This report from STAT discusses how, to move toward suppression of COVID-19 in the United States, financially strapped state and local public health agencies nationwide will need to hire potentially hundreds of thousands of fieldworkers to conduct the labor-intensive work of contract tracing.

To successfully move into the post-outbreak phase of disease suppression, our public health efforts will need to focus on (a) ensuring the public has access to widespread testing, and (b) undertaking contact tracing efforts which include interviewing those diagnosed with COVID-19 and track down those who may subsequently have interacted with and been infected by those people. Some areas of the country, such as Massachusetts, have begun the process of engaging staff to conduct this work (either through direct hiring or subcontracting with organizations like Partners in Health).

Estimates on how many will have to be hired vary widely. The executive director of the National Coalition of STD Directors estimates about 30,000 people would be needed nationwide; but former CDC director Tom Frieden stated, “We need an army of 300,000 people” to successfully undertake this work. Technology like tracking apps may be able to support these efforts, but will not erase the need for real people in the communities. Given the significant rise in unemployment over the past few weeks, the difficulty will be in committing the effort and funding to hiring, not in finding qualified potential employees.

According to this report, it is likely that states, rather than the federal government, will need to take the lead on these initiatives. This raises significant concerns about uneven efforts nation wide, due to varying public health workforce capacity investments. Funding from the $2 trillion stimulus package, including a $150 billion Coronavirus Relief Fund for states, local, and tribal governments, might be sources for funding such efforts.