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U.S. States Prepare Test-and-Trace Programs to Reopen Their Economies

Bloomberg logo Bloomberg 4/11/2020 Emma Court and John Tozzi
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Several states have launched new efforts to contain Covid-19, laying plans to test aggressively and track the potentially infected with help from nonprofits, universities and the private sector.

Massachusetts, Utah and North Dakota are among those working on the kinds of comprehensive strategies that public-health experts agree are needed to arrest the coronavirus’s spread and lift the social-distancing measures that have shuttered much of the U.S. economy.

“Even if the curve does flatten, we won’t be able to go back to work and school and regular life unless we chase the virus down much more significantly,” said Joia Mukherjee, chief medical officer of Partners in Health, a nonprofit working with Massachusetts to expand the state’s capacity to trace contacts of Covid-19 patients.

The question is how quickly the efforts that have begun can advance with beleaguered diagnostic testing programs across the U.S. still facing shortages of swabs, chemicals and other supplies that severely limit capacity at many labs.

Only now does the U.S. have the capacity to do 110,000 to 135,000 tests daily, far short of the 1 million a day that Howard Forman, director of the Yale School of Public Health’s health-care management program, said would make him “feel much more confident in where we’re going.”

Tracking Cases

Contact tracing presents its own challenges, requiring armies of trained staff. It’s tedious and time-consuming work to find those who have been near an infected person, direct them to testing or treatment or help them self-isolate, and follow up.

To do so, North Dakota has re-purposed an app called The Bison Tracker, built to help fans of the North Dakota State University Bison football team follow their progress on a 1,000-mile drive to the league’s championship game in Texas.

In Massachusetts, an April 3 announcement about its tracing program attracted 9,000 applicants for about 1,000 positions. Expanding the program may produce a silver lining.

“Would I be sad if we ended up hiring 40,000 to 50,000 people in Massachusetts to do this? Absolutely not,” said Partners in Health’s Mukherjee. “We could put people to work and end the epidemic.”

Massachusetts has so far been able to swab roughly 100,000 individuals, an increase made possible with the help of 22 labs. One is the Broad Institute of MIT and Harvard, which pivoted from DNA sequencing to test for Covid-19 in late March. It can now run 2,000 tests a day, and the goal is to get to 10,000 per day -- if it can get enough supplies.

“We’re going to learn a lot about how to do this in the next month,” said Stacey Gabriel, who heads up the testing initiative for the institute.

Testing and tracing are also the focus in Utah, which expects to be conducting more than 7,000 tests daily by next week, said Kristen Cox, executive director of the governor’s Office of Management and Budget.

Everyone Helps

The state is working with the private sector to make that happen. A group called Silicon Slopes secured Covid-19 test kits from the Salt Lake City company Co-Diagnostics Inc. and also helped develop a website, TestUtah.com, that launched on April 2 to allow residents to assess their risk for Covid-19.

“The state needed help,” said Mark Newman, founder of Nomi Health, a health-care payments startup. He worked to mobilize Utah’s tech and business leaders to launch the testing effort, paid for by companies and the state.

About 2,000 tests have been conducted so far, said Clint Betts, executive director of Silicon Slopes. The group is in discussions with other states interested in replicating Utah’s approach.

“If every state did what Utah did and put it up as fast as Utah put it up, they’d have an unbelievable amount of testing horsepower,” said Dwight Egan, chief executive officer of Co-Diagnostics.

Utah will follow up with those who are positive to trace their movements and contacts; it recently deployed about 1,200 state employees to local health departments for that task. The state may be as close as two to four weeks away from the “stabilization” stage, Cox said.

“I want to be humble on this. This is a goal, not a guarantee.”

In North Dakota, Governor Doug Burgum said 250 contact tracers have been trained but that 1,000 or more may be needed.

“If we can do that, then we can have the right people isolated and quarantined,” the governor said.

The hope is that the new app will speed up the process. Tim Brookins, a Microsoft engineer in Fargo, tweaked the Bison Tracker to build Care-19, an anonymous location tracker. It had more than 10,000 downloads in its first 36 hours.

The app can serve as a record for people to remind them where they’ve been if they test positive, and to alert them to possible contacts with infected people. They can choose to share information with state health workers.

Burgum said he’s been in touch with officials in Iowa, Nebraska and South Dakota who are considering rolling out the technology.

Yale’s Forman said apps could also be deployed for people to record their symptoms every day, which might help identify outbreaks. But he said any containment plan must include testing and tracing.

“I would love to see some states be in a position to open May 2,” he said. “But they better have a very, very rigorous plan.”

States with relatively few confirmed cases, unlike hot spots including New York, Louisiana and Michigan, still have an opportunity to avert widespread transmission, Centers for Disease Control Director Robert Redfield said in an interview.

“We are preparing to make sure we have the public-health assets so that when that first case gets identified in County A, it’s recognized and then there’s real-time contact tracing and isolation,” Redfield said. “And we need to do that across this whole country so that we can prevent clusters from becoming community transmission.”

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