HARRISBURG - As coronavirus cases continue to rise in Pennsylvania, the state health department has received approval to spend nearly $27 million to ramp up contact tracing efforts, warning of potentially dire consequences if it’s unable to do so quickly.

Contact tracing - the practice of locating people who have come in contact with individuals infected with COVID-19 and asking them to quarantine - is a key public health tool. Alongside wearing masks, practicing social distancing, and implementing widespread testing, experts say it’s one of the best ways to slow the spread of the coronavirus.

Now, the state is looking to outside companies for help with this critical work.

Official documents show the health department has filed at least two emergency requests, using an expedited contracting process, to hire companies to assist with contact tracing. One proposed contract for $25 million is with an Atlanta-based staffing agency to recruit, hire and train up to 4,000 tracers in 90 days. The other, for nearly $2 million, is with an Irish software company to launch a Bluetooth-enabled smartphone app that could notify users if they’ve been in close contact with an infected individual.

Neither contract has been finalized yet, according to a department spokesperson.

“At present, the spread of COVID-19 in the community is so overwhelming that the ability to track, trace, isolate and test the individuals suspected to have the virus is impossible without the influx of additional staff and use of technology-assisted applications,” the health department wrote in one of the requests for emergency funding.

Cases on the rise

Over the weekend, cases jumped in the Lehigh Valley and were on the rise in all counties.

In Carbon County, cases increased by 10 to 352. Deaths remain at 28.

In Lehigh County, there were 64 new cases for a total of 4,688. One additional death has been reported for a total of 335.

Luzerne County is reporting 3,144 cases, an increase of 37 since Friday. Deaths remain at 183.

In Monroe there were 13 new cases, bringing the total to 1,553. An additional death has been reported for a total of 121.

In Northampton County, 43 new cases brought the total to 3,746. Deaths remain at 289.

In Schuylkill County, there were 13 new cases. The total is 845, with 49 deaths.

Over the past 14 days, about one-third of Pennsylvania counties have seen a rise in cases. The state’s seven-day average of new cases is double what it was last month, driven by infections in the western region.

Restrictions

The concerning trend has prompted Gov. Tom Wolf and Secretary of Health Rachel Levine to impose tighter restrictions on bars, restaurants and indoor gatherings, and require people to wear masks in public. With surges in the southern and western parts of the nation, they worry travel could bring more cases to the state if action is not taken swiftly.

As of Wednesday, there were 661 contact tracers across the state, the health department said. That includes state and county employees, as well as volunteers. Although the department has met its original goal of 625 tracers, spokesperson Nate Wardle said, “we know that we will need to continue to increase our capacity as we move toward the fall.”

But public health experts - much like the state’s own emergency funding requests - say the time to ramp up contact tracing is now.

A tool built by George Washington University’s Institute for Health Workforce Equity estimates Pennsylvania needs nearly 4,500 tracers based on its current case count. Other public health experts have cited 2,000 to 4,000 as the target.

The main question, said Edward Salsberg, a senior researcher who helped build the George Washington University tool, is whether the state can reach all contacts of new cases within 24 hours. By notifying people who may have contracted the virus within that time frame and advising them to stay home, you limit the spread, Salsberg said.

On a day like Friday, when Pennsylvania announced a recent high of 1,213 new cases of COVID-19, that would mean contact tracers would have to call between 1,000 and 13,000 people, depending on how many contacts each infected individual had.

The question is whether 661 tracers can reach that many people the next day, Salsberg said.

Patchwork effort

With concerns about increasing case counts and the fear of a second wave in the fall, the department is looking to bolster its contact tracing systems further.

It has posted 12 job openings for contact tracing field managers and community health nurses. And one of the emergency contract requests it filed suggests a plan to hire thousands more.

Alongside the boost in personnel, Pennsylvania is also looking to supplement traditional contact tracing efforts with an app built by an outside company.

Typically, this kind of technology relies on a large number of people downloading an app and consistently carrying their smartphones. A user is notified when they’ve been in close contact with someone who’s self-identified as having COVID-19, though identifying information, like the infected person’s name and location, is not revealed.

Pennsylvania’s proposed vendor, NearForm, has already built a contact tracing app and implemented it successfully in Ireland, a country with strict privacy regulations. The company has made the technology’s source code publicly available, allowing outside engineers to vet the app for potential weaknesses, and recently joined a new global technology initiative to help public health agencies combat COVID-19.

Drawbacks

Still, social factors could hinder any app’s ability to provide meaningful information in Pennsylvania.

When two users come into close contact, Bluetooth technology isn’t able to discern whether they’re both wearing masks or whether the contact was outdoors - factors that have been proven to reduce the risk of infection.

Additionally, bottlenecks in lab capacity occurring around the country mean COVID-19 test results can take days or even weeks to come back. If users don’t have up-to-date information on their results, the technology won’t be effective.

And in Pennsylvania’s political landscape, where the coronavirus has become a divisive debate, questions remain about whether enough people would be willing to download an app - and self-report honestly - for the technology to actually be useful.

But experts say Pennsylvania currently has a critical opportunity to get a handle on cases.

“Now that numbers are coming up and we’re reopening society, you want to stem this,” Salsberg said. “This is how you keep your society open.”

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