Contact tracers try to keep up with Iowa's soaring coronavirus infections. Experts say the state needs many more.

Van Buren County health administrator Lindee Thomas hopes that local residents who have been infected with the coronavirus pick up the phone when she calls. If they do answer, she hopes they understand why she must ask who they’ve been hanging out with.

Thomas, who is a nurse, is one of a few hundred Iowans serving this summer as contact tracers. Their goal: Reach out to every Iowan who tests positive for coronavirus, then call everyone they might have been inadvertently exposed to the virus. The callers encourage everyone exposed to quarantine for 14 days. And they try to get all the calls done within 24 hours of the positive test.

“I feel like we’re on top of it,” said Thomas, who has made hundreds of such calls. But it’s a growing challenge, she said. 

Iowa’s coronavirus epidemic is surging, with some days bringing more than 1,000 new positive cases. State and local health departments have about 350 people working full time on contact tracing, according to the Iowa Department of Public Health. The Iowa National Guard, universities and school districts also have people pitching in.

But some public health experts say Iowa doesn’t have nearly enough people making the calls.

Dr. Christine Petersen, an epidemiology professor at the University of Iowa, said there’s no way a few hundred contact tracers can keep up when the state is adding thousands of new confirmed coronavirus cases per week. “That’s just terrible math,” said Petersen, who is director of the university’s Center for Emerging Infectious Diseases.

Petersen said it would be particularly tough to do contact tracing in an area like Iowa City, where hundreds of college students have tested positive for the virus recently. Young adults probably are more likely to ignore calls from numbers they don’t recognize on their cell phones, she said.

"Close contacts" are generally defined as anyone who was within 6 feet of the infected person for 15 minutes, from 48 hours before the person became ill or was tested until 10 days afterward.

Many college students have been in social settings with dozens of other people, including strangers. Tracking all those folks down and persuading them to go into quarantine could be nearly impossible, Petersen said.

Contact tracing is most useful when an area has a few cases of a disease, Petersen said. That's when health officials can hope to smother an outbreak before it catches fire. “Once the fire is going, it’s really things like social distancing and mask wearing that are going to make the difference,” Petersen said. However, she believes it’s worth continuing to try contact tracing.

Number of tracers falls short

Public health researchers at George Washington University have published estimates of how many contact tracers they believe each state should have. On Friday, the researchers estimated Iowa should have 5,702 people performing the tasks, around 10 times as many as are actually doing it.

Edward Salsberg, a George Washington University researcher who helped develop the tracker, called its estimates "an aspirational goal." But he said adding contact tracers shouldn't be seen as just a cost. Instead, he said, it should be seen as a way to save money, because it can be an alternative to having to shut society back down if the pandemic continues to rage out of control.

Salsberg's project assumes that each contact tracer would make several follow-up calls with people who are quarantining, to see how they're feeling and ask if they need any assistance to stay home.

Many people infected with coronavirus may feel fine for a week or so, or they may never develop symptoms, Salsberg noted. They could be tempted to run errands or return to work early. Then they could wind up infecting others. Follow-up calls from health agencies can reinforce the need to stay home, he said. 

Iowa contact tracers said many residents don’t answer their calls or respond to their texts or voice mails. Some people who do answer the calls hesitate to name people who they were near in the two days before they tested positive or became ill. “I often get the answer, ‘Well, I’ll let everyone know myself,’” said Thomas, the Van Buren County public health administrator.

In such cases, all she can do is ask the infected person to tell anyone whom they might have exposed that they should quarantine for 14 days — then hope they actually do it.

In general, Iowa contact tracers have not been calling people back once the initial interviews are done, said Dr. Ann Garvey, deputy Iowa state epidemiologist.

Garvey said the department's practice is for contact tracers to try at least three times by phone and once by text message to reach each Iowan who has tested positive for the coronavirus. Of those reached, about 96% agree to be interviewed, Garvey said. The interviews generally take 15 minutes to a half hour, she said.

The state health department has 30 people working full time on contact tracing and is in the process of adding 20 more, Garvey said. Additional staffers could be added if needed, she said. Local public health departments have about 320 people doing contact tracing, she said. The state team is assisting about three-dozen counties, including Polk County.

The Iowa National Guard also has been pitching in. Maj. Gen. Ben Corell, the Guard's top commander, said 150 soldiers and airmen began making contact tracing calls in April out of call centers in Sioux City, Cedar Rapids and Johnston.

Those numbers have been reduced as the state health department has added employees and as the Guard has picked up other duties, including cleanup from the August derecho wind storm. Corell said 32 Guard members are still making contact tracing calls, and he intends to wind down the mission at the end of September. 

Corell said his soldiers adapted quickly to the unusual assignment, one of many in this turbulent year. "If you'd have told me a year ago all the things we'd have done in 2020, I'd have laughed and said, 'No way,'" he said.

Garvey said the state's contact tracers are encouraging people to follow up with their own health care providers for guidance on how to care for themselves and their families.

When is a person 'recovered'?

In July, the state started routinely listing people as having "recovered" from the coronavirus 28 days after they tested positive, unless officials had information that the person had died or was still hospitalized.

That definition includes some patients who continue to feel effects from the disease. Sophia Stewart of Altoona is among them.

Stewart, 19, was diagnosed with COVID-19 in July. Shortly after she tested positive, she received a call from a state contact tracer. The woman asked about Stewart's symptoms and where she might have picked the virus up.

The contact tracer also asked Stewart whom she had been in close contact with. Stewart said she told the staffer that she lives with her boyfriend, who had taken a test and come up negative. The contact tracer never spoke to Stewart's boyfriend, who became ill a couple of days later and just stayed in with Stewart until they both felt better. Although he never took a follow-up test, he apparently had COVID-19, Stewart said. But he would not have been counted in the state statistics because he didn't have a positive test. 

Stewart said she spent three or four weeks with serious symptoms, including fever, shortness of breath, a racing heart and skyrocketing blood pressure. Although she was never admitted to a hospital, she went to an emergency room one night because she was having so much trouble breathing.

Even now, nearly two months into her illness, she continues to have some shortness of breath and fever, and her heart sometimes races.

Stewart said her experience with contact tracing lasted just a few minutes. "They never called me back. I think they kind of just assumed it was over," she said. "...I think it's weird that they say people have recovered when they haven't always really."

Dr. Patricia Quinlisk, who retired in 2018 after 24 years as Iowa's state epidemiologist, said contact tracers face a particularly tough challenge with the coronavirus pandemic.

With many other diseases, such as measles, it's easier to determine who is infectious and how long they should isolate themselves, Quinlisk said. But now, some infected people with no symptoms are spreading the coronavirus to others, and scientists aren't sure how long people can be contagious, she said.

Quinlisk agreed with other experts that contact tracing is most effective when there is a relatively small outbreak that could be contained by putting a few people in quarantine. She supports continuing to try to do contact tracing amid the widespread cases. "But it's not on its own going to stop this epidemic," she said. "The numbers are just too big."

Tony Leys covers health care for the Register. Reach him at tleys@registermedia.com or 515-284-8449. 

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