Tracking COVID cases: money, county lines threaten Kansas City contact tracing efforts
The reopening of Kansas City’s economy is approaching full swing, and with it comes a long-awaited increase in testing supplies that may finally give public health personnel a better idea of who’s infected by the novel coronavirus.
But another element, contact tracing, is critical to putting that testing data to use and limiting another wave of coronavirus infections.
“Contact tracing is the most effective way for us to get a handle on this disease, who’s got it and where it is,” said Jackson County legislator Crystal Williams.
It’s a massive undertaking — following the trail of positive tests to discover where and to whom it might have spread. And already there are fissures in what experts say needs to be an area-wide effort.
Millions of dollars may be required to hire and train workers. Yet some governments are looking to volunteers, and that also concerns the experts. They say the job requires sensitivity and empathy — not to mention a knowledge of medical privacy laws.
Williams sponsored an ordinance that requested $5 million, a conservative figure, from the Jackson County Legislature to fund contact tracing.
Some of her colleagues, namely legislators Theresa Galvin and Dan Tarwater, were not in agreement, and whittled that $5 million request down to $1.5 million. Galvin suggested volunteers from eastern Jackson County fire departments are willing to pitch in.
Brigette Shaffer, the Jackson County health director, said they were welcome to help, but she needed trained staff — 52 in all — who are willing to work 40-hour weeks for the next six months.
Public health experts say now is the wrong time to skimp on funding contact tracing, arguing that instead there’s a greater need for the capacity to investigate the spread of coronavirus to decode new data coming from test results.
Rex Archer, director of the Kansas City Health Department, said he has the equivalent of seven full-time positions working on contact tracing, but that’s borrowing time from 19 people who have other duties within his department. He said a city with the population of Kansas City’s should have 150 people working on contact tracing full time.
So far, Kansas City has spent $1.4 million on contact tracing. Archer said he will need another $9.9 million through December. Next week, the Jackson County Legislature will consider a measure that would send $2.8 million to Kansas City from its federal CARES Act fund to pay for contact tracing costs.
Even counties who say they’ve so far had the capacity to carry out contact tracing express concern about their ability to keep up their work if a second surge of coronavirus cases occurs as local jurisdictions relax the stay-at-home restrictions that slowed spread of the disease the last two months.
Johnson County, where many of its 679 positive cases are attributable to clusters in nursing homes, may see a broader spread of cases in a second wave.
“I’m fully anticipating a surge in cases at some point,” said Elizabeth Holzschuh, epidemiologist for Johnson County.
Some say it might be wiser for local governments to pool their resources and approach the challenge of ramping up contact tracing by doing it on a regional basis. That discussion is being driven by business and civic groups through the recently formed C19KC Task Force.
While government and business leaders are hopeful the talks will lead to something, so far they have borne no fruit. They aren’t even sure how it might be accomplished in practical terms.
A central contact tracing phone bank? A looser affiliation?
“That’s exactly the question,” said task force member Aaron Deacon, managing director of the non-profit KC Digital Drive. “What does it look like?”
Like many aspects of the Kansas City region’s response to the coronavirus pandemic, political differences and geographic boundaries have splintered a cohesive regional strategy for sharing resources and strategies for contact tracing.
“It’s been like herding cats,” said LaMont Eanes, a task force consultant. “Getting nine counties across two states to come to agreement, that is tough to do.”
Critical to stopping spread
Eanes, a former telecommunications executive who co-owns a business and government consulting firm in Overland Park, got a call two months ago from someone with the C19KC Task Force asking if he could research contact tracing and how it might help reopen the local economy.
What he discovered were large gaps in government’s ability to handle contact tracing, which he believes is crucial to getting life back to something approaching normal.
“Short of a vaccine or a cure, contact tracing is the only thing we’ve got,” Eanes said. “It’s the only string on our guitar, so to speak.”
Concerned by the lack of progress, he and his wife, Linda, decided they’d start up a contact tracing division of their company, Agile Government Services Inc.
Their plan is to hire and train contact tracers that governments could turn to when they’re short on workers. When they posted their first help-wanted ad, they got 800 applications within four days. Three thousand in the past three weeks, many of the applicants having public health backgrounds.
Since placing his ad, he’s heard from some counties directly. He presented one with a proposal and has workers trained and ready to start earning $15 to $25 an hour to help fight the spread of the virus.
