County and federal leaders are looking at ways to improve contact tracing in order to find and limit the number of people becoming infected with the new coronavirus.
The Maricopa County Department of Public Health says it’s trying to scale up contact tracing capacity by eight to 10 times its current level, according to Dr. Rebecca Sunenshine.
MCDPH has done contact tracing for every confirmed case of COVID-19, beginning with the county’s first case in January. An expanded team of contact tracers will help meet the need as more individuals are tested, which will inevitably raise the number of positive cases requiring contact tracing.
More testing is likely after state health director Dr. Cara Christ said Arizonans who think they have COVID-19 can get tested without a doctor’s order or symptoms, or from having been overseas.
“We need to be able to enhance our investigators and the number of people we have doing the investigations,” she said. “We have to scale up our investigations as number of testing goes up.”
Ms. Sunenshine said officials are currently contacting about 100-150 people each day, which she added is about the average number of new cases reported each day in the county.
The ability of contact tracing to be as effective as possible relies heavily on the public trust of information shared between community members and MCDPH. Maricopa County places the protection of this information as a top priority and takes every precaution in keeping this information private.
Ms. Sunenshine said it is that privacy trust that has allowed officials to be successful in getting information they need from contacts to share with others and help keep the public safe.
“The unified command leadership team at Maricopa County understands that in order to safely lift physical distancing restrictions, there must be certain resources available,” said Marcy Flanagan, director of MCDPH. “Testing, personal protective equipment (PPE) and a comprehensive contact tracing system are a few of those important resources.”
What is Contact Tracing?
Contact tracing has been used for over a century and is an important tool in interrupting the spread of infectious diseases, MCDPH states. People are most familiar with contact tracing for sexually transmitted disease, tuberculosis and measles.
Contact tracing is conducted by trained investigators who are part public health, part detective and part social worker. They work closely and quickly with positive cases to establish trust, uncover as much information as possible, and then decipher information to put it into public health interventions.
After Public Health receives notice of a positive case from electronic lab reporting, the following occurs:
The investigator reaches out to the positive case by phone and conducts an interview. They ask a series of questions about who the individual may have exposed while infectious. Investigators also ensure the individual has all the information they need to know how to best take care of themselves and protect those they love.
Questions might include:
Who are the people in your household? This is because we know they are at the highest risk of getting exposed and developing COVID-19.
Did you seek healthcare? MCDPH will need to make sure proper PPE was worn and ensure that any exposures in the healthcare setting are known.
Who were you in contact with while infectious? Were you at work? Where do you work? The investigator is trying to discover who of the case’s other contacts could be at risk for exposure. They look at 48 hours before a case’s symptoms occurred.
The investigator then reaches out to close contacts and household contacts to educate them on risk of exposure, what to do if they experience symptoms, what they need to do to avoid exposing others and if they need to be quarantined. These talks are confidential, and the positive case’s name is not identified to maintain confidentiality of the case’s personal information. If a contact is required to be quarantined, the investigator will help to ensure the contact’s basic needs, including healthcare and food, are met.
The investigator reaches out to healthcare institutions that treated the exposed case and ensure proper PPE was worn. MCDPH then works with facilities to notify any individuals that could have been exposed to this individual.
The investigator continues to check up on close contacts to see if they have developed symptoms, depending on how high risk the exposure is — anywhere from daily to at the end of the period when they are no longer at risk of developing disease. Anyone who develops symptoms is given instructions on how to seek healthcare safely without exposing others at medical facilities.
The process above is traditional public health contact tracing. In March, as cases rapidly increased and Gov. Doug Ducey’s stay-at-home order went into effect, MCDPH changed its investigation process to case-mediated contact tracing.
MCDPH still interviewed every positive case but worked with the case to reach out to contacts and provided them with instructions in writing.
Since the beginning of the outbreak, MCDPH has doubled the amount of staff that has been doing investigations to about 25. This includes five staff members solely focused on supporting long-term care facilities which also includes skilled nursing facilities, nursing homes, group homes, assisted living, Arizona Long-Term Care System and rehab facilities.
