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Staffing hampers contact tracing effort in some Arizona counties

Posted at 7:34 PM, May 11, 2020
and last updated 2020-05-11 22:34:05-04

Arizona health departments could need hundreds of more people to contact trace everyone with coronavirus, according to an estimate by public health researchers.

The researchers with Arizona State University's Biodesign Institute say countries like Germany and South Korea have been leaders in quelling the spread of coronavirus.

"When you look at those places where they've been successful and really reducing death rates and the morbidity attached the virus," said Josh LaBaer, executive director of the BioDesign Institute. "It has all been a heavy emphasis on having a very aggressive contact tracing program."

"Contact tracing just gives us the ability to find people immediately, in that two-day window, when they may be transmitting the virus, and they may not know it yet," said Prof. Tim Lant.

The ASU professors say their nursing students, if called upon, can assist the contact tracing efforts. They could even get credit toward their degrees.

In contact tracing, a public health investigator should call all people with positive coronavirus test results. They would be urged to self-quarantine and provide names and phone numbers for everyone they've been in contact with while possibly infectious.

The investigator would then call all of the contacts and tell them to get tested and quarantine with their families, regardless of symptoms.

The investigator then follows up during the disease incubation period, and if one of those people gets sick, that person also providers a list of contacts. Contact tracing continues until you isolate all possible spreaders, so the general public can return to normal.

Maricopa Assistant County Manager Lee Ann Bohn said health workers in her county need to make about 1,800 contacts a day.

The County Health Department has been doing some work, but only has about 25 people making all those contacts. Thursday, the Maricopa County Board of Supervisors approved funding to hire 50 contract workers on top of prior approval for 60 more full-time employees.

"The public health department needs to ramp up it's contact tracing staffing very, very quickly," Bohn said. "This is a best practice and really necessary in order to support the reopening of businesses and other venues in Maricopa County."

Ready or not, those businesses are opening now, which means more contacts, per person, per day, to find.

Some smaller Arizona counties, not hard-hit by coronavirus, have health departments that are contact-tracing every person with a positive test. Health officials in Yavapai, Gila, and Pinal counties confirmed they currently have the staff and resources needed.

Last Monday, the state health director promised even more help for counties struggling to improve their contact tracing efforts. She mentioned the assistance in a news conference and in a blog post.

Director Cara Christ said federal funding would find the effort, including "implementing enhanced state-level contact tracing that could expand to up to 40 teams." ADHS responded to questions this Monday about their progress in a Q&A below.

Q&A: ADHS answers ABC15 questions on contact tracing procedures

Q: How many of the 40 teams ADHS wanted to hire are working today? How many people per team?

A: In Arizona, contact tracing is completed by the local health departments and has been a critical component of public health in Arizona for decades for control of many communicable diseases. In addition to the systems in place in each county, ADHS is implementing a statewide contact tracing resource that can provide additional capacity. We are currently utilizing internal ADHS staff to conduct contact tracing activities with jurisdictions we are partnering with. Ideally, there will be 10-15 people per team.

Q: Can you explain how the automated symptom monitoring process works?

A: Contacts will be contacted by a public health professional to provide initial notification of exposure. Enrollment into the automated system used for symptom monitoring will be offered. Once enrolled, the contact can choose to receive an automatic daily notification (text, call, email) for 14 days. This automatic notification will prompt a contact to log into the system and report if they are symptomatic or not. If they report they are symptomatic, that will prompt follow up from public health.

Q. How many contacts do you typically have to trace for each coronavirus patient?

A: Estimates are being used for 10 contacts for each confirmed case.

Q: Do we have enough contact tracers to handle the pandemic, and whom do you prioritize for tracing?

A: We estimate that case investigators can work up approximately 50 cases/week and up to approximately 75 initial contacts/week. We are monitoring our data to determine the average case and contact counts to estimate the number of additional contact tracers needed. CDC has provided guidance on how to prioritize contact tracing efforts, starting with close household contacts and contacts in a congregate setting. ADHS is prepared to scale up contact tracing with additional personnel as needs are identified and continues to work with local health departments and partners in order to expand capacity.

Q: How soon after ADHS or a health department becomes aware of a case is it getting contact-traced?

A: Rapid identification and notification/education of contacts is an important component of preventing further transmission of COVID-19. Contacts are prioritized for outreach by public health based on the individual circumstances of each case, with close household contacts or contacts within a congregate setting as the most immediate priority.

Note: Some questions/answers have been shortened for clarity.

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Arizona health departments could need hundreds of more people to contact trace everyone with coronavirus, according to an estimate by public health researchers.