Volunteer Army, Millions of Tests Needed to Open the U.S. West

(Bloomberg) -- The West Coast’s plan for emerging from the coronavirus lockdown relies on millions of tests, tens of thousands of volunteers -- and a certain amount of privacy invasion.

Governors of California, Oregon and Washington, who are coordinating plans, say they won’t ease stay-home orders until they’ve established systems to spot new cases, find everyone who’s come into contact with infected people and test as many as possible. Without that capability, they say, they would risk triggering another wave of infections in a region that has already lost more than 1,500 people to Covid-19.

Most public-health agencies already perform limited contact tracing to fight threats such as measles and tuberculosis. But the scale required by the coronavirus is daunting: The region is about the size of France and the U.K. combined, and includes teeming cities, open deserts, vast suburbs and rural pockets with limited public-health resources. The challenge illustrates how difficult it will be for the country as a whole to lift restrictions and restart the economy.

President Donald Trump acknowledged Thursday that governors would be in charge of restarting their own states, but said that some could resume normal commerce by May 1. Even though the West Coast states appear to have avoided the kind of explosive outbreak ravaging New York and New Jersey, their governors aren’t in a rush to reopen.

“We move too quickly, we will see a spike in cases that could still lead to an overwhelmed hospital system and unnecessary deaths,” Oregon Governor Kate Brown warned this week.

Epochal Effort

On the West Coast, the process to stop a disease that has killed more than 34,000 Americans so far will require a historic effort, one of the biggest civilian mobilizations since the New Deal.

In California alone, the effort to trace new infections could take 40,000 public-health workers and volunteers, by one estimate. That’s more the entire number of firefighters employed in the state, and five times the total of Peace Corps volunteers deployed around the world. There is, however, a large pool of potential workers: Unemployment claims across the three West Coast states top 3.5 million.

The effort will require a rare level of public trust. Volunteers, after all, will be phoning strangers with the unnerving news that they may have been exposed to a deadly virus. And those strangers may not want to talk to the government. San Francisco, which already has such a system and is expanding it, has found that some people have been unwilling to cooperate. Mayor London Breed has tried to reassure undocumented residents that the city won’t hand over their data to immigration enforcement.

“I don’t want you to have any fear about ICE or any other federal resource coming in and trying to obtain this personal information,” she said Wednesday. “We have to make sure that people feel safe.”

Banding Together

Nationwide, the coronavirus lockdowns that began in March have cost more than 20 million Americans their jobs and threatened the survival of countless businesses, large and small. Trump has advocated a rapid reopening, but many state leaders and health officials have pushed back, saying the nation’s ability to test for the coronavirus is nowhere near sufficient. State confederations have arisen in the Northeast and Midwest, as well as the West Coast, to coordinate policies.

Before Thursday, they had little input from the White House, as Trump said states should spearhead the virus response, then claimed total authority, then backed down.

On Thursday, the administration handed out guidelines in a booklet, recommending states document a “downward trajectory” in cases before they lift stay-home orders. Trump said governors could consider reopening schools and workplaces by May 1, when federal social-distancing recommendations are scheduled to expire. The new guidelines call for companies to conduct temperature checks of employees and require symptomatic workers to be cleared by doctors before returning.

But testing programs have stumbled thanks to shortages of supplies like swabs to collect samples, limited lab-processing capacity, and inadequate staff, particularly in some rural areas.

“We’ve got some counties where literally their health department is composed of less than a handful of people,” said Anthony Chen, public health director of Washington’s Pierce County, where Tacoma is located. “We could be doing a great job here. But then if our neighboring counties outside of this region are not doing well, it will eventually come back and affect us.”

Despite frequent promises from the Trump administration that anyone who wants to be can get tested, many places still struggle to provide it even for symptomatic patients. The shortages -- along with more general disorganization and chaos -- have contributed to long delays in sample processing.

California has been an extreme example. Two weeks ago, the state faced what appeared to be a backlog of more than 59,000 samples. After Governor Gavin Newsom said that the state was expanding testing capacity, that shrank overnight to around 15,000: Many labs had simply not been reporting negative results, leaving the state to mark them as “pending.” Newsom said this week that the state’s labs had managed to process 12,000 tests in a day, and he’s aiming for 20,000 per day by the end of April.

California has completed only 239,181 tests since the outbreak began. It has almost 40 million residents.

San Francisco Mobilized

In order to lift restrictions, states must provide vast and accurate testing, said George Rutherford, the head of infectious disease and global epidemiology at the University of California at San Francisco.

“We need to have enough testing so we can test at least everybody who is symptomatic, and then everybody we find through contact tracing,” he said.

Rutherford and his school have helped San Francisco rev up its tracing program, which is drawing volunteers from universities, libraries and city agencies. An effective statewide program, he said, could require 40,000 workers -- one for every 10,000 residents. It would last until a vaccine becomes widely available, which likely won’t happen until at least 2021.

“Remember, this isn’t forever,” Rutherford said. “We’ll need this big workforce for a year, maybe two. Then it can all dissipate.”

When coronavirus outbreaks hit the West Coast in late February -- first in the Seattle area, then Northern California -- public-health agencies went to great lengths to track people who tested positive, hoping to contain the virus. The numbers soon overwhelmed them.

Delicate Approach

The work requires both professionalism and finesse.

Patients will be interviewed by trained tracers, who will ask where they have recently been and whom they have seen. Those acquaintances will first receive a text, followed shortly by a call from a volunteer. The volunteers are trained to be open about what they’re doing and to reassure the person they’re calling that information will remain confidential. The conversations can be delicate.

“You’re not sure who you’re going to get on the line and how they’re going to respond,” said Jazmin Flores, an administrative assistant in the San Francisco City Attorney’s Office who began training as a tracer this week. “You could be breaking it to them.”

Flores, who has a sister who is a nurse, says she’s eager to start. “It’s just to do anything that will protect more people, maybe speed up the timeline of when we can go back to work,” she said.

With testing and tracing programs still spooling up, many experts consider it unlikely that West Coast states will lift lockdowns in the coming weeks. That’s particularly true in spots such as Los Angeles County, where the number of deaths reported daily continue to rise.

Robert Kim-Farley, a University of California at Los Angeles professor of epidemiology, said that may take until mid-June or July.

“We’re at least a month away from seeing these downswings and significant testing being available to begin really contemplating a reopening,” Kim-Farley said.

And while California, Oregon and Washington have a clear-eyed view of the task ahead, 47 other states must follow their lead if America is to be safe.

©2020 Bloomberg L.P.