First in a three-piece series, today we focus on the current state of contact tracing in Benton County. Tomorrow, we bring you into a mock tracing demonstration, and on Wednesday, we conclude with a look at tracing technology across the globe.
As COVID-19 incidence in the state of Oregon has slowed over the past few weeks, talk has turned to when and how the state will go about reopening.
Because there is still no vaccine for COVID-19, and because the virus has the potential to spread rapidly and through asymptomatic carriers, management of the reopening effort will rely heavily on traditional public health methods for case identification and contact tracing – similar to those used across the country every day for tuberculosis, sexually transmitted infections, and vaccine-preventable disease control.
An Unprecedented Effort
As officials begin to introduce their reopening strategies, it has become apparent that a national effort to scale up and expand local, state, and territorial case investigation and management is necessary before U.S. communities can begin to return to normal.
As a recent Johns Hopkins report observes, “A contact tracing effort of this unprecedented scale and of this critical and historical importance to the functioning and reopening of society has never before been envisioned or required. And our current core public health capacity is woefully insufficient to undertake such a mammoth task.”
Contact Tracing in Corvallis
In order to learn more about the contact tracing program here in Corvallis, I spoke with interim co-director of Benton County Health Department Charlie Fautin, along with Benton County Health Officer Dr. Bruce Thomson.
Fautin supervises the county’s Communicable Disease (CD) Program, while Thomson is one of two full-time contact tracers in Benton County throughout the year. Their department conducted over 800 communicable disease investigations last year.
This year, their job has become an important pillar of Oregon’s response to this worldwide public health emergency.
As Fautin sees it, contact tracing is about prevention—finding and disrupting the person-to-person and/or environmental transmission of a bug, whether bacterial or viral. The difficulty of this task is determined both by the scale of the bug’s distribution and the amount of resources allocated toward its containment. COVID-19 has, of course, posed significant challenges on both of these fronts.
Corvallis Increases Tracing Staff
Before the pandemic ramped up, Oregon employed three contact tracers per 100,000 residents. Governor Brown’s reopening prerequisites required counties to have 15 contact tracers per 100,000 population. That computes to 14 tracers for Benton County.
The Benton County CD staff has been steadily growing to meet this figure over the past few weeks. By mid-week (May 13), Benton County Health Department will have 16 fully trained contact tracers, with plans to add 6 more in the coming week.
Fautin says the size of the team is intended to assure several important factors: “1) Multi-lingual / multi-cultural that reflects the diversity of Benton County’s population at all times; 2) Depth and sustainability since several of these staff perform other functions and cannot do this work full-time; 3) Coverage and assurance in case some of them become ill or need to care for ill family members.”
While it posed a large challenge, Fautin said his team has been able to investigate every positive COVID-19 case that the county has seen over the past several weeks — which was 29 at the time of our interview.
This effort has involved successfully making contactwith about 60 people who emerged as named contacts from interviews with individuals who had tested positive for the disease. These 60 contacts represent about 75 percent of the people they tried to get in touch with in order to inform them of their potential exposure to the coronavirus.
As will be seen in Part 2 of this piece, each “contact” involves an extensive amount of data gathering and information sharing, as well as routine check-ins. It is far more labor-intensive than a quick phone call.
Educated Population Helps Community Health
Benton County residents have done a good job of self-isolating in order to limit the virus’ spread. Fautin cited this as one reason his staff are able to keep pace with the county’s caseload. As such, there have been relatively few cases, which have been spread out over a manageable period of time.
In part, this has to do with a larger pattern of appreciation for the importance of public health. In addition to being the second city in the nation to move toward smoke-free workplaces, Corvallis was also the first city in Oregon and among the first cities in the country to institute “social-distancing” measures during the 1918 flu pandemic.
As Dr. Thomson noted, “Our county is fortunate in many ways to have a group of leaders who are in tune with the whole notion of what public health is about, to have commissioners who are supportive and listen to advice from people like Charlie [Fautin]. There are other [Oregon county health] departments that are not structured in that way.”
More Testing Could Strain Resources
Notably, another reason the contact tracing program has been able to keep up with its workload is because of a lack of sufficient testing capacity across the state. Fautin stressed that for many critical weeks, “the only tests available were for people sick enough to be in the ICU. Just being hospitalized wasn’t enough. If you didn’t need life support, if you weren’t in critical care, you weren’t getting tested.”
Dr. Thomson added that, “Without the ability to do widespread testing, it’s really hard to estimate what is going on in our population.”
Although their department has been able to follow up with the 29 positive cases identified in Benton County, Fautin and Thompson agree that the total number of people who have been infected with mild symptoms or no symptoms at all is undoubtedly many times that figure.
It is estimated that Oregon needs to work toward maintaining the capacity for 15,000 tests per week, with the distribution of these tests varying based upon local outbreaks. Fautin mentioned that on April 26, the state finally reached that level, but then it dropped back down.
With regard to statewide testing capabilities, Fautin believes, “We’re getting there, but we’re still a little ways away from having that sustained capacity we need.”
Testing capacity should see some significant expansion in the coming weeks. The statewide testing criteria that medical professionals have to observe have eased to include pretty much anyone who is symptomatic.
Couple that with factors like the OSU TRACE-COVID-19 project and the imminent easing of social distancing measures, and Benton County could be facing an uptick in positive COVID-19 cases over the next several weeks.
In response to this prospect, Fautin observed that, “We’re just not sure how many more positive tests that will bring up or how much more contact tracing will need to be done. So, we’re just trying to get ahead of the curve by reassigning other health department workers in order to train them right now to do contact investigations.”
Bolstering the contact tracing program is not the only way their job has been impacted by the upcoming shift toward reopening. Fautin and Dr. Thomson, and their counterparts in counties across the state, have been working hard to provide recommendations to the governor’s office so that there are specific criteria for opening that are based on objective metrics, such as how many tests per 100,000 people are being done, and what is the proportion of positive to negative test results.
While it is important to get these measures recognized and standardized, Fautin believes the real hurdle will be sustaining this level of intense monitoring for however long we will be dealing with the virus, whether that be 6 or 12 or 18 months—at least through the upcoming flu season.
As he puts it, “The virus is in charge at this point. We’re not. We don’t have a vaccine; we don’t even have a definitive medical treatment. We don’t have any medical treatment. The virus is in charge and we have to respond.”
At the time of our interview, findings were pending for Remdesivir, but even now, most clinicians agree the drug is not a panacea, and notably, availability may be a problem for some time.
Hopefully Benton County—with the help of state and federal funding and the mutual aid from members of the community—will continue to affirm the deep respect for public health that Fautin and Dr. Thomson described.
As Thomson observed, “Contact tracing is pointing out how much we are all connected. In this training that we’re undergoing, perhaps society will get a better sense of how important it is for each of us to look out for one another. It would be a hard lesson to learn in this way but it would be a benefit that could come from this.”