Health experts call for Roosevelt-style programs to kill virus, revive economy
A first-of-its-kind program that will deploy almost a thousand people across Massachusetts may be a small-scale test of what public health experts hope could eventually stamp out the coronavirus even before a vaccine becomes widely available.
Massachusetts Gov. Charlie Baker (R) said Friday that his state would join with Partners In Health, a Boston-based global health nonprofit, to turn staffers into contact tracers, the backbone of any robust public health effort to squelch a deadly disease.
Those contact tracers will interview people who have been infected with the coronavirus to determine who around them might also have been exposed. Those who may have been exposed will be warned to watch for symptoms themselves, giving public health officials a window into how the coronavirus is spreading and who might next be at risk.
“Massachusetts is the only state in the nation implementing this type of programming, and this collaborative tracing initiative will break new ground as we work together to slow the spread of COVID-19,” Baker said in a statement Friday.
Public health experts across the country hope Massachusetts will not be alone for long. Increasingly, those who have warned for months about the virus’s potential spread now say a mass-scale national program aimed at suppressing the virus at a community level through that sort of robust contact tracing is crucial to stopping its spread.
Such a program aimed at bolstering national public health would be unprecedented in the history of the country. But as the economy nosedives into what could be a depression and millions lose their jobs in the space of a few days and weeks, a government-backed effort to get those people back to work does have a precedent, in Depression-era programs like the Works Progress Administration (WPA) and the Civilian Conservation Corps (CCC).
In their brief histories, the WPA and the CCC employed nearly 1 in 10 Americans, giving people a paycheck in the years between Franklin Roosevelt’s election and the outset of World War II. In its first year, the WPA accounted for more than 6 percent of the nation’s gross domestic product — the equivalent of about $1.3 trillion in today’s dollars.
That, public health experts said, would be money well-spent to both get a handle on a virus that has infected more than 332,000 people and killed almost 9,500 as of Sunday afternoon.
“We need an army of contact tracers in every community in the United States to find every contact to warn them to take care of themselves and not to infect others,” said Tom Frieden, the former director of the Centers for Disease Control and Prevention who now runs the global health nonprofit Resolve to Save Lives. “Contact tracing is a core public health activity. It’s bread and butter of public health.”
The outlines of a program that would marry both the country’s public health system and its struggling economy are evident too, health experts say, in places like China, South Korea and even Iceland, nations that took drastic steps to stop the spread of the coronavirus.
At the core of a nationalized program would be small teams of contact tracers, people tasked with interviewing those who are diagnosed with the coronavirus to build a roster of those who have been exposed. In Wuhan, China, the government dispatched 1,800 five-person teams to track down every contact to warn them they were at risk. South Korea invested heavily in building virtual nets around those who had been exposed.
In Iceland, 50-person teams include everyone from law enforcement to social workers.
In some ways, the United States needs to take a page from countries with far weaker health systems, countries that cannot afford high-tech hospitals and cutting-edge medications and treatments. Those countries are instead forced to invest in community health in order to prevent small-scale outbreaks from becoming wide-spread disasters.
“In the developed world we tend to over-invest in hospital and clinical treatment and under-invest in public health,” said Jeremy Konyndyk, a senior fellow at the Center for Global Development and the former head of the U.S. Agency for International Development’s Office of Foreign Disaster Assistance under the Obama administration. Developing countries “tend to underinvest in medical treatment by default, because it’s expensive, but labor is cheap, and they can invest in public health.”
No country has the reservoir of epidemiologists and public health experts necessary to surge tens or hundreds of thousands of people into the field to stop an outbreak. But in countries like China, the government enlisted people who were not health experts and either taught them basic health functions or used the expertise they already had.
Today, there are thousands of newly idled workers already on the government payroll. In mid-March, the Peace Corps suspended its operations and brought 7,000 volunteers home. Another 75,000 members of AmeriCorps are still on the job, in some cases filling in gaps for social service organizations that are now hurting for volunteers.
The calls for larger national programs reflect the reality of a pandemic that will continue to spread until any of the 40 or so vaccine candidates in trials around the world become accessible on a mass scale. In the meantime, billions are at risk of infection, and millions are at risk of death.
American politicians have focused on what epidemiologists and the modelers they depend upon call a peak, the day on which the virus most strains the public health system. Those peaks may come as early as this week in hard-hit places like New York City, but they might not come for weeks or months in places where the virus has yet to begin spreading quickly.
Once the peak is reached, the number of new cases tapers off, as those who have recovered are no longer susceptible to infection and the virus has fewer potential victims to infect.
But the number of cases will not shrink to zero, and those who have not yet been infected will once again be at risk if the economy begins to open again and people adhere less to social distancing practices.
At the same time, what the American public now views as a public health threat will eventually be seen as an economic crisis. After decades of declining trust in government, some experts say a community-driven effort — in which neighbors, not government agents, are leading contact tracing and quarantining measures — will pay dividends.
Some call for a social safety net component, like paid sick leave for those who must be quarantined, as an especially crucial element in communities where distrust of government runs deep, including conservative rural areas and in minority communities.
“Trust hangs in the balance, and that has really significant future ramifications for whether or not people will be receptive to public health messages,” said Prabhjot Singh, a physician and health systems expert in the Mount Sinai Hospital System and the Icahn School of Medicine. “If you start attaching punitive measures, fines, et cetera, to isolation orders, you’re going to double down and deepen the damage and trust is going to erode further.”
Other nations have decades of experience in mobilizing local community members to fight a virus. In West Africa, countries like Liberia, Guinea and Sierra Leone are reactivating contact tracing teams they used to track down and stomp out the Ebola virus that broke out six years ago. In that outbreak, Nigeria repurposed a team meant to fight polio to stop Ebola’s spread in Lagos.
“There are plenty of precedents for having community members mobilized and engaged in their communities to help extend the public health effort,” Konyndyk said.
During this outbreak, South Korea, Taiwan and Singapore have used contact tracing techniques aggressively to find and contain the coronavirus.
China’s authoritarian government’s extreme lockdowns and mandatory isolation would not work in the liberal democratic United States, which puts an added premium on understanding the communities most in need of help in the coming weeks or months. In epidemiology circles, understanding the anthropology of a community matters as much as understanding the biology of the virus that is attacking it.
“Hospitals are a critical circuit breaker, but we won’t solve this in the hospitals,” Singh said. “This coronavirus spreads in a community, and it’s going to end in a community.”