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Editorial: Protect viability of contact tracing

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With COVID-19 infections surging to staggering counts on the U.S. mainland — including in West Coast states that serve as key markets for Hawaii tourism — it seems counter-intuitive for the state Health Department (DOH) to be scaling back its lineup of workers dedicated to contact tracing.

Along with testing for virus infection and isolation for the infected, contact tracing is viewed as a pillar or leg of a public-health stool that could collapse in the absence of sustained attention. Also, given the DOH’s initial missteps in establishing an adequate contact- tracing program, public skepticism about plans to downsize now to match demand is warranted.

But the DOH maintains that due to stepped-up efficiency, the program is now overstaffed in the area of contact-tracing cases that do not rate as high-priority. In priority cases, those with potential to touch off cluster outbreaks — such as cases in which infected persons have attended large gatherings — DOH investigators will remain on the job.

As of last week, the state had roughly 400 tracers: 103 permanent DOH staffers, 194 contractors, 62 National Guardsmen and 32 volunteers conducting contact-tracing duties.

Addressing the Star-Advertiser’s editorial board, DOH Director Dr. Libby Char said “There a lot of people within the DOH that were assigned to contact tracing when the numbers got high. … Now that we’re meeting the need, we can scale back a little bit and shift those people back to their primary duties.” Further, she said, it doesn’t make sense to renew contractor agreements at this time.

Apparently nudging the downsizing is the state’s financial outlook. Federal CARES Act money used to fund the contact-tracing program will expire at the end of this month. And amid the challenge to balance a state budget with 25% reduction in revenues, due largely to COVID-19’s economic woes, the prospect of state government picking up full funding for the program is unlikely.

Gov. David Ige has said contact tracing must be organized as a “sustainable” program — accordion-like in structure — through which “we can respond to surges and we can downsize when it’s wasteful.” With the virus spreading like wildfire elsewhere, DOH’s ability to rapidly ramp up contact tracing could soon be stress-tested.

Also concerning is that the state’s take on contact tracing seems to be out of sync with Honolulu Hale. While Mayor Kirk Caldwell’s term expires next month, he said the city intends to keep 130 tracers in place at least through the end of the fiscal year in June, despite the state’s plan to reduce the DOH workforce in the program.

The DOH must work in tandem with city officials and Mayor-elect Rick Blangiardi to determine whether Caldwell’s proposed city “insurance policy should we see another increase in cases” is viable.

Due to the DOH’s downsizing, tracing responsibilities tied to lower or “non-priority” cases will be bumped to primary care physicians, laboratories and other health care providers. This move’s success will hinge on whether the department clearly communicates what a more-active tracing role requires of providers, and that DOH conduct follow-up monitoring.

Also in need of attention: strategy for improving COVID-19 patient participation in contact tracing. In October, tracers could not reach 578 people due to missing or incorrect phone numbers, and those who did not answer or return phone calls. Infected residents and visitors alike have a personal responsibility to be forthcoming with the potentially life-saving information via retracing their steps.

Since the DOH was heavily criticized during summer months for contact-tracing weaknesses, it seems to have made strides in building an efficient program. This pillar must remain strong, with DOH ready to respond robustly should the numbers, and demand, arise.

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