Hospitals struggle with pandemic amid testing and contact tracing woes

Erin McCallister Senior Manager, Health Research Institute, PwC US July 23, 2020

With new policy moves, the FDA and the CDC are trying to address some of the nation’s ongoing testing challenges. Contact tracing efforts depend on expansive and timely testing; left unchecked, hospitals experiencing surges in COVID-19 patients could become overwhelmed.

A model published by researchers at Utrecht University in the Netherlands found that for contact tracing to successfully reduce the spread of the virus, testing results must be available within three days. A lack of supplies and capacity in the US has caused a lag in COVID-19 testing reports, with some national testing companies estimating that in some cases it could take more than a week for results to be returned.

On July 17, the CDC announced that a second negative test result was no longer necessary as a criterion for healthcare personnel to return to work. The CDC previously recommended that individuals test negative twice before returning or wait 20 days after first showing symptoms.

The test-based strategy “is no longer recommended because in the majority of cases, it results in excluding from work healthcare providers who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious,” the CDC said.

The FDA on Monday also issued new guidance that would loosen the requirements on transport media used to store specimens in transit to testing sites. “Policy set forth in this guidance will help address public health concerns regarding the availability of such transport media devices and therefore help expand the availability of SARS-CoV-2 diagnostic testing,” the guidance says.

Additionally, the agency issued an Emergency Use Authorization (EUA) that allows for pooled testing of specimens from multiple individuals to be run in one test. “This EUA for sample pooling is an important step forward in getting more COVID-19 tests to more Americans more quickly while preserving testing supplies,” FDA Commissioner Stephen Hahn said in a statement.

HRI impact analysis

If testing is able to catch up to demand, contact tracing programs could still fall short of their containment goals. Public health officials have estimated that nationally, the US would need at least 100,000 contact tracers to quickly reach out to contacts of potentially infected individuals and alert them to get tested and self-isolate.

Massachusetts launched early efforts to contact trace with up to 1,900 people, but the state cut staff to about 700 earlier this month, as cases declined. New York City had hired about 3,000 contact tracing staff by mid-June, and the public health department reported that it was able to reach about 72% of named contacts within 24 hours, but that only about half of individuals with positive cases completed the contact tracing interview in the first place. Among named contacts, only about half completed the interview process for the week ended July 4. New York and Massachusetts both continue to report low numbers of new cases after being hit hard by the pandemic in the spring.

Alternatively, in states that are reporting an increase in cases and hospitalizations, the number of needed contact tracers is much higher than what the state has reported. The Contract Tracing Workforce Estimator from the George Washington University estimates the number of contact tracers needed at baseline and at the current case counts.

For Texas, the tool estimates a need of 4,441 contact tracers at baseline and over 50,000 needed at the current case counts. For Florida, the estimate is 68,000 given its increasing rate of new cases. According to reports, Texas had about 2,800 contact tracers as of the end of June, while Florida had about 1,600.

At the same time, the number of hospitalized COVID-19 patients more than doubled in Texas from June 21 to July 20. In Florida, hospitalizations increased nearly 50% from July 10 to 20.

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Ingrid Stiver

Senior Manager, Health Research Institute, PwC US

Erin McCallister

Senior Manager, Health Research Institute, PwC US

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