As of Friday, there were 455 cases among residents at long-term care facilities in Maricopa County, with 73 deaths. Staff members account for 207 cases and one death.
Expanding contact tracing
Currently, MCDPH is in the midst of developing a plan to scale up capacity anywhere between eight to 10 times from where it is today.
As more testing and PPE become available, MCDPH will be ready to return to traditional contact tracing for every positive case. More information on this plan will be available very soon, according to officials.
Funding made available to Maricopa County through the CARES Act has helped make this possible, Ms. Sunenshine said.
Visit www.bit.ly/mcdphcovid19 or www.Maricopa.gov/COVID19 for details on what you can do to protect yourself and those around you.
At the federal level, U.S. Sens. Kyrsten Sinema (D-AZ) and Mitt Romney (R-UT) urged the director of the Centers for Disease Control and Prevention to implement a robust contact tracing system to protect citizens from the spread of COVID-19 and future pandemics.
“Protecting Arizonans from future waves of the coronavirus, or other dangerous diseases, requires comprehensive information on how the virus is spreading,” Ms. Sinema stated. “I’m urging the CDC to implement a contact tracing system that will keep Arizonans safe and help save lives.”
The Senate’s recent supplemental coronavirus package provided the CDC an additional $1 billion for public contact tracing, test reporting, and workforce support, according to a release.
Ms. Sinema is calling for the CDC to implement a contact tracing system that protects individual privacy while aggregating case information from state and local health departments, physicians, hospitals, labs, and coroners; collects hospitalization rates from the disease broken down by underlying health conditions; notes patient treatment regimens; collects rates of ICU admissions, lengths of stay, recovery, and mortality; and includes appropriate demographic information.
In March, Ms. Sinema wrote Vice President Mike Pence about the need for the federal government to implement a single online webform to begin contact tracing from travelers for more complete, accurate, and timely data.
Following her letter, Ms. Sinema was joined by Sen. Ted Cruz (R-TX) on a separate letter to Mr. Pence and members of the coronavirus task force urging them to implement a single online webform that would allow the CDC to directly collect complete, accurate, and timely data to trace infected or exposed travelers.
The Maricopa County Unified Command has distributed more than half a million pieces of personal protective equipment to date, but requests continue to pour in. During a press conference Thursday, Unified Commanded updated its efforts to provide critical PPE to health care workers and first responders and explained how it prioritizes distributions.
Maricopa County has prioritized PPE to acute care hospitals and EMS transport, with the highest priority given to long-term care facilities like nursing homes and hospice with positive/active cases.
As of Thursday, Maricopa County has distributed 65,800 N95 respirators; 149,450 surgical masks; 29,813 face shields; 82,025 surgical gowns; and 180,618 gloves.
Maricopa County has ordered millions of additional units of PPE to keep up with the demand, officials said. However, like many others, the county is waiting for those items to be delivered at a time when supply nationwide is limited.
Unified Command is also coordinating options with local manufacturing partners as well as federal and state agencies.
So far, the Maricopa County supply of PPE has included inventory from the Strategic National Stockpile, purchases by MCDPH, the Arizona Department of Health Services and private donations.
Health care facilities throughout the county submit requests for PPE to Maricopa County. Those requests are reviewed, with priority given to facilities with positive cases.
Cities, towns and tribal communities follow a similar process. In some cases, municipalities may request PPE from the regional cache warehouse being operated by the Phoenix Public Safety Incident Management Team.
“Due to high request, the county is not processing requests from facilities without cases,” said Robert Rowley, director of the Department of Emergency Management. Instead, those are rerouted to an emergency operations center.
Individuals and organizations with personal protective equipment to donate can drop items off at the Donations Warehouse at the Reception Area, 1645 E. Roosevelt St, Phoenix AZ, 85006, from 9 a.m. to 1 p.m. Monday through Friday.