The state will receive $50 million in federal funding to identify new coronavirus cases, trace contacts and ensure those infected are isolated to stop the spread of the disease.
The Department of Health said it plans to use part of the money to train about 300 contact tracers after being criticized for being slow to expand the public health workforce to deal with a surge in cases.
“One of the essential pieces of public health infrastructure … is an army of contact tracers. Now that we have this money it’s not a question of the availability of resources. We’ve done so well with the virus that it would be a shame to not be prepared to deal with all the contingencies as we carefully move towards reopening our economy,” U.S. Sen. Brian Schatz (D-Hawaii) told the Honolulu Star-Advertiser.
The money, part of the Paycheck Protection Program and Health Care Enhancement Act passed by Congress in April, can be used to “develop, purchase, administer, process and analyze COVID-19 tests, scale-up laboratory capacity, trace contacts, support employer testing, and support other testing-related activities.”
The Health Department currently has 50 staff and about 30 volunteers to do the labor- intensive work of following up on close contacts of COVID-19-infected cases. The National Association of County & City Health Officials suggests that in an emergency, teams of 30 — including epidemiologists, disease investigation specialists, public health nurses and community health workers — per 100,000 should be in place for contact tracing to be effective. In Hawaii’s case, that means 420 staff — 300 on Oahu alone — would be needed for a population of 1.4 million.
Dr. Chad Meyer, a retired Maui physician who worked for 20 years in the U.S. Department of State and has studied rat lungworm disease and the dengue fever outbreak, said contact tracing is critical so that the state is not “flying completely blind.”
“We’re taking the lockdown period and just throwing it away. All the benefits are gone if we don’t respond to the next phase properly,” he said. “We bought time to get infrastructure in place and we have not done that. We’re in the same place we were three weeks ago and now we’re getting ready to open back up.”
It is critical for the state to be able to identify within 24 hours all the contacts of a COVID-19 case to “interrupt the chain” of infection, he said. That is particularly challenging since Hawaii has so many multigenerational families that must be separated if someone in the household is infected.
“If you let the disease go for five days with an infected person walking freely without a mask in a group setting, they are capable of being multiple transmitters,” Meyer added. “We shouldn’t race to reopen the flood gates again — we’ll pay dearly if we do.”
The DOH has partnered with the University of Hawaii to use $2.5 million over one year to quickly establish a contact tracing program to train those already in the medical field over two to three days. Those without medical backgrounds can be certified within two to three months.
In addition, the university is planning a special training program for 100 community health workers each year who will work with high-risk populations, including Native Hawaiians and Pacific Islanders disproportionately affected by COVID-19, as well as the unemployed and homeless.
The new public health workforce will be activated as needed and can be used as emergency hires and as part of the DOH’s volunteer Medical Reserve Corps if a surge in coronavirus cases occurs.
“With 300 staff to extend the capacity for monitoring and investigation, we expect to build the capacity up to at least 1,000 cases a day,” Health Director Bruce Anderson said at the state’s daily COVID-19 briefing. “Hopefully we will not be approaching anything close to that, but we are planning for the worst and building up our capacity.”
Oahu’s shopping malls and retailers plan to reopen on Friday, as part of the first phase in reviving the state’s economy.
“As Hawaii moves forward toward reopening, COVID-19 will continue to be a risk,” said Dr. Sarah Park, state epidemiologist. “Maintaining social distancing as much as possible will help to slow down the spread of any new infection by the COVID-19 virus by minimizing the number of contacts an infected person has.”
Three new infections were reported today — an adult and two minors that were part of a cluster of seven cases in an extended family in public housing on Oahu, the DOH said. The new cases brings the total statewide to 638 — among the lowest per-capita in the nation. As of today, 58 infections in Hawaii were still active with a total of 563 patients now classified as “released from isolation” since the start of the outbreak — or about 90% of those infected in the islands.
The state’s coronavirus death toll remained at 17 — the lowest mortality rate in the country. Of the more than 37,436 coronavirus tests conducted by state and clinical laboratories, just 1.7% have been positive.
“We have to contemplate a new phase of our fight against this virus and that means we need more public health infrastructure than we currently have. It means that the government has to move at the speed of the virus. There’s simply not any time left, but there is plenty of money to get this done,” said Schatz, a member of the Senate Appropriations Committee. “It’s essential that we set aside any squabbling and move forward together. We just can’t afford to be arguing with each other or moving slowly. We have to anticipate that the per day case rate will rise as we reopen and our objective should not be and cannot be to keep the coronavirus rate close to zero, but to make sure that it’s manageable while we try to have a society and an economy again.”