How Many Contact Tracers does Allegheny County Need

Rich Fitzgerald and Dr. Bogen gave a press conference on July 7, 2020. I had thoughts on three topics that were discussed, so this is blog post part 1.

While Progress is Being Made, More Contact Tracers are Still Needed

Dr. Bogen stated that the Medical Reserve Corp of Allegheny County is being used to recruit volunteer contact tracers. I encourage anyone reading this blog who has time to click the hyperlink and consider volunteering as more contact tracers are desperately needed.

Dr. Bogen stated that 6 volunteers are currently working and 60 more have just completed training and will start working soon.  She did not indicate whether the volunteers would be working full time. This is very good news, and represents a significant increase from the 25 contact tracers that Dr. Bogen said were on staff at a June 24, 2020 press conference.

Public Source stated that the National Association of County and City Health Officials (NACCHO) recommends 15 contact tracers per 100,000 people. This corresponds to 182 contact tracers for Allegheny County. Public Source asked Dr. Bogen how Allegheny County’s staffing compares with this recommendation. Dr. Bogen stated that she prefers to compare the number of tracers with the number of a cases, with staffing determined by whether everyone can be contacted within a day with some margin.

She said that contact tracers can contact 8 people a day, and case investigators can contact 15 people a day. While Dr. Bogen didn’t state a goal for the number of contact tracers the county should have, one can be estimated from these numbers.

This paper estimates that an effective contact tracing program needs to isolate between 15 and 40 people for every positively infected person. Assuming there are 200 new cases a day going forward, and Allegheny County only attempts to trace 15 contacts per case, Allegheny County would need 225 contact tracers.

$200\times\frac{15}{15}+\frac{200}{8}=225$

While Dr. Bogen’s approach of using case numbers may be fine when we have high case numbers as we do now, it risks understaffing for contact tracers when case numbers are low like they were at the beginning of June. The potential number of cases for a new outbreak seeded from outside the county is significantly affected by the county population. Therefore I consider 182 contact tracers to be the minimum until a vaccine is available. More may be needed at times like now when there is a surge in cases.

In a previous post published June 23, 2020 I compared Allegheny County and Pennsylvania’s contact tracing numbers with New York City and Massachusetts. Table 1 updates the table from that post to include the latest volunteers. The Massachusetts numbers are from a New Yorker article dated June 12, 2020 and the New York City contact tracer numbers are from a New York Times article dated June 21, 2020. The 66 volunteers in Allegheny County are in addition to the 25 full time contact tracers that Dr. Bogen said were on staff at a June 24, 2020 press conference. This table may overstate Allegheny County’s numbers if any of the volunteer tracers are less than full time. The Pennsylvania numbers are based on a separate June 24, 2020 press conference by Governor Wolf. Allegheny County has said it is still actively hiring contact tracers, so it is possible there have been additional contact tracers hired since these dates that are not included in the table.

New York and Massachusetts are doing well compared with the NACCHO recommendation. By both the number of contact tracers per case and per population, they have significantly more contact tracers than Allegheny County.

Table 1

	Cases per 100,000 over 14 days prior to June 18	Contact tracers per 100,000	Contact Tracers per 100 Cases Over Last 14 Days	Contact Tracers	NACCHO Recommended Number of Tracers
Massachusetts	43.39	14.51	33.4	1000	1034
New York City	30.87	35.72	115.7	3000	1260
Pennsylvania	69.98	4.69	6.7	600	1920
Allegheny County	158.31	7.48	4.7	91	182

The scope of Allegheny County’s contact tracing program is less than other more successful contact tracing programs. Additional staffing would also allow the program to improve by increasing scope.

In some programs, businesses like restaurants require patrons to sign in with a time and phone number so they can be contacted easily if someone was in the establishment around the same time and has tested positive. Allegheny County should wait to open restaurants until it has the capacity to do this.

Additionally, other contact tracing programs include assisting people who have tested positive to isolate. In the press conference, Dr. Bogen said that it is best if people who test positive stay home, but if they must go out, please wear a mask. Our county should get to the position where it can say if you have an essential need that you can’t meet staying at home, call your county case manager who will help you. At a minimum a case manager should be able to arrange for food and medicine to be delivered to make leaving home unnecessary.

Update July 10, 2020:

In a Post-Gazette opinion piece by Brian O’Neil, it stated that there are 140 people doing contact tracing in Allegheny County. I reached out to Brian who stated that his source was an email from the county dated July 8, 2020. The 140 people includes both the paid staff and volunteers, including the 60 volunteers who had not started as of Tuesday. This suggests that Allegheny County has onboarded a significant number of contact tracing staff since the June 24, 2020 press conference, with there being 74 contact tracers on staff. This is good news.

Brian’s article also stated that volunteers have agreed to perform at least 10 hours a week making contact tracing calls. Therefore many of the volunteers will likely be less than full time equivalents. If each of the 66 volunteers only works 10 hours a day, this corresponds to 16 full time equivalent volunteers. Assuming all of the paid staff are full time, there are 90 full time equivalent contact tracers if the volunteers only put in the minimum hours, and 140 if they each work full time.

The main point of this post remains valid. Allegheny County needs to hire more contact tracers to correspond with what experts recommend and what the states with the most developed programs are doing. However, Allegheny County is much closer to meeting that goal than it was just a few weeks ago.