Why COVID contact tracing isn’t working in Chicago

Newly hired as a coronavirus contact tracer, Ajamu Carter began reaching out to people who possibly had been exposed to COVID-19 in October.

He quickly ran into a roadblock: Many of them, especially young Chicagoans, didn’t want to talk to him.

“It can be difficult to deal with the millennials, which is interesting because I’m a millennial myself,” says Carter, who’s 30.

A COVID survivor with experience working in health care and a degree in biology, Carter hopes to go to medical school. When the city of Chicago was looking for contact tracers this past summer, he jumped at the chance. 

With his health care knowledge and personable approach, Carter seems well suited for the job. But he figures that, for every 10 people he calls in an effort to trace and slow the spread of the virus, maybe four will call him back.

That’s still a far higher success rate than the overall numbers reported by the city’s case investigators, the ones who do initial interviews and then pass along to Carter and others the names of people to call. From August through late November, the city’s public health investigators managed to reach and interview only about 16% of Chicagoans who’d tested positive.

Those initial investigations are a crucial step in tracing. Carter and hundreds of new contact tracers who recently have been hired rely on the health department’s case investigators to provide them with leads.

The problem, as Carter discovered, is that many people won’t cooperate. Or they can’t be reached.

Contact tracing begins with trying to locate and interview anyone who recently tested positive. Its success depends on those people opening up about others they recently have been in close contact with. And, beyond that: convincing people who possibly were exposed to the virus to quarantine themselves to keep from spreading it, even when they haven’t experienced any symptoms. 

Touted early in the pandemic as a critical tool to help slow the spread of COVID-19 by interviewing people who might have been exposed, the effort in Chicago is falling far short of expectations.

There’s the city’s low rate of success even reaching COVID-positive people.

Beyond that, those who do get interviewed aren’t giving up the names of their friends and family, health officials say. City officials hoped they would get names from the COVID-positive Chicagoans contact tracers reach of five to 10 people each who potentially had been exposed. But city officials say that so far they are getting little more than one contact, on average, for each COVID-positive person interviewed. 

Why so few? According to city officials, the reasons include:

• The continuing and growing surge of the coronavirus has overwhelmed the roughly 100 city employees assigned to investigating the cases. “In the span of two weeks, we went from getting 300 cases a day to one day seeing 3,000 new cases,” says Christina Anderson, deputy commissioner of the city’s health department. “It ramped up very, very quickly.”
• They can’t reach people when they don’t know how to contact them, and they often have no contact information. As a result, the city workers have been able to try to reach fewer than one-third of the people in Chicago who have tested positive. The state of Illinois has said that health departments should try to reach 90% of COVID-positive patients within 24 hours of being diagnosed.
• Even when they have contact information, people aren’t answering when city employees call.
• And frequently the people they do reach don’t want to talk or are reluctant to pass along the names of their acquaintances.

City officials are aiming to get more contact tracers, like Carter, working over the next few weeks. About 500 have been hired under a $56 million city program overseen by the Chicago Cook Workforce Partnership, which is working with community groups. More than half of the hired contact tracers are in the final stages of training.

The program particularly aims to contact some of the hardest people to reach in low-income communities hardest hit by COVID — on the West Side and South Side.

But city officials acknowledge that they won’t have enough work for the new tracers to do unless investigators produce more contacts for them to track down.

Tyler LaRiviere / Sun-Times

Precious Justice, 21, a college senior who hopes to go to medical school next year, is among the tracers. One day this past week, she was given just two leads from the city’s public health department.

“Some days can be really slow,” says Justice, who has found younger people are less likely to cooperate. 

Like Carter, she was hired by the National Able Network, one of 31 community groups taking part in the Chicago COVID Contact Tracing Corps.

The contact tracers identify themselves as working on behalf of the Chicago Department of Public Health. When they call someone, the number they call from shows up on the contacts’ phones as (312) 742-6843  — that’s (312) 74COVID.

Justice and Carter went through extensive training on how to get people to talk with them. They were taught to try to put people at ease by showing empathy and compassion and to be cognizant of the need to build trust in communities that aren’t prone to trust government. The city spread the money for contact tracing through community organizations in the hope of reaching communities of color where people often are distrustful of government.

Provided

Cynthia Rodriguez, 36, supervises Carter and Justice. She says that seeing family members and friends in her Belmont-Cragin neighborhood suffer from the pandemic influenced her to join the tracing program. 

“Seeing the effect it had on my community, especially on my block, I said, ‘I have to get involved,’ ” she says. 

Nationally, public health officials hoped that contact tracing, which has been used for well over a century, would help bring down the numbers of infections, hospitalizations and deaths.

“We have a lot of folks who are just not that interested in providing the information,” Dr. Allison Arwady, commissioner of the city’s public health department, says of the problems getting people to talk with the contact tracers. “There’s been a lot of hesitation for people to cooperate.

“We are talking to people, and sometimes they tell you they’ve had absolutely no contacts,” Arwady says. “That’s not possible, right?”

Pat Nabong / Sun-Times

Without the intervention from contact tracers, Arwady says she fears many asymptomatic people unknowingly continue to spread the virus. 

“Certainly, compared to most diseases for which we do case investigation and contact tracing, this one has proved to be really challenging because there is that significant period where people are spreading disease without any symptoms,” she says. 

Contact tracing still can have other benefits even if preventing significant spread of the virus is looking unlikely. Community education and support efforts, including distributing masks and hand sanitizer, are all benefits the Chicago workforce initiative is aiming for once the Chicago COVID Contact Tracing Corps, which got a late start, is fully up and running.

Putting community organizations in charge of hiring tracers was seen as important given the perception that Black and Latino residents would respond better to people from community groups they know. 

Howard Brown Health

“There’s mistrust with the medical community in general among Black and Brown communities,” says Dr. Aniruddha Hazra, co-medical director of Howard Brown Health’s 55th Street clinic. “Institutional racism in medicine is all baked in. We can’t expect African American or Latinx communities to just start trusting us.”

Howard Brown Health has been doing contact tracing since the beginning of the pandemic and has interviewed nearly 3,700 people who’d tested positive. It also has reached nearly as many contacts. Its tracers also do community outreach and education.

Hazra says he has called employers to assure them that their workers who previously were infected with the virus can safely return to their jobs. 

Anderson, the deputy city public health commissioner, says for now the city is in a “triage” mode, prioritizing investigations to identify potential outbreaks at congregate settings, like nursing and group homes. It’s focusing on household contacts, aiming to target vulnerable populations such as the elderly and people with other health conditions.

The U.S. Centers for Disease Control and Prevention posted guidelines last month for that sort of prioritization when health departments are overwhelmed.

In Chicago, the city plans to direct some of the contact tracers who are about to start work to focus for now on other educational and outreach work.

“Some of what we’re working on is how can we work with the contact tracing organization to do other kinds of outreach that can help mitigate transmission,” Anderson says. “The contact tracers we thought we were going to need to trace the contacts — we really right now don’t need as many. That will change as we do more case investigations.”

Brett Chase’s reporting on the environment and public health is made possible by a grant from The Chicago Community Trust.