Put Americans back to work fighting the coronavirus

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Nearly 17 million Americans have lost their jobs since mid-March, when the coronavirus started spreading around the country. Many won’t be able to return to work until the outbreak is contained. Meanwhile, there’s a proven strategy for containing infectious diseases, which is notoriously difficult to carry out because it’s so labor-intensive.

Why don’t we solve both problems at once?

With “contact tracing,” a mainstay of infectious disease control, health workers identify people who have been infected, contact them, learn who they may have exposed, and reach out to those people to limit the spread. Right now, the coronavirus is too widespread and testing too limited for such a targeted approach to work. But once case numbers become more manageable, the U.S. will move away from what epidemiologists call the “population-based” approach, which requires everybody to self-isolate, and toward one focused on containing individual cases. This will be the only way most of us can get back to normal life without risking devastating new outbreaks.

It’s a strategy that’s been shown to work against Covid-19 in New Zealand and Iceland. In the U.S., health officials use it to contain mumps and other diseases. But in the current crisis, the U.S. doesn’t have enough public-health workers to do the job. Contact tracing helped snuff out Liberia’s Ebola outbreak in 2014, but it took 4,000 workers to protect the country’s 5 million citizens. Wuhan, a city of 11 million, reportedly needed 9,000 contact tracers to suppress Covid-19. Estimates vary, but the U.S. will need 100,000 to 300,000 contact tracers to contain the coronavirus. That’s a lot of manpower.

Digital tools, such as apps used in Singapore and South Korea to automatically alert people who have been exposed to the coronavirus, can augment human labor — but they can’t replace it. This is especially true in the U.S., where stronger privacy protections and weaker quarantine authority limit technology’s reach. The high-profile contact-tracing program under development by Apple and Google will operate on an opt-in basis — which could limit its use substantially. As Dr. Farzad Mostashari put it on Twitter, “How do you get virtually everyone to put an always-on app on their phones that tracks their contacts, eats battery, and doesn't do anything to delight them?”

So state and local health departments should start thinking about how they can scale up their work forces. A pilot program in Massachusetts could serve as a model for others. The state is working with Partners in Health — the Boston-based nonprofit best known for its work in Haiti — to some hire some 1,000 contact tracers. Since training will be provided, these entry-level jobs are open to anyone with a high school education. The workers will track the ill and exposed using a web-based contact-management system, and ultimately connect them with testing and other services needed for quarantine, such as food delivery and even housing.

In return, entry-level contact tracers will earn $27 per hour. That’s considerably more than the state minimum wage, but given the importance of fighting the virus — and relieving workers’ distress during this stunning economic crisis — it will be money well spent. Epidemiologist Gregg Gonsalves recently called for “a WPA for public health,” referring to the Depression-era program that employed millions to build roads, parks and other projects that endure to this day. Eradicating the coronavirus would require fewer workers, but the employment situation is, for now, no less dire. And importantly, containing the virus would allow the U.S. economy to return to normal as scientists work on a vaccine.

Many temporary contact tracers could return to their jobs once the crisis abates. For others, contact tracing could be a stepping stone to a career in public health, where workers are desperately needed, because more than 50,000 public-health jobs evaporated during the Great Recession. By one estimate U.S. is short a quarter-million such workers — who will need to be hired if we want to avoid future pandemics.

Expanding contact tracing is one of many ways to shore up the public-health workforce. Lawmakers from both parties have called for a Public Health Infrastructure Fund, which would raise $13 per person to ensure that the public-health system can meet its “foundational capacities.” That would amount to $4.5 billion, a tiny fraction of the money allocated for coronavirus relief so far. Partnerships with universities, nonprofits and businesses — such as Massachusetts’s with Partners in Health — might offer another way for cash-strapped public-health agencies to scale up.

Until there’s a vaccine for Covid-19 — with luck, sometime next year — coronavirus is going to be a problem. We have, broadly speaking, three choices. We could maintain shelter-in-place indefinitely, devastating the economy. We could end it for everyone, leading to more outbreaks and needless deaths. Or we could be strategic — identifying the sick and at-risk through testing and tracing, suppressing outbreaks, building up our public health capacity, and keeping laid-off workers employed until the economy has recovered enough to reabsorb them. The choice is easy.

Bloomberg News
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