Stay-at-home orders are beginning to lift in the Kansas City metro, and people will begin coming into closer contact. But the coronavirus pandemic is not over. That means conversations about how to stay safe will involve the new and potentially uncomfortable idea of contract tracing.
“We absolutely know that when the stay-at-home orders are lifted, that we will see increase incidents of cases and therefore we will also see an increased need for additional contact tracing,” says Ashley Wegner, the health planning and policy section chief of the Clay County Public Health Center.
After a health care provider notifies the health department that a person has tested positive for the virus, a staff member calls the person and works to figure out whether they’ve spent more than 10 minutes within a six-foot radius of another person while infected.
“It's not the government policing us,” Wegner explains. “This is what we need to do to keep the community open so people can go to work.”
The number of contacts can vary from person to person. Health care workers on the frontlines will have more contacts compared to people working from home.
“You could identify 30 to 50 contacts for one person just because they're going to work every day because they have coworkers and then have patients,” Wegner says.
It can take time for a contact tracer to gain a patient’s trust. Someone might struggle with remembering who they came in contact with or be reluctant to admit they didn’t follow the stay-at-home directive.
With a list of people who came in contact with an infected person, the contact tracer notifies everyone on the list and asks them to self-quarantine.
“We run through the signs and symptoms and make sure that they're not having any symptoms,” says Cass County epidemiologist Brooklyn Lampe. “And then we're also looking at … if they have any underlying health conditions that would put them at high risk.”
With businesses in Clay County beginning to re-open this week, Wegner says she’s confident her county is ready to respond, with enough contract tracers to handle a surge of cases.
In Kansas City, where the stay-at-home directive remains in place until later next week (though some businesses can begin to reopen as soon as May 6), the Health Department has roughly a quarter of the workers it needs.
Kansas City’s 19 contact tracers aren’t enough to handle the nearly 600 cases confirmed as of Monday, says Kansas City Health Department Deputy director Tracie McClendon-Cole.
“We're not currently able to handle necessarily the capacity that we need to in order to make sure that we're testing the results as well as following up with each person who has identified as COVID positive in Kansas City,” McClendon-Cole says.
Efforts are underway to increase the workforce. Next week, the Jackson County Legislature is set to vote on spending $5 million on contact tracing. Kansas is recruiting volunteers to do the work.
Contact tracing is not a new idea. It’s been used to fight Ebola and tuberculosis across the world. In Kansas City, contact tracers were already busy stopping the spread of communicable diseases before the novel coronavirus arrived. Now, in addition to tracing contacts of people who contracted COVID-19, they still have to keep up with their usual work managing outbreaks of syphilis, chlamydia and gonorrhea, says McClendon-Cole.
On Sunday, the city posted job openings for five additional contact tracers after the City Council approved funding from the health levy in late April. This falls well short of the 75 to 150 contact tracers McClendon-Cole says the city should have. The National Association of County and City Health Officials estimates a city needs 30 contact tracersfor every 100,000 people, which would equal about 148 workers for Kansas City.
“We're hoping that as we move further into this period, especially as the federal government starts releasing more funds, that more will flow to the local level and we'll be able to add to our staff,” McClendon-Cole says.
Counties should get federal CARES Act payments Wednesday, according to an announcement from Missouri State Treasurer. Kansas City hopes this funding will trickle down to the city.
In Kansas, while local health departments conduct investigations, the state is in the process of recruiting 400 volunteers, according to Kansas Department of Health and Environment spokeswoman Kristi Zears.
“With many LHDs (local health departments) overburdened with case counts and community spread, it makes disease investigation very challenging,” Zears said in an email.
Lafayette County, about 35 miles east of Kansas City, has been training its health department’s board members and volunteers in case there’s a surge in cases, says Lafayette County Health Director Tom Emerson.
“It's been tough sometimes, but we haven't been overwhelmed yet. We have had to work weekends and after hours, but that's just part of it,” Emerson says. “So our current staff has handled what we have now.”
To help manage workload in Clay County, the health department has a text message system that can be used to reach back out to people who are self-quarantined after being exposed to someone with the virus.
“We can, you know, a couple of times a day send out an automatic text that says, ‘Hey, do you have any symptoms? Yes or no?’” Wegner says. “If not, we go about our business. If you do, then yes, we need to have another conversation.”
