How Louisiana’s Massive Effort To Test And Trace Coronavirus Cases Could Fall Short

May 12, 2020

Louisiana hasn’t “declared victory” and “it’s not mission accomplished,” but Gov. John Bel Edwards said the state will begin its first step towards more normal times on Friday.

The state now meets all of the White House criteria for reopening — a decline in people with COVID-like symptoms, a steady drop in new coronavirus cases and enough capacity in hospitals. That’s prompted the launch of Phase One of the governor’s plan to loosen stay-at-home orders for many businesses. Nail salons, movie theaters and gyms can finally open their doors.

The plan to ease restrictions relies on a dramatically ramped-up state-wide effort to test for the coronavirus and trace and quarantine anyone who’s had contact with someone infected. The state is aiming to conduct 200,000 tests a month and hire 750 contact tracers, 250 of whom are expected to be working by the end of the week.

But some estimates suggest Louisiana’s goals fall far short.

Success would lie in the details and the scope.

Harvard's Global Health Institute calculates Louisiana needs to perform over 600,000 tests in a 30-day month, nearly triple the goal set by the governor.

A separate estimate from the National Association of County and City Health Officials found that states should employ 30 contact tracers for every 100,000 people. Louisiana’s plan would give the state half that.

“Let's just acknowledge that we don't know exactly what the right number of tests is,” said Rebekah Gee, the former secretary of health for the state and a current professor at Louisiana State University. “We don't know exactly what the right number of contract tracers is. Those numbers really depend on how many cases we have going forward in Louisiana. And so whatever planning is being done, assumes fidelity to a certain model, and there's some uncertainty.”

Gee said she had faith in state officials — “we have a very strong Office of Public Health” well-connected to Johns Hopkins and other leading national organizations in the fight against COVID-19, in addition to White House and Centers for Disease Control leadership — but she also said success could lie in the details.

Testing is still a source of uncertainty.

For one, coronavirus tests vary widely in their accuracy — something LSU is investigating. One test has a 30 percent rate of false negatives.

“They actually have the coronavirus, but the test tells you they don't, and that's dangerous,” she said.

Then there’s the fact that the components of these tests remain in short supply, especially the swabs that reach up your nasal canal to collect a sample. Edwards said the government has pledged to supply enough testing equipment to meet the monthly testing goals at least through June. Last week, Dr. Alex Billioux, the state’s assistant secretary for the Office of Public Health, said the state could branch out into new varieties of tests, including a saliva-based test.

High risk-setting will be crucial in this expanded-testing future, particularly nursing homes and prisons, where outbreaks of the coronavirus have been devastating. The state wants to test every resident in these facilities, but it is not mandating the tests, nor is it forcing staff to get tested.

There’s also the question of how often to re-test those who’re first found to not to have the virus, Billioux has said. “You can't just go through and say we're going to test either of those populations once and be done.”

Another key detail is whether those most at risk for the virus will get sufficient access to testing. LSU and the City of New Orleans have been expanding mobile testing to communities with high rates of infection. But Gee remains worried about employees who’ll be heading back to work.

“I'm not worried about the people that work in office towers, legal offices and healthcare workers throughout the city, I know that they will get access,” she said. “I'm worried about mom and pop businesses. I'm worried about small family-owned businesses not being able to get tests and the workers not having the protection we need.”

Focusing on workers could be key to reducing the high rates of cases and deaths among the state’s black residents, she added.

“I really think that the lack of protection for essential workers and the lack of testing for them has led to some of the health disparities because we know that essential workers are disproportionately people of color.”

Antibody testing is also growing in the state, but the accuracy of those tests can vary widely. And while they can reveal just how widespread the virus is in our communities, it remains unclear how long those antibodies can provide immunity to the virus.

Contract tracers are the other vital prong of the plan.

Their job is to contact newly positive patients and trace who they’ve come into close contact with — any contact within 6 feet sustained for 10 minutes or more — Dr. Jennifer Avegno, the director of health for the city of New Orleans, said on Monday.

“Anyone who is in close contact with someone that tests positive for COVID will be quarantined for 14 days,” she added.

But the state and city are not forcing people to participate in contact tracing or quarantine. And how well people voluntarily comply could play a crucial role in containing viral outbreaks.

“A large component of it is, how do people then react and respond to contact tracing?” Billioux said. “Are they helping us as we reach out? Find people who could be exposed? Are they themselves adhering to isolating if they're — if they have COVID? Or are they quarantining?”

And if they’re not: “We should expect that there would be a challenge and that we would see a growth in cases again, and then we would have the same kind of picture that we had going into this.”

None of this is a return to normal, and officials will be watching the data.

State and city health officials stressed that they’ll rely on the data to show whether the testing and tracing are working — that is, whether we’re able to avoid an outbreak during Phase One. Data analyst Jeff Asher has launched a new tool to do exactly that. It tracks overall testing numbers, hospitalizations, and most importantly, new coronavirus cases.

“What really matters is, is that number going up? Is it going down? Or is it steady? You can break it down not just at the statewide level, but at a parish level or regional level,” he said.

There are two regions in particular where the trends are worrying, he added. In both northwest and Central Louisiana, new coronavirus cases have been rising.

Despite the potential rush for a haircut, officials stressed on Monday that social distancing has not changed. Wear a mask in public. Stay six feet away from others. Wash your hands. Disinfect surfaces, and people who aren’t well — or at a high risk of complications from COVID-19 — should stay at home.

Even the best-laid plan followed by Louisianians could fail. One month after Germany began easing its lockdown, the rate of infection is growing. Going back, Avegno said, would be even more devastating than shutting down the first time.