Today, we’re excited to announce a fourth metric added to our COVID warning system: contact tracing. We will lay out how we calculate whether states have sufficient contact tracing capacity, and why we think it is an important metric to assess reopening.
Why Does Contact Tracing Matter?
When people contract the virus, they do not show symptoms right away. Even as states begin to reopen, people will need to quarantine themselves if they have been silently exposed to someone with COVID.
How will they know? That’s where contact tracing comes in.
Because of this problem, it is critical that enough tracing capacity exists to rapidly trace the contacts of individuals who test positive for COVID. Those contacts can be tested, quarantined (if necessary), and asked about whom else they have come into contact with. Because exposed individuals begin infecting others, it is critical that this process be completed in less than 48 hours. If this routine of testing and tracing is done quickly and completely, it can contain COVID, as we have seen in South Korea and Taiwan, and without the need for costly lockdowns.
The White House Coronavirus Task Force’s Guidelines say that contact tracing is a “core responsibility” of states in order to be prepared to reopen. As of May 21, 27 states (CA, CT, DE, FL, HA, IL, IN, KS, KY, ME, MD, MI, MO, MT, NE, NV, NM, NY, NC, ND, OH, PA, RI, SD, WA, WV, and WI) call for contact tracing in their reopening plans. The American Enterprise Institute’s roadmap to reopening says states must massively scale up contact tracing and isolation/quarantine of traced contacts.
How Should We Measure Contact Tracing?
So how do we calculate contact tracing capacity? Experts recommend tracing contacts of someone who tests positive for COVID within 24 hours, to contain the potential of transmission. Based on conversations with practitioners and public health experts, our metric assumes that tracing all contacts for each new positive COVID case requires an average of five full-time contact tracers.
Therefore, our contact tracing metric measures the percentage of new cases for which all contacts can be traced within 48 hours relative to available contact tracing staff in the state (assuming 1:5 new-positive-COVID-case:contact-tracing-staff ratio).
We use green if greater than 90% of the contacts can be traced within 48 hours, yellow if between 20% and 90% of the contacts can be traced within 48 hours, orange if between 7% and 20% of the contacts can be traced within 48 hours, and red if fewer than 7% of the contacts can be traced within 48 hours.
Here is an example from Wyoming:
As of June 13, Wyoming has an average of 12 new cases per day. If Wyoming needs 5 contact tracers per case, that would be 60 contact tracers necessary to trace all cases in 48 hours. Since Wyoming has 50 contact tracers, that is enough to trace 82% of cases.
What Should The Goals Be?
How did we choose our targets? Research estimates that the infection rate can be driven below 1.0 if 70-90% of cases are identified and 70-90% of those contacts are traced and isolated within 48 hours or less. Therefore, we chose 90% as the cut-off between green and yellow.
The boundaries between yellow, orange, and red are trickier. When less than 90% of positive cases have their contacts traced within 48 hours, contact tracing will likely be insufficient to contain COVID. We use 90% as the boundary between green and yellow. In the absence of expert consensus, we have set inclusive lower thresholds for yellow and orange. We peg the cut-off between yellow and orange at 20% — the number required for there to be one contact tracer per active case per 48 hours — and the cut-off between orange and red at 7%. Every state currently coded red is either currently experiencing a new outbreak or effectively has no tracing capacity.
A state can become green either by increasing the number of contact tracers, or by decreasing the number of new daily COVID infections. We hope that this new metric will help states factor contact tracing capacity into their reopening decisions.