“You can’t sustainably fight a war with unpaid volunteers,” he said.
Going the volunteer route
Some are trying to do just that. Recognizing the urgency for contact tracers, states and local governments have put out calls for people to help.
In Kansas, there’s a plan to find 400 volunteers to assist with contact tracing. That would represent about half of the 800 workers needed for a state of Kansas’ size, according to an analysis by Johns Hopkins Center for Health Security.
Truman Medical Center is also calling for volunteers. Meantime, the city of Independence’s emergency preparedness division is referring contact tracing cases to the Medical Reserve Corps of Greater Kansas City.
Before making their first phone call, each corps volunteer must pass a three-hour, online course that teaches them interviewing skills and drives home their ethical responsibilities in preserving the privacy of the people they contact, corps spokesman Doug Norwood said.
But there’s a pressing question about how many volunteers are practical for contact tracing, a labor-intensive practice that requires certain interviewing skills and a deftness in dealing with people who are scared and sometimes angry that they are being asked to quarantine for up to two weeks.
“Quite honestly, they are getting burned out,” Eanes said.
Archer from Kansas City agrees, adding that it’s difficult to keep volunteers on for what amounts to full-time work. Plus, there’s the risk of volunteers without enough training running afoul of medical privacy laws.
“You can use volunteers but how do you hold volunteers accountable and what happens if they violate a rule or order or something and you don’t have any discipline process other than letting them go?” Archer said. “You invest a lot of time in training a volunteer and all of a sudden they don’t want to work 40 hours a week because they’re volunteers anyway.”
How it works
Contact tracing isn’t merely someone on the phone asking questions off a clipboard of someone with coronavirus.
More than perhaps anything, it involves tact and empathy on the part of people who are talking to someone who is learning they have or may be infected with a virus that could put their life at risk.
The process starts with identifying who has tested positive for coronavirus. A health department official will call that person to let them know.
The script that contact tracers follow after the bad news has been delivered begins with asking the infected person about their symptoms, how they plan to isolate themselves and do they have someone to bring them groceries?
That not only helps establish trust, it lays a foundation for the detective work that follows. Where have they been in the days leading up to the positive test and who did they come in close contact with, other than members of their household?
“We don’t live in isolated bubbles, we intermingle with the rest of our communities,” said Erin Groenweghe, chief epidemiologist with the Wyandotte County Health Department. “We go grocery shopping, we go to church groups.”
Contact tracing involves reaching out to those individuals, without telling them who may have passed on the virus, advising them to self quarantine and asking about their contacts.
If that‘s not labor intensive enough, the tracers check back regularly with all those people to see how they are feeling, every day in some instances.
Epidemiologists then track that data. Infection control specialists inspect places where there’s a cluster of cases — say, a nursing home — to help control the spread. There are also people assigned to monitor high-risk patients and let them know when to seek medical care.
Contact tracing has been a function of public health departments for nearly a century to track or stem the spread of communicable diseases like tuberculosis, measles, HIV/AIDS and syphilis.
“If you can imagine the skill set it takes to contact somebody who was having an affair and now has a sexually-transmitted disease and their spouse is potentially affected, as well as they may have had other partners, there is a skill set of our folks who deal with that and that’s the kind of training of people who need to not be judgmental, who can establish rapport,” Archer said.
Contact tracers also run into privacy concerns from the people they reach.
Epidemiologists say those worries have always been present in their line of work. They acknowledge it’s been accompanied by suspicions about what government officials are trying to accomplish with personal health information, given the muddied public debate from the White House on down about the spread and the effect of the coronavirus.
“That’s a burden no matter what time period we’re in,” said Holzschuh, the Johnson County epidemiologist. “It’s certainly in the forefront now.”
She added that public health’s ability to do its job is restricted to the public’s participation.
“We can only be as effective as we can without the whole community coming together to slow this down and protect all our community members,” Holzschuh said.
Archer would add that it also takes resources. He notes that Missouri ranks last in the United States in public health funding.
While public health will command attention now while it’s needed for a response to a pandemic, Archer said funding shouldn’t be cut once it’s over.
“This is not something where we can say we’re done with this and we don’t have to fund these issues,” he said. “We’re vulnerable for the next virus.”
