As Hawaii’s COVID-19 counts surge — there were more than 500 new cases over the past week, including 207 on Monday alone — frustrations are mounting that the state doesn’t have enough contact tracers to prevent officials from reverting to lockdowns to contain the spread.
State Department of Health director Bruce Anderson said Monday that the state has about 105 active contact tracers, a number he said was sufficient and could increase if needed.
“I believe as does the governor that we are in good shape there and we are going to be able to continue our activities as we have and follow up in a timely way with all the cases that we are hearing about,” Anderson said.
Still Hawaii’s contact tracing team is much smaller than what’s been put together by other countries, states, cities and counties, who see contract tracers as the best level of defense to avert lockdowns. And it’s only about 25% of the tracer level recommended by the National Association of County and City Health Officials, which have estimated that 30 tracers per 100,000 in population is optimum during the COVID-19 pandemic.
Based on Hawaii’s population, NACCHO’s recommendation would be about 420 tracers during emergency conditions. That’s the number Lt. Gov. Josh Green said he and other like-minded stakeholders have championed, especially given that COVID-19 case numbers in Hawaii are surging to a level that increases the possibility of another widespread shutdown.
It’s thought that tracers can protect the community from the spread of coronavirus by moving quickly to locate everyone who comes in close contact with a person who has tested positive.
The DOH says it already has scaled up tracers to meet increased demand and could expand more if needed.
On July 29, State Epidemiologist Sarah Park told the Senate’s Special Committee on COVID-19 in a letter that DOH had 77 active contact tracers. Park also said that DOH could increase the number of tracers from within the department to 196.
Anderson said Monday during a media briefing that the state has a bench of about 450 tracers that had been trained at the University of Hawaii and 100 of them were ready to be hired at anytime.
The DOH hired 20 people this week and plans to hire another 20 next week in anticipation of higher COVID-19 counts, he said. DOH also can tap other staff members, public health nurses and Hawaii National Guard members, Anderson added.
Anderson said new computer applications allow each tracer to track up to 20 individuals a day — so 100 tracers could potentially trace 2,000 people per day.
“We’ve got quite a bit of capacity there if we need it, but we never want to get to that situation,” he said. “If we were to see an extended period of time with high triple-digit numbers, obviously we’re going to be stressed a bit and would certainly need to bring on more tracers.”
This isn’t the first time state staffing levels during the pandemic have been questioned.
Earlier this year the Senate’s Special Committee on COVID-19 struggled for months to get the state Department of Labor and Industrial Relations to add enough personnel to make a dent in the overwhelming surge in pandemic-related unemployment claims. The situation got so out of hand, before it got better, that DLIR director Scott Murakami was placed on an extended paid leave of absence.
The Senate committee has been equally frustrated by the DOH’s contact tracing levels.
When they asked Park what the DOH would do if coronavirus cases exceeded the department’s testing capacity, she reminded them that “most states’ pandemic plans, including Hawaii’s, as well as guidance documents from government agencies or organizations who have dealt with pandemics, focus on the need for definitive and consistent community mitigation measures to control the pandemic.”
The committee sent Kenneth Hara, incident commander for the state’s coronavirus response, a July 31 letter seeking recommendations for establishing a robust contact tracing center.
“(The DOH) has accepted the (Hawaii National Guard’s) offer to provide immediate support,” Hara said in an Aug. 1 response to the committee. “In my opinion, I believe the committee should allow the (DOH) to focus on the increase in COVID-19 infections, both through its contact tracing program but also through other public health efforts including public outreach. Inundating the division with emails, calls, and requests fo information detracts from its ability to respond effectively.”
However, conditions at the DOH already have caused several of the state’s contact tracers to complain to their union, the Hawaii Government Employees Association, about limited resources and overwhelming workloads.
That’s a disappointing revelation for community members who believed government leaders when they said they were closing Hawaii down for several months to give officials time to gather resources so that when Hawaii reopened the state would be prepared to handle the spread.
Dr. Scott Miscovich, who leads broad testing efforts across the islands, said the surge is here and the state is not ready, at least from a contact tracing and testing standpoint, to handle it.
“Contact tracing goes hand-in-hand with the need to increase testing, especially to prevent the biggest issue that we have on Oahu, and that is the disease spreading through families,” Miscovich said.
Miscovich said his organization, Premier Medical Group, is identifying 20 to 30 positives every few days. Miscovich said discussions with patients and contact tracers indicate that the “process is just overwhelmed by the surge in volume.”
To be effective, Miscovich said, contact tracing should be conducted within 24 hours, and no longer than 48 hours.
“I am certain that that the overworked staff does not have the ability to do this effectively — not because they are not dedicated, hardworking employees, but because they are tremendously overworked and understaffed,” he said.
Miscovich said the DOH’s thinly stretched team of tracers is “set up for failure,” especially when coupled with serious concerns about the shortage of lab access.
“Until we address these two issues, which is the lack of same-day turnaround testing and the lack of adequate contact tracing, … this disease will overtake the island of Oahu,” he said.
While the DOH is increasing tracers, the process hasn’t been fast enough for those who view robust contact tracing as a means to lower the chance of community spread and reduce the need to shut down businesses.
Anderson said the DOH sees contact tracing as only one pillar in a plan that includes prevention, detection, containment and treatment.
“We can’t control an outbreak by relying on only one of these pillars such as contact tracing,” Anderson said. “The surge would have been greater had we not had contact tracing, but it’s not a panacea to the problems. The prevention activities are probably far more important.”