Contact Tracing Investment Yielded No COVID-19 Insights, Report Finds

Oklahoma’s boost to its COVID-19 contact tracing efforts led to no insights and was marred by technology problems and a failure to collect the proper data, a new legislative report finds.

Lawmakers discussed the report by the Legislative Office of Fiscal Transparency at a hearing Thursday at the Capitol.

Oklahoma spent more than $6.7 million to centralize its COVID-19 contact tracing last summer at the Shepherd Center in Oklahoma City. The state used temporary workers from Express Services Inc. to staff the call center, which had its own coronavirus outbreaks among employees at times.

Oklahoma Watch reported in December the project was abandoned as cases spiked and contact tracers got behind in their outreach efforts. The Oklahoma State Department of Health has since moved to decentralize its contact tracing back to its county health departments.

Health Commissioner Dr. Lance Frye said the state falling behind in contact tracing using outdated technology wasn’t unique to Oklahoma.

“As far as data from contact tracing, we were working in crisis mode when this happened,” Frye said at the hearing. “The system that was in place was an archaic technology was never developed in a way that could handle a pandemic. It was not able to keep up with the numbers. Most of the systems in the United States were having difficulties at that time.”

Contact tracing is one of the core responses to any infectious disease outbreak. When done quickly, it can tell public health officials where outbreaks are happening and how people became infected. It can also provide insights into possible mitigation efforts like limiting public gatherings or cutting capacity at higher-risk indoor places like gyms, bars and restaurants.

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Officials say Oklahoma’s surge in COVID-19 cases overwhelmed its contract tracing efforts.

The state health department’s contact tracing “had no measurable impact on the pandemic” and data on transmissions was not timely or accessible to the public or local governments, the draft report concluded.

“The lack of data is a missed opportunity for the state, its citizens and small businesses to make more informed decisions regarding policy and assessing risks within local communities and their economies,” the report said.

The health department’s COVID-19 alert map for counties was confusing to the public and didn’t align with maps produced using the same data by the federal government’s White House Coronavirus Task Force and other entities, like one for schools by the Oklahoma State School Board Association. The state’s alert map also changed its “triggers” for additional mitigation measures several times in the late summer and fall as the virus continued to spread.

“These two color-coded state resources further illustrate the clear divide in the state’s response and messaging to its stakeholders on the situational reality of COVID-19,” the report said.

Meanwhile, Oklahoma’s infectious disease tracking system, known as PHIDDO, was at the end of its product cycle before the pandemic began and hindered the state’s response, according to the legislative report. The system even had trouble communicating with a short-term replacement to handle the large caseloads from the COVID-19 pandemic and regularly crashed when performing routine functions like adding new users. Independently run health departments in Oklahoma and Tulsa counties reported delays of more than two weeks in getting case reports from the system.

“Often, these health departments received data from PHIDDO too late to have any measurable impact on limiting the spread of the virus,” the report said.

Frye and the health department acknowledged some of the shortcomings in its case investigation and contact tracing response. But it said other states with stronger mitigation efforts didn’t fare much better as the virus reached a third peak in late 2020 and early 2021. Contact tracing is less useful for diseases like COVID-19, where asymptomatic spread can occur before an infected person knows they have the virus.

“Public health had a momentous task in 2020 — testing and tracing COVID-19,” the department said in its written response to the legislative report. “Resources were an issue at every step of the response. Our technology was inadequate to meet the needs of such a high demand on a system.

“In attempting to track and record the spread of COVID-19 in our own state, because of the communal spread of the disease, data transparency became a critical focus. With this need for data was a conflicting need for privacy.”

Many Oklahomans weary of the pandemic also had “quarantine fatigue” and refused to answer the phone calls of contact tracers or cooperate when contacted.

“Despite repeated efforts to determine contacts and quarantine those affected, many refused to comply and continued to work and participate in social events in town, infecting others and spreading COVID-19,” the department said. “Many had difficulties in complying for numerous reasons, with no paid leave or the inability to isolate in a crowded apartment or home.”

The health department said more robust efforts to contact trace in other countries, like China or Singapore, relied on centralized national governments that prioritized the common good over individual privacy. It said those strategies don’t work in countries and states with more democratic societies that prioritize individual liberty.

“Here in the United States, and in Oklahoma, many people do not completely trust the technology that might make digital contact tracing effective,” the department said. “Privacy and individual freedoms seem to rub against the protections offered by quarantining and isolating.”

Frye said contact tracing is only as good as the information the state receives from people depending on their willingness to share and their willingness to follow infection guidelines. Changing guidance from the CDC also complicated the response, he said.

The agency said it is already working on a plan to replace its outdated infectious disease tracking system with new lab-reporting software and a system offered by the Centers for Disease Control and Prevention. It did not provide an estimate on when those projects would be finished.