The soaring number of COVID-19 cases in the United States has far outstripped many local health departments' ability to trace the contacts of those infected, a step critical in containing the virus' spread. 

With the pandemic claiming about 1,000 American lives a day, many city and county departments say they lack the money and staff to quickly identify people who have been exposed, according to a Reuters survey of 121 local agencies, as well as interviews with dozens of state and local officials, epidemiologists and tracers. 

The U.S. badly lags other wealthy countries in contact tracing, including South Korea and Germany, which ramped up their programs months ago. 

Contributing to the faltering U.S. response is the government's failure to provide accurate and timely diagnostic testing, something other countries were able to roll out much faster and more broadly. 

On Alabama's hard-hit Gulf Coast, health department staffers are stretched so thin they are directing individuals who test positive to notify any contacts themselves, said Rendi Murphree, director of Mobile County's Bureau of Disease Surveillance and Environmental Services. 

"Everything is overwhelmed," she said. 

Politicization of the COVID-19 response

Adding to the challenge has been a sharp politicization of the COVID-19 response, with many Americans, from President Donald Trump on down, often portraying mask-wearing and other measures as an infringement of personal liberty. 

The U.S. has by far the world's largest COVID-19 caseload, with over 4.6 million confirmed infections and more than 155,000 deaths. Yet public health measures during the pandemic have been largely decentralized, coming down to patchwork efforts by state, and especially local, governments. Federal funding has proved unreliable, caught up in fierce debate over the crisis. 

Now, as part of log-jammed negotiations over new relief legislation, Republicans and Democrats in Congress are arguing over funding proposals for testing and tracing that are tens of billions of dollars apart. As of June, U.S. Centers for Disease Control and Prevention director Robert Redfield said the country had 27,000 contact tracers – about a quarter of what has been recommended. 

Although some local health departments told Reuters their efforts have proved successful – and many said they were worthwhile – several researchers described U.S. contact tracing overall as too little, too late. 

"You don't clean up an oil spill with paper towels," said Marc Lipsitch, a professor of epidemiology at the Harvard public health school. 

On this point, the Trump administration does not disagree. Admiral Brett Giroir, Assistant Secretary for Health at the U.S. Department of Health and Human Services, told Reuters that given the spread of the disease, mask wearing and other prevention measures are more effective. 

"It is really impossible to contact trace," Giroir said, until the numbers come down. 

The agencies responding to the Reuters survey serve at least 27 million residents in large cities such as Minneapolis, Boston, and Cleveland, as well as smaller communities including Allentown, Pennsylvania, and Dare County, North Carolina. Collectively, as of last week, they accounted for at least 230,000 COVID-19 cases and 7,300 deaths. The responses cover the week ending June 22. Reuters followed up in late July with several departments, such as Las Vegas and Kansas City, Kansas, where officials said circumstances had not improved. 

(Cover: Contact tracers with the Houston Health Department monitor the spread of COVID-19 outbreak in Houston, Texas, U.S., July 22, 2020)