WICHITA, Kansas —Contact tracing is a key component of stopping the spread of infectious or sexually transmitted diseases, and has been for years. It’s also the linchpin in Kansas counties’ plans to effectively reopen and isolate cases of the coronavirus.
“The volume has become quite a bit larger than anything we’ve really ever dealt with,” Johnson County epidemiologist Elizabeth Holzschuh said.
National experts from Harvard, Johns Hopkins, and the Association of State and Territorial Health Officials say that in order to loosen restrictions on businesses and people’s movements without causing a new wave of cases, states need to have a plan and infrastructure in place to drastically increase testing and tracing — the latter involving discovering infected people, finding out where they’ve been and getting a hold of people they may have come in contact with.
In Kansas, that would include testing more than just people with symptoms, as well as having 15 investigators and contact tracers per 100,000 people. That’s about 400 tracers statewide.
As of Tuesday, Kansas had about 220 tracers. So as the state Department of Health and Environment works to increase that capacity, the main responsibility will fall on county health departments.
Johnson County, in eastern Kansas, has more than 600,000 people and about 600 cases of COVID-19. However, the county has just five case investigators, which must have a medical or public health background in order to track down initial details when a person tests positive for COVID-19.
And Holzschuh said there are about 17 people trained to work as contact tracers, who don’t necessarily need a health background to do the bulk of communicating to the ring of people with whom the infected person has been in contact.
Johnson County, as well Sedgwick and Douglas, rely on technology as a force multiplier.
“We are actually texting them daily, asking them whether or not they’ve developed any signs or symptoms of COVID,” Holzschuh said. “So that really helps alleviate the staff needs in terms of just the volume of contact that we’ve gotten through these investigations.”
Kansas officials are also looking at using phone data and apps from Google and Apple to trace and contact, but it’s unlikely the state would be able to implement that anytime soon.
“I personally think it’s a good idea,” KDHE Secretary Lee Norman said last week. “We want to make sure the technology is safe, it’s private, it works, and it’s helpful.”
Reopening safely
In Sedgwick County, which has among some of the highest counts of cases in the pandemic, epidemiology program manager Kaylee Hervey told the Wichita Eagle that contact tracers sometimes break the news that someone has the coronavirus. But, she said, about 80% of people already thought they may have been exposed.
That’s not always the case. The coronavirus poses a challenge for health officials because anywhere from 25% to 40% of people are asymptomatic, said Danielle Allen, director of Harvard’s Edmund J. Safra Center for Ethics.
That means it’s harder to find people with COVID-19 and prevent it from spreading without testing and tracing on a bigger scale.
“If you’re not that aggressive about following the chain of transmission, you won’t be able to actually decelerate the disease,” Allen said.
Kansas moved into the first phase of loosening restrictions on May 4 — and the second phase is slated to start May 18 — without having the recommended amount of contact tracers in place.
About 25 KDHE staffers have been assigned to lead detailed investigations of people with positive tests, Norman said. The state is also attempting to train 400 volunteers to perform the simpler task of reaching out to contacts; it’s already trained about 220 as of Tuesday.
Johnson County credits stay-at-home orders for helping with its contact-tracing work. Even if someone was infected, Holzschuh said, they likely hadn’t spent much time near other people outside of immediate family. It minimized the number of people the tracers had to track down.
“As soon as we reopen,” she cautioned, “the number of contacts are going to increase, as are the number of cases.”
Experts said building contact-tracing capacity quickly is key to preventing an even worse wave of coronavirus infections in the next few months. Without it, states will likely have to slow down reopening, or go back to staying at home.
“We are trying to do what’s best, but at the baseline, (reopening) is going to be a calculated risk,” said Sonia Jordan, director of informatics at Lawrence-Douglas County Public Health. “And just trying to keep our communities safe and healthy will always be our goal.”
Brian Grimmett reports on the environment, energy and natural resources for KMUW in Wichita and the Kansas News Service. You can follow him on Twitter @briangrimmett or email him at grimmett (at) kmuw (dot) org.
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