MECKLENBURG COUNTY, N.C. — Contact tracing is considered one of the best ways to prevent the spread of COVID-19, but Mecklenburg County Health Director Gibbie Harris said the longtime epidemiology practice is not working.
In fact, she said Mecklenburg County is having so much trouble, she's not convinced contact tracing, in its current form, is the best use of resources. Harris said case investigators are calling more than 800 people a day, but not getting "strict compliance."
"They're hanging up on staff sometimes. Sometimes they're not answering the telephone and there have been occasions when the staff has been yelled at because people are tired of this and don't want to hear the information," Harris said. "The other challenge we have right now is we're hearing people say, 'Thank you for the information, but I have to work.'"
Harris blames the ineffectiveness on a lack of community cooperation and a lack of enforcement. At the recommendation of the Centers for Disease Control and Prevention and the North Carolina Department of Health and Human Services, Harris said Mecklenburg County stopped issuing mandatory isolation and quarantine orders early in the pandemic.
"For it to be effective, we have to have people who are willing to communicate with us, be honest with us, recognizing the fact that we're not out to get them. We are out to try to help and that help can come to the individual that we're talking to, but also the bigger community. In public health, the community is our patient, so we're trying to look at the big picture here," Harris said. "Yes, those efforts can be useful, but I'm also concerned about how much time and energy we're spending trying to contact people, leaving messages, getting hung up on. If the community is not interested in participating and working with us on this, it makes our job really difficult."
Harris said county health officials are having conversations with the CDC and state about whether contact tracing in a pandemic is as useful as it needs to be. Mecklenburg County has long used case investigation and contact tracing to effectively prevent the spread of tuberculosis, HIV and sexually transmitted diseases, but Harris said with those diseases, there are far fewer cases, which means if you can't get in touch with someone by phone, you can go out and find them and then issue mandatory isolation or quarantine order.
In addition to the higher number of cases with coronavirus, she said those who are answering investigators' calls are disclosing less and less information.
"We're depending on people to be honest with us," Harris said. "One of the things that we've seen recently is when we ask people about their contacts, the number of contacts people are giving us is shrinking significantly and it's because they don't want to give us the information for whatever reason, whether it's they're trying to protect their friends or whether they don't want their place of work to be impacted. The number of contacts is shrinking."
While Charlotte criminal defense attorney Rick Winiker believes health department staff are well-intentioned, he's not convinced Mecklenburg County is "good" at contact tracing. Winiker said he tested positive for COVID-19 in June but didn't talk to a contact tracer until nearly two weeks later.
“My own anecdotal experience left me a little shaken in terms of how vigorous the county is being in its tracing efforts," Winiker said. "It's one thing to say you're doing efforts at tracing. It's another being actually good at it. My conversation with the tracer didn't indicate to me that this was a very fine-tuned process."
Winiker admits he's not an expert. Instead, he calls himself a concerned citizen. Even so, he knows other places are successfully contact tracing and it leaves him puzzled.
"In my experience, there's enough for people to be legitimately concerned," Winiker said.
It's well documented Paterson, NJ is finding a way to identify and isolate a large percentage of its COVID-19 patients.
Other countries have also found great success. South Korea uses a cell phone and credit card data and surveillance video to track and trace COVID-19 patients and then shares their steps with the public. The country believes the public health benefits of that process outweigh privacy concerns.
"The way we are going about this in the country would have to change for that to happen," Harris said of the stringent rules in other countries. "Right now, it's a strictly voluntary system and we're depending on people to do what we're asking them to do and to provide the information that they need to provide. The places that you're talking about (East Asia) have much more control over their population than we do in the United States, so that makes it a little more challenging and for that to really work the way we would want it to, I would think we would have to have a national agreement in what that looks like and how we're all doing it."
Whatever the solution, Harris said something needs to change to ensure contact tracing during this pandemic is useful.
"Whether we either slow down on the contact tracing or whether we crackdown on enforcement, there are two different ways you can go with that," she said. "We can't eliminate (COVID-19), so what we have to do is try to manage it."
When asked if NCDHHS is considering any enforcement options, the agency did not answer specifically.
"Contact tracing only works if everyone does their part and responds," Communications Manager Kelly Haight Connor said in an email. "There are challenges in contact tracing in North Carolina, like there are in other states, including the volume of cases and whether or not people answer the call when contact tracers reach out. Contact tracers in North Carolina have investigated thousands of cases to identify possible exposures to help individuals get tested, stay isolated and get the resources and services they need, and they continue to investigate the increasing number of cases. Additionally, testing and contact tracing will have limitations when you have a respiratory virus that easily spreads and almost half of people don’t have symptoms. This is why prevention is incredibly important, so people don’t get infected or exposed in the first place, and why everyone should practice the 3 Ws."
This story was produced in partnership with the Charlotte Journalism Collaborative.