More contact tracing may be key to halting COVID spread. But is Kansas City too late?
Just as documented COVID-19 cases in the Kansas City area have surpassed 10,000, fresh platoons of contact tracers are being trained and mobilized to try to help slow the spread.
It’s a tough job that’s only getting harder.
Now that stay-at-home orders have expired, asking someone who is asymptomatic to self quarantine for 14 days is a bigger challenge than it was in the spring. And some people are just more reluctant to confide in government agencies as the pandemic has dragged on, local epidemiologists say.
But aside from those challenges, there’s an even bigger issue: Is the added manpower coming too little too late to make much of a dent?
As more and more people let down their guard, gather without masks and put less distance between themselves and others, they are passing the virus onto friends, co-workers and perfect strangers. Positive cases are beginning to spike again.
“I will say contact tracing is so much harder than it was back in April,” said Elizabeth Groenweghe, epidemiologist in Wyandotte County. “It’s just a lot more challenging because people are having a lot more contact with other people now.”
The hardest hit county in the metro area, Wyandotte’s seven-day rolling average of cases is higher than it’s ever been. The clusters are now smaller, but there are far more of them.
Can even beefed-up contact tracing efforts keep up?
“This is the thing we should have been doing way back in February and March,” said Erin Petro, an epidemiology specialist with the Jackson County Health Department.
“Some days we’re just really inundated with cases.”
While there were plans on the shelves, no public health department was ready for this pandemic.
Local governments didn’t have sufficient resources to mount an aggressive contact tracing effort early on. No viral disease they’d fought before — be it zika, measles or Ebola — was so contagious and had the potential to spread so quickly to so many people.
But in recent weeks, city councils and county boards have allocated millions in federal aid dollars to beef up their contact tracing operations.
The first waves of these temporary employees have been filling in for permanent health agency workers who had been forced to give up their regular duties back in March and April to track and contain the transmission of the new coronavirus. Pay for the temporary employees ranges locally from roughly $18 to $26 an hour with no fringe benefits.
Now more reinforcements are being hired to increase the capabilities of health departments that, pre-COVID-19, had few employees whose only job was to track the spread of contagious diseases.
Two weeks ago, Jackson County legislators allocated an additional $2 million in federal Cares Act funds to the $1.5 million already earmarked for the health department’s contact tracing effort.
As of last week, the county had hired 21 of the 52 staffers that the department proposed adding through the end of this year to follow up on positive coronavirus tests of people who live in eastern Jackson County.
“We all know that this is literally the most important thing we can do to keep everything open,” county legislator Crystal Williams said in arguing for the additional funding. “Until we have a vaccine, it’s the only way we’re going to know where the hotspots are.”
Kansas City’s health department has approval to add 97 positions to the 15 already hired, which is closer to the numbers the Centers for Disease Control and Prevention says are needed for a city its size.
Jackson and Clay counties made that possible by providing $2.8 million and $1.5 million, respectively, from their pool of federal dollars earmarked for fighting COVID-19.
Asked if contact tracing was a Johnny-come-lately to the public health response of the coronavirus, Kansas City Health Department director Rex Archer took a long pause.
“It’s very difficult to stop a tsunami, if you have that many cases,” he said, “but in these kinds of outbreaks, every bit can make a difference.”
Across the state line, the Johnson County Department of Health and Environment is hiring 35 part-time, temporary workers to call people who have tested positive and coax them to share the names and numbers of friends and acquaintances they came in close contact with.
The additional staff will take a load off some volunteers and department employees. About 100 had been pressed into service on a rotating basis — about 25 a day — to help with contact tracing needs.
“We are very much in an all-hands-on-deck mode right now in Johnson County,” chief epidemiologist Elizabeth Holtzschuh said.
In Wyandotte County, the United Government Public Health Department has been relying on 60 volunteer medical students to assist staff with contact tracing.
However, “medical student volunteers are not always available over predictable periods,” the department said last month in requesting $108,160 to hire two full-time contact tracers on a contract basis for 12 months at $26 an hour.
The UG wasn’t able to add staff earlier because only now are federal funds becoming available to Wyandotte County from state government, which received the bulk of Kansas’ share of Cares Act Funding.
The UG health department also proposed spending $25,000 to hire an interpreter service to help with contacting non-English speaking households.
On Tuesday and Wednesday, Wyandotte County is planning a “COVID blitz” that will recruit as many health department and Unified Government employees and others to make as many phone calls as they can to whittle down the backlog of contact tracing cases they hope to investigate.
“I would say things have become more strained and difficult since April,” Groenweghe said. “At this point, we are behind in the number of cases that we have.”
Challenging job
Testing labs supply the state health departments in Kansas and Missouri with the names of people who test positive for the coronavirus, and they pass that information onto the appropriate local public health agencies.
Oftentimes there’s a phone number attached to the name, but not always.
In Johnson County, each contact tracer is given four of those names at a time, and they set to work finding the right number or phoning the one they’re given, Holzschuh said.
If someone can’t be reached that day, they’ll get a letter and a followup call. But if the tracer is lucky enough to make contact, the interview can take about an hour. In addition to inquiring about the person’s health and seeing what kind of help they might need to self quarantine for two weeks, the contact tracer will then try to get a list of everyone that person has come in contact with.
Some people are more than willing to provide the information, but may not have good contact information. Following up takes resourcefulness in those cases. It helps to know one’s way around the internet and knowing offbeat ways of finding phone numbers from public records.
“We’ve had to be creative to leverage our detective skills,” Holzschuh said.
Indeed, retired cops, investigators and researchers are naturals for the job, she said.
But not everyone is forthcoming, and some can be downright rude, even if those instances are few and far between.
Other area health departments have the same frustrations.
“One of the challenges we have is people not answering the phone and not wanting to give out contacts,” Jackson County Health Department spokeswoman Kayla Parker said.
The more time it takes to gather that information, the less there is to move onto the next case. And they’re starting to pile up.
Archer said that across Missouri they’re seeing outbreaks in youth sports camps where they previously hadn’t seen many infections among the 10- to 19-year-old age group.
The largest group of new infections, he said, are 20- to 29-year-olds.
“Yes, they’re less likely to die from this disease but they’re likely to pass it on to people who can die, so that’s a big concern we have,” he said.
One big reason for that concern is that, while he now has the money for contact tracers, it takes time to staff up.
A slow process
Nothing happens fast in government. There are processes and procedures that have to be followed.
You have to advertise the jobs and find candidates with the right qualifications. Bachelor degrees are preferred and sometimes required.
Then come the interviews, and training can take up to a week because contact tracers have to know and comply with all the health-related privacy rules.
As the number of cases is on the rise now, it has Archer and others wishing that the money for contact tracing had been available long ago.
“It’s like saying let’s wait for a house fire, and then we’ll advertise for firefighters and we’ll train them and we’ll buy a fire truck, too,” he said. “Oh, we should have put a hydrant close to that house.”
Now the house is on fire again. The Kansas City area recorded more than 370 new COVID-19 cases on Thursday, which was up from 335 on Wednesday, 209 on Tuesday and 174 on Monday.
“The problem is if you don’t have a core of folks on board all the time who are well versed and trained, then it’s very difficult to surge in the middle of these outbreaks and handle this and it’s in no way, shape or form ideal,” Archer said.
