As active coronavirus cases remain above 30,000 in Oklahoma, the state health department says its contact tracers are having to prioritize calls and will advise most people with confirmed cases to do their own contact tracing.
In addition, the state has shuttered a contact tracing call center in Oklahoma City paid for by federal CARES Act money. A related contract for additional temporary contact tracers continues but the Oklahoma State Department of Health is looking for additional funding to keep those positions in the new year. Weekly reports from this fall show just how far behind contact tracers and case investigators were getting as cases continued to rise.
The agency sent a notification to health care providers on Tuesday updating them on new quarantine guidance for coronavirus cases and mentioning the contact tracing situation.
“The increasing COVID-19 case counts across the state pose the risk of compromising the ability of the OSDH to do timely and thorough case investigations,” said the Health Alert Network notification. “While we remain committed to fulfilling our mission on vital public health interventions and activities, we want to enlist the assistance of health care providers and laboratory testing sites in communicating critical information to patients tested for COVID-19.”
The document advises people with positive test results to notify close contacts from two days before their symptom onset or test date. It defines a close contact as “household members and people within six feet of you for 15 minutes or more.”
Contact tracing is a key part of controlling infectious disease because it tells public health officials where the outbreaks are occurring and how positive cases might have become infected, according to the Centers for Disease Control and Prevention. It can also provide insight into stronger mitigation efforts like limiting operating times and capacities at bars and restaurants. But in times of high infection and widespread community disease transmission, it is less useful if notifications are not done quickly.
The CDC released new contact tracing guidance earlier this month allowing local public health officials to prioritize their contact tracing investigations and notifications.
The health department said it is following the latest CDC guidelines. In certain instances, it could mean an infected person should work with their health care provider to determine if any contacts should be notified.
“Like most states, Oklahoma is working with an increased number of daily cases which, of course, means an increased number of contacts,” said Hayden Benge, a spokeswoman working on behalf of the department for Saxum Communications. “In order for contact tracing to be effective, it must be done quickly so that contacts can be quarantined in time to reduce or eliminate the threat of additional transmission. A large surge in case numbers threatens our ability to reach contacts in a timely manner.”
Last summer, the health department contracted with Express Services Inc. to provide additional contact tracing support and rented space at Shepherd Center in Oklahoma City for a contact tracing call center. Through October, the health department has spent about $4 million on the Express contract and $326,000 for the office space to VTA Oklahoma LLC, according to the state’s online checkbook.
Benge said the department has ended its Shepherd Center lease and is moving those positions to work remotely.
“The actual contact tracing is still operational and will continue to be so,” Benge said. “Instead of renting the space at Shepherd Mall, they are pursuing a shift in administration from that centralized location to the county health departments, so each of the nine regional (OSDH) directors will be assigned the existing contact trackers for their regions.”
Weekly contact tracing summary reports obtained under the Oklahoma Open Records Act show the difficulty case investigators had reaching people this fall as cases rose statewide. The reports don’t list places or activities where case investigators asked infected individuals about their recent movements. But they do show more than 350 workers were making outbound calls and answering questions each day.
The reports show how far behind contact tracers and case investigators were getting as cases rose in October and November. Almost 1,600 cases were waiting to be investigated at the beginning of October. That had risen to more than 10,000 the week before Thanksgiving.
Benge said the health department is looking to continue its contact tracing operations after CARES Act money ends.
It’s been a long, strange trip for Oklahoma’s $2.6 million shipment of hydroxychloroquine, bought a year ago as a once-promising treatment for COVID-19.
“We are pursuing grant opportunities and are evaluating cost-saving measures, such as remote working for the contact tracers who previously reported to the leased space at Shepherd Mall,” Benge said in an email.
Randolph Hubach, an associate professor of rural health at Oklahoma State University-Center for Health Sciences in Tulsa, said the state’s move to pull back on contact tracing is reflective of the underfunding of the public health infrastructure in Oklahoma.
“Given that contract tracing was not fully utilized from the beginning, our disease investigators and contractors were placed in a position in which they could not engage COVID contacts in a timely manner,” said Hubach, who is also associate director of OSU’s master of public health program. “This only highlights the need, during and post-COVID, to re-fund public health agencies to proper levels.”
The state’s contact tracing changes don’t affect cases worked by the Oklahoma City-County Health Department and the Tulsa Health Department. Those departments work closely with the state but are independently run.
Leanne Stephens, spokeswoman with the Tulsa Health Department, said disease investigation has been conducted by the department’s existing staff. But it did use some CARES Act money to supplement its efforts with temporary staff. Once that money runs out, the department will absorb the costs, she said.
“Contact tracing remains an important public health tool to slow the spread of COVID-19,” Stephens said in an email. “The increasing case counts in Tulsa County, along with the increasing number of individuals who decline to participate in disease investigation and contact tracing efforts, do present challenges. At this time, we are prioritizing cases that have tested positive within the last 14 days.”
Stephens said recent case increases in Tulsa County have come from multiple types of locations and activities.
“In the past two weeks, there have been outbreaks associated with commercial facilities, food service, long-term care settings, religious services and a K-12 setting,” Stephens said. “This reflects the fact that we have widespread uncontrolled community transmission, as outbreaks are being identified at a large number of facilities/settings, and are not isolated to one sector.”
Molly Fleming, public information officer for the Oklahoma City-County Health Department, said high case numbers have meant some changes in the department’s contact tracing protocols. If the positive notification is within the first eight days, the person will get a call from a contact tracer. After that, it will be an automated call from its vendor, Qualtrics. The county health department is using CARES Act funds to supplement its contact tracing efforts. It is in discussions with Oklahoma City about future funding after Dec. 30.
Disclosure: Paul Monies’ wife works for Saxum Communications, which has communications contracts with several state agencies, including the Oklahoma State Department of Health.
Monies has been a reporter with Oklahoma Watch since 2017. He covers state agencies and public health. Call or text him at (571) 319-3289 or email firstname.lastname@example.org. Follow him on Twitter at @pmonies.
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