Despite Florida setting record numbers of new covid-19 cases, health authorities often don't follow up on contacts

What is "contact tracking" for? 1:34

(CNN) - When Shaila Rivera and her new husband returned home from their honeymoon and tested positive for covid-19, they were waiting for a phone call from local health authorities in Florida asking for a list of the people they had been with close so contact tracking could begin.

The Riveras waited for that phone call. And they waited. And they waited ... But the call never came.

"I was surprised," said Rivera, a nurse who has already recovered from the virus.

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Despite claims that Florida tracks all covid-19 cases, a CNN investigation found that health authorities in Florida, now the country's number one access point for the virus, often do not track for contacts, something that has long been considered a key tool in containing an outbreak.

Florida set a record for most U.S. coronavirus cases in a single day on July 4, totaling 11,458, according to data compiled by Johns Hopkins University, and on Sunday, the state topped 200,000 cases of covid-19.

Florida contact tracking challenges are indicative of how difficult it is for states affected by covid-19 to do proper contact tracking, which is a challenge even in the best of circumstances. The virus is so advanced in states like Florida that it is an apparently Herculean task to track down each infected person and keep track of all their close contacts.

CNN spoke to 27 Floridians, or their families, who had tested positive for covid-19. Of these, only five said they had received a call from the health authorities asking for their contacts.

There are concerns about contact tracking nationwide, not just in Florida. In a June interview, CNN asked Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, how he believed contact tracing was going in the United States.

"I don't think we are doing very well," he replied.

What is contact tracking?

Tracking contacts is a centuries-old practice, and the basics haven't changed much: Essentially, healthcare workers ask infected people for a list of everyone they've been in contact with while potentially contagious. The worker then tells those contacts to quarantine and watch for symptoms.

The CDC provides detailed contact tracking guidance to state health departments, explaining that "monitoring these covid-19 contacts can effectively break the chain of disease transmission and prevent further spread of the virus in a community."

White House guidelines describe contact tracing as one of the "basic state preparedness responsibilities."

An online infographic from the Florida Department of Health describes contact tracking as a "basic public health function" and claims that a local epidemiologist will ask people with the virus for a list of everyone they've been with. Contact for the past two weeks, and the county health department will monitor those contacts.

Contact tracing is a core public health function and can help contain # COVID19 in 3 main steps:
1⃣You test positive for COVID-19
2⃣An epidemiologist will ask who you've been in contact with in the last 2 weeks
3⃣Your county health department will monitor you and your contacts pic.twitter.com/sIdKexouH3

- Florida Dept. Health (@HealthyFla) July 4, 2020

A spokesman for the Florida Department of Health in Miami-Dade County sent CNN a statement about tracing contacts in his state.

"When the Department of Health receives a notification that a person has tested positive for covid-19, the department conducts an extensive epidemiological investigation in conjunction with the CDC [Centers for Disease Control and Prevention] to identify individuals they may have had close contact with the virus. These individuals are then notified by their county health department and instructed to self-isolate for 14 days after exposure to the virus, and to contact their county health department and healthcare provider immediately. if they develop symptoms. This process must be followed by all those who test positive in Florida, ”Olga Connor wrote in the email.

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The number of contact trackers in Florida is unclear

The National Association of County and City Health Officials estimates that during a pandemic, communities need 30 contact trackers for every 100,000 people. Florida, with a population of 21.5 million people, would need 6,443 contact trackers.

Florida does not have anywhere near that number, and it is not alone. According to a July 3 report from Nephron Research, only seven states have a sufficient number of contact trackers to meet NACCHO standards.

It is unclear how many contact trackers are employed by the state of Florida, as spokespersons for the Department of Health gave CNN two different numbers.

“More than 1,600 people, including students, epidemiologists, and other staff from across the Department, are currently involved in tracing contacts for every positive case of COVID-19 in Florida,” Candy Sims, spokesperson for the Florida Department of Health at the Broward County wrote to CNN.

The department has hired a private company to hire 400 additional contact trackers, Sims added.

But Alberto Moscoso, a spokesman for the health department, quoted a larger number, writing to CNN that Florida has 2,300 "individuals involved in contact tracing."

Sims and Moscoso did not respond to CNN's questions about the differences in their numbers.

In an online infographic, the Florida Department of Health asks infected people to call their contacts on their own.

"Immediately notify those with whom you have had close contact while sick," according to the chart, noting that those contacts should be quarantined for 14 days.

The CDC, however, gives different advice. The agency recommends that local health departments ask infected people for a list of everyone they have had close contact with, starting two days before symptoms develop.

The Florida infographic doesn't explain what to do if someone tests positive for covid-19 but has never shown symptoms. According to the CDC, in that case, people should be notified if they had close contact with the infected person two days before that person was tested for covid.

5 of the 27 Floridians received follow-up contacts

Of the 27 Floridians who tested positive for covid-19, five told CNN that they had received a call from a health official asking for their contacts.

Among the 27 cases, the earliest diagnosis was in February, and the most recent was last week.

The Riveras contracted covid-19 in early March, when contact trackers had considerably less pressure than they are now. Shaila Rivera said a Miami-Dade County Health Department official called and asked about her illnesses, but did not ask about her contacts.

"We were surprised," said Rivera, a pediatric nurse. “The entire conversation lasted less than a minute. There were no questions like who did you have contact with? She went to work? Nothing of that".

Eleven of the 27 said they, like the Riveras, received calls from a Florida health official, but were not asked for their contacts.

David Pugh, who lives in Broward County, said he received that call.

"I don't know if we can count on the state to do a complete job. I think there are obviously flaws in the system, ”he said.

Doubts about the usefulness of contact tracing

Tracing contacts has been done since the first case in the United States more than five months ago, and there are several reasons why the outbreak could not be contained.

First, the CDC estimates that 35% of covid cases are asymptomatic, and those people are as contagious as those with symptoms.

"How do you trace contacts when someone doesn't have any symptoms?" Fauci said in his interview with CNN. "The standard, classic paradigm of identification, isolation, contact tracing doesn't work, no matter how good you are because you don't know who you're tracing."

In addition, he said some people hesitate to speak to government officials.

"The dots are not connected because much of it is done over the phone," Fauci said. "Fifty percent of people, because you come from an authority, don't even want to talk to you."

In addition to these problems, some experts doubt the usefulness of contact tracing in areas like Florida, where cases are on the rise.

Epidemiologist Michael Osterholm urged Florida leaders to focus on other strategies, such as finding out where the virus is spreading.

"For example, if young adults in bars are the problem, they need to be closed," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who recently released a report on contact tracking.

With thousands of new cases per day in Florida, Osterholm doubted that contact tracing would have much effect.

"If Florida could reach 50 to 100 cases per day, contact tracing could be helpful. But right now, it is not likely to have a measurable impact, "she said. “It is like trying to put out a forest fire with a single fire truck. It just won't make a dent. ”

- CNN's Jacqueline Howard and Dana Vigue contributed to this report.

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