Health departments getting temporary workers to trace contacts of people who have COVID

By Lisa Gillespie
Kentucky Health News

As restaurants have reopened and people are gathering more after three months of social isolation, Kentucky’s health departments are finally getting extra help to help track down people who may have been exposed to the coronavirus and ask them to self-isolate.

The “contact tracers” will allow health-department employees who have been reassigned to covid-19 work to get back to their normal work in public health. But most of the new workers haven’t been hired yet, because officials expect a surge of cases when school begins.

Congress gave states money to hire temporary contact tracers. Sara Jo Best, public-health director at the Lincoln Trail District Health Department in Elizabethtown, said contact tracing has been done for decades, but it might be a new term people haven’t heard of.

“If you’ve ever seen in a newspaper, ‘If you ate this food product between this date and this date, you need to call us,’ that’s contact tracing,” Best said. “No one ever thought anything about that; it was almost expected. It would be unethical for public health to know that you’re at higher risk of a disease or injury and withhold that information from you.”

But some legislators at the June 24 meeting of the Interim Joint Committee on State Government expressed privacy concerns.

“I know we’ve been doing contact tracing at local health departments for a long time, but at the level that we’re doing it here . . . it could very much infringe on people’s freedom and liberty,” said Senate Majority Leader Damon Thayer, R-Georgetown.

Mark Carter, the state official leading Kentucky’s contact-tracing efforts, said “We are not going to be tracking people’s movements. The purpose for this contact tracing effort is simply to help people protect their family, friends, loved ones from the spread of covid.”

The state covid-19 website says contact tracing is completely confidential. When someone is contacted, they’re only informed that they may have been exposed to someone who has the virus, and aren’t told the identity of that patient.

Rep. Patti Minter, D-Bowling Green, spoke up for contact tracing: “We have been a hotspot in Warren County, so one of the reasons we’re not a hotspot anymore has been the heroic work that has been done in the eight-county area by Barren River health department, and contact tracing has been a very big part of that.”

Some job slots wait for start of school

So far, the state Department for Public Health has hired 180 contact tracers and investigators to work in health departments across the state but is waiting to fill another 520 jobs, Carter said.

“The staffing is ahead of the disease,” he said. “We kind of want to see what the virus is going to do, because it wouldn’t make sense if they had 500 people right now, because most of them would be sitting around with nothing to do. But they’re probably going to be busy in September and October with schools back.”

Robert Redfield, director of the federal Centers for Disease Control and Prevention, told a congressional committee June 23 that tracing the contacts of infected people and getting them to self-isolate will be “critical” as schools open.

For the Barren River District Health Department, the new help will mean the staff reassigned to covid-19 work can go back to their original work in public health; things like health education or work to reduce infant mortality rates.

About 80 of the Bowling Green-based agency’s approximately 100 employees were reassigned in March, Director Matt Hunt said. Before the pandemic, he said, only seven full-time staff notified members of the public if there was a possibility of contracting a communicable disease.

“We had to move very, very quickly to repurpose nearly 80 percent of our staff to work on covid,” Hunt said.

At the Lincoln Trail department, Best said her staff were moved to contact tracing and other covid-19 tasks. Night and weekend work became the norm, with many hours of overtime or comp time. Meanwhile, unemployment from the pandemic restrictions brought more clients into the department’s Women, Infants and Children food program.

“It’s nice to have the ability to bring in the additional staff to be able to relieve our staff so they don’t burn out,” Best said.

Asked if permanent staff would now give more attention to enforcing covid-19 preventive measures like limits on business’ space capacity, Best said her environmentalists working with restaurants try education first.

“You’re treating it as a partnership,” she said. “Because we’re good at educating people on risks, most people comply and do all right. Also, with restaurants, there is a liability issue; they want to know how to operate so they can successfully follow the rules.”

State-local dispute caused delay

Each state handled the federal money for contact tracing differently. Health departments said the money should go directly to them. They have years of experience tracing diseases, from food-borne illnesses caused by bad grocery food to wide outbreaks of diseases such as hepatitis.

“We do this all the time for things like pertussis [whooping cough], hepatitis, tuberculosis, and we’re actually still doing that right now while we’re doing covid-19; other diseases didn’t take a vacation when covid-19 came to town,” said Best.

Kentucky decided to use staffing agencies to hire tracers. But these agencies only conduct initial resume screenings, interviews and background checks. Health departments do the final hiring and supervision of contact tracers and investigators.

Best and Hunt said their district health departments could have used extra dollars for contact tracers much earlier, but they made do with the employees they had.

Most of Barren River District’s eight counties have relatively high per-capita infection rates. Hunt said he doesn’t think the delay led to more infection or negative health outcomes, mostly because his district didn’t wait for federal funds to arrive. He said he has hired 26 people, with five slots left to fill.

Carter said he and other state officials decided to use temp agencies for several reasons. While most health departments will hire local contact tracers, the state is also hiring regional tracers who can work anywhere within a broad region.

“If you had an outbreak in Bowling Green, for example, and it was quiet in Somerset, what that [our model] allows us to do very easily is to redirect some of those resources in Somerset to focus on the problem in Bowling Green,” he said.

Though the strategy might work best for state control of the contact tracing project, Best hopes the legislature will help increase staffing levels to help health departments prepare better.

“Local health departments have been carrying the bulk of the load of this since March; that’s a long time,” Best said. “I hope this is enough to highlight the necessity to invest in our infrastructure, like our staffing levels, so that we’re nimble and able to respond quickly to the next thing, because there will be a next thing … that would reduce negative health impacts.”

Information for this story was also gathered by Melissa Patrick of Kentucky Health News.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. For details, contact Al.Cross@uky.edu.

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