list totaled more than 300 people spanning six counties in the state, Matyas estimated. Four of those people — including three health care workers — tested positive, each prompting an investigation of their own.
This process, called contact tracing, is a critical element in containing the spread of the virus. But the ability of California’s 61 county and city public health departments varies greatly as they struggle to keep pace with rising numbers of patients.
“What we had to do was clear from the beginning,” Matyas said. “But actually being able to do it was very hard.”
Some local health departments, like the one in Madera County, have managed to trace the contacts of every person who tests positive for the coronavirus. Others, like the city of Long Beach and Placer County, are so overburdened that they are only trying to trace contacts that could put vulnerable people at risk, such as health care workers or people in nursing homes.
To handle the pandemic, the nation will need 30 contact tracers for every 100,000 Americans, according to the National Association of County and City Health Officials. But no California city or county has anywhere near that many. Under that formula, for example, Long Beach would need 140 investigators, seven to nine times more than it has now.
Placer County, north of Sacramento, with a population of almost 400,000, would need 120 tracers.
“It certainly illustrates the point that 18 — which is our expanded capacity, which is more than our baseline of six — is woefully inadequate,” said Aimee Sisson, Placer County’s public health director.
Contact tracing will become even more important as the state starts reopening parts of its economy. The concern is that more human interaction could cause flare-ups, especially since people can spread the virus before feeling ill and limited testing leaves people unaware they’re infectious.
“We need to make sure that there is capacity in every county to do adequate contact tracing. That’s part of containing the disease,” said Kat DeBurgh, executive director of the Health Officers Association of California. “Are we ready today? No. When will we be ready? I don’t know.”
Gov. Gavin Newsom addressed the concern about inadequate contact tracing on Wednesday, announcing plans to train 10,000 people to help local health departments. “The good news is we believe we have the capacity to build an army of tracers,” Newsom said, although he did not say when they’d be ready to deploy.
Jeffrey Martin, a professor of epidemiology and biostatistics at the UCSF, said that fighting an epidemic is like fighting a wildfire: The state can’t afford to mess up containment.
“[It’s] important to track all of those people down to extinguish all the embers in that brush fire,” Martin said. “If we don’t do it right, and if the brush fires are not extinguished, you’d have to be a magical, wishful thinker, to think that there would not be a raging wildfire.”
Some Counties Keep Up, Others Can’t
Madera County, in the San Joaquin Valley, typically has two to three people keeping tabs on tuberculosis and sexually transmitted infections among its roughly 157,000 residents.