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As N.H. Scales Back Contact Tracing, Experts Say Other Measures Needed To Mitigate Virus

Allison Quantz for NHPR

Last week, after reports of delays in contact tracing and schools beginning to do their own, top state health officials announced New Hampshire would scale back its contact tracing efforts to focus on populations most vulnerable to COVID-19.

Now, health care providers are expected to advise COVID-positive patients on how to follow the CDC's recommendations for quarantine and isolation. Doctors say they will not be doing any actual contact tracing, but once a patient tests positive, they’ll be expected to notify their close contacts, and isolate.

“I think that there’s a worry right now that people won’t do that, that people are fatigued and that’s contributing to community transmission,” said Steve Norton, the chief strategy officer for SolutionHealth, the provider that includes Southern New Hampshire Medical Center and Elliot Hospital.

Dartmouth-Hitchcock infectious disease physician Michael Calderwood said this doesn't change much for physicians, who have already been offering state health officials information about patients that may be helpful with contact tracing.

But, he said, community transmission is now far too widespread for the state to trace every contact. Daily new case counts dwarf New Hampshire’s previous peak in the spring, and that trend is expected to continue.

"We may not understand as readily as we did in the past...was there community transmission in a local restaurant? And the state's comment to that is that every community in the state right now has substantial transmission and you should be expecting that you're going to come in contact with it if you're out in the community,” Calderwood said.

“This has gotten so far, and the numbers are so high, that we can’t track down every case and every contact, and you just have to assume it’s out there and you have to mitigate your risk,” he added.

Calderwood and other health experts say contact tracing is only one of many ways to contain the spread of COVID-19, and that other measures are necessary in order to mitigate the virus. He said he understood the need to balance guidelines with economic risk factors, but said the state should consider a mask mandate and updated travel guidance as many make plans for holiday travel and gatherings.

Crystal Watson of Johns Hopkins University studies COVID-19 risk factors and the importance of contact tracing amid pandemics. She said it's likely that other states have had to scale down their contact tracing efforts, too, as the number of cases overwhelms public health workers.

But unlike surrounding states, New Hampshire has been reluctant to implement additional guidelines that Watson said will be crucial in mitigating COVID-19’s spread. This week, Vermont Gov. Phil Scott banned multi-household gatherings in preparation for Thanksgiving, imposed a curfew on bars and social clubs, and limited restaurant seating to one family per table.

In New Hampshire, more towns have been imposing mask ordinances, but the state remains the only one in the region without a statewide mandate.

"If we wait so long to put in place some common sense measures like masking and restricting indoor activities, we're really at danger of health care system collapse as well as just increased deaths from this virus,” Watson said.

Watson said states didn’t get enough resources from the federal government for contact tracing programs that could have successfully slowed the spread of the virus. Some jurisdictions that had more robust programs are seeing lower levels of transmission.

“But it doesn’t make a community immune from the virus if we’re not taking other precautions as well,” Watson said. “So if we’re not taking other precautions like mask wearing, contact tracing alone is not enough to control the spread of this virus.”

New Hampshire is past the point of COVID-19 containment: according to state health department spokesperson Jake Leon, the number of close contacts per positive case has increased from two or three in the summer to five or six in recent weeks. Data through Sept. 30th showed that 75 to 85 percent of all cases responded to a contact tracer within 24 hours.

“The rest were attempted but not reached,” Leon wrote in an email. “It is far more common that people refuse to take our calls or work with us.”

“The rising case counts and increasing community transmission have certainly stressed the contact tracing program,” Leon added. When New Hampshire began contact tracing, it employed 90 tracers, which soon increased to 150 in the early summer. The number of personnel declined through the late summer and is now back up to around 140.

Health officials say contact tracing will still be conducted among the most at-risk populations, including people under the age of 18 or over the age of 65; communities of color; people in communal living settings or health care facilities; and any clusters or outbreaks.

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