Idaho health districts say they’re ready for contact-tracing challenge as state reopens
A month ago, two of Idaho’s health districts faced so many new coronavirus cases that they had to temporarily stop tracing all contacts of infected people.
As the state reopens, the health districts expect cases to increase again — but they say they’re prepared for the workload.
Boise-based Central District Health, which has handled the most cases in the state, plans to hire up to 17 temporary employees for contact-tracing roles. The state began its four-stage reopening process Friday.
“As positive case counts stand today, we are able to meet the needs for contact tracing,” Christine Myron, the public information officer for CDH, wrote in an email to the Idaho Statesman. “However, with the reopening of our state, we anticipate that we will see another wave of cases, and we need to be ready to respond to what might come.”
Contact tracing is considered one of the pillars of any plan to reopen the economy and return life to something closer to normal while we wait for a vaccine and treatments. Other key ingredients include ample testing and health care capacity.
For each positive case, Idaho’s seven health districts make contact with the patient to explain the responsibility to self-isolate and to gather information, including any recent close contacts. Close contacts are defined as anyone who was within 6 feet of a patient for at least 10 consecutive minutes, Idaho’s health districts say. The Centers for Disease Control and Prevention recommends tracing any contacts who were within 6 feet for 15 minutes “starting 48 hours before illness onset.”
The health districts then contact each of those people and, ideally, check in with them daily for about two weeks to monitor for symptoms.
The process allows the districts to determine how the COVID-19 disease is spreading. It also could prevent further spread, because contacts are “encouraged to stay home and maintain social distance from others (at least 6 feet) until 14 days after their last exposure, in case they also become ill,” according to the CDC.
Campfire or forest fire?
A group of former federal health leaders have called for $12 billion in federal funding to expand contact tracing nationwide, National Public Radio reported last week. The group, which includes members who have advised Republican and Democrat administrations, also asked for money to help people self-isolate when they’ve been exposed.
“Testing, complemented with a full contact-tracing strategy, will allow states to prevent small campfires from becoming big forest fires,” Andy Slavitt, former director of Medicare and Medicaid under President Obama, told NPR.
Central District Health, which includes Ada County, and South Central Public Health District, which includes Blaine County, told the Idaho Statesman in early April that they were no longer able to trace all contacts in those two counties as case counts expanded quickly. Idaho’s new coronavirus cases peaked with 205 on April 2 — the middle of a six-day span during which the state reported more than 90 cases each day.
Ada County reported 63 cases on April 2 and April 4 but hasn’t reported 20 in a day since April 9.
“CDH is performing contact tracing for all positive cases in our four-county jurisdiction,” Myron wrote. “There was a short span where we saw a sudden increase of cases, which forced us to prioritize contact tracing and reserve in-depth contact tracing for higher-risk cases. Fortunately, it was only a short time frame — about one week — that we had to move to a prioritized approach, and we were able to quickly shift back to thorough contact tracing for all positive cases.”
South Central got hit hard about the same time. Blaine County reported 64 cases on April 1, 95 on April 2 and 54 on April 3.
It, too, has returned to full contract tracing. And, like CDH, South Central is preparing for a potential uptick in cases.
“We are able to keep up with the workload with our current staff,” wrote Brianna Bodily, the public information officer for South Central, in an email to the Statesman. “… However, we are looking into possible options to quickly expand our workload capabilities just in case we get another surge in confirmed cases.”
More government funding could be on the way
The state’s other five health districts also say they are able to manage the current contact-tracing workload.
Southwest District Health, which includes Canyon County, has the state’s third-highest caseload. It has managed in part by separating contacts into a group that is symptomatic or high risk and another group that is asymptomatic and low risk. The first group gets contacted daily; the second group gets contacted weekly, said Ellie Morgan, a Southwest District epidemiologist.
Idaho Gov. Brad Little said Thursday during a press conference that the state is “putting more resources into the health districts.” The districts are only partially funded by the state; they also receive funding from the federal government, contract services and the counties they serve.
Dave Jeppesen, the director of the Idaho Department of Health and Welfare, said Thursday that some federal relief money will be targeted toward contact tracing.
“We will be moving across the state to increase our capacity, both with people and with technology,” he said at the press conference.
But only CDH told the Idaho Statesman that it needed, or was getting, additional resources at this point. The Southwest, South Central, North Central and Panhandle health districts have reassigned existing staff members to handle the coronavirus workload. Eastern Idaho Public Health and Southeastern Idaho Public Health say they can do the same if needed.
“Thus far, we have been able to utilize our existing (epidemiologists) and train internal staff to meet the demand,” Katherine Hoyer, the public information officer for the Panhandle Health District, wrote in an email to the Statesman. “If we need to expand further in the future, we have the capacity to do so.”
The challenges ahead
CDH is getting $360,000 from a Public Health Preparedness subgrant through the federal government to help fund its COVID-19 response, Myron said. The Idaho Department of Health and Welfare has told CDH to expect another federal grant through the CDC, she said.
CDH also has asked the state for additional funding.
“We recently submitted our COVID-response cost estimate to the governor’s office in anticipation of additional funding through the state,” Myron wrote. “No projections on amounts yet, and unsure of the specific state source.”
Two of the challenges the districts will face as the state reopens, she said, is an increase in contacts per patient and an increase in some of the regular work the districts do that was limited during the stay-home order.
The more mobile the population becomes, the more people the positive cases likely will encounter.
“We recognize that some people are going to be more on the move than they have been the past month during the order, which means they’ll potentially be interacting with more people, in more places,” Myron wrote. “The number of places an individual goes within the community and the number of people they interact with directly impacts the complexity and time it takes to do proper contact tracing.
“Additionally, as CDH begins resuming more of its standard programs and services in the weeks and months to come, some of our team members who have been utilized in our COVID response may need to return to their regular positions. Having temporary employees that are exclusively allocated to this response will ensure we are able to continue with thorough investigations.”
This story was originally published May 4, 2020 at 4:00 AM.
