With the daily rate of new COVID-19 cases in Minnesota more than quadrupling in the space of a month — from about 26 new cases per 100,000 people a month ago to 120 cases per 100,000 people last week — state and local health departments are struggling to keep up with case investigation and contact tracing efforts.
When a person tests positive for COVID-19, someone who works in public health is supposed to call, discussing who the person may have potentially passed the virus to in the course of their infection. Public health workers then follow up with those contacts, advising them to stay home to stop the spread of the virus.
This process of case investigation and contact tracing, a joint project of the state and local health departments, works best when it’s done quickly: if contacts can be reached before they become infectious, they may not infect any, or at least as many, others.
But with the number of new cases over 5,000 each day in Minnesota for most of the last two weeks, state and local health departments have been struggling to keep up.
MDH hires staff, enlists technology
As cases have skyrocketed, the Minnesota Department of Health has hired more staff in order to stay on top of things.
Chris Elvrum, who oversees contact tracing for the department, said MDH is halfway through adding an additional 500 case investigators from a staffing vendor. The department has also tapped state employees from other agencies, so far bringing on 150 for case investigation, with another 50 expected soon to help do case intake and data work. All-told, the department will have about 750 full-time equivalent staffers working on contact tracing.
“So while we are currently still behind and having a struggle really keeping up, we are staffing to a level that we should [be] sustainable,” Elvrum said, at least at current caseloads.
MDH is also relying on technology to streamline its process. This month, the department launched a text-before-calling program, so people who test positive or are close contacts of people who test positive get a text notifying them to expect a call, and showing the number the call will come from. This is designed to help reach the many people who screen their phone calls and don’t pick up when they don’t recognize a number.
“The texting piece that we rolled out recently has been helpful for at least prepping people ‘Hey, you’re going to get a call soon,’” said Cody Schardin, a lead case investigator at MDH. “Sometimes they will actually call us before we call them.”
While the department had been following up with people who couldn’t be reached with follow-up calls for five days, it is now making a call and then sending a letter, Elvrum said.
The state also debuted an app Monday that will alert Minnesotans who use it when their phone has been in close proximity to the phone of someone who has notified the app they have tested positive for COVID-19 for a long enough period of time to be considered a close contact.
While it’s helpful to get information into people’s hands quickly, the plan for now is to continue case investigations per usual, Elvrum said, though if the app is widely adopted, it could potentially take the place of some of the contact tracing work down the line.
With high caseloads in recent weeks, Elvrum said Minnesotans can help contact tracing efforts by keeping transmission of COVID-19 down.
“There’s a lot of cases, and we’re doing our best to keep up. The more people can do to follow the safe distancing guidelines [the better],” Elvrum said. “Stay home. This break that the governor has put us on is really important so we can really bring those cases back down.”
Olmsted County adapts
The state health department isn’t alone in struggling to keep up with the recent surge in COVID-19 cases. Local health departments do case investigations and contact tracing for many of their local cases, too, and the spike in cases is stretching some local departments’ resources thin.
Earlier this month, Itasca County told the Mesabi Tribune it had suspended individual contact tracing because it couldn’t keep up with all the cases coming in, and suggested residents just assume if they’ve been in a group setting that someone in the group had COVID-19.
Last week, Olmsted County announced that with an uptick of cases, from between 20 and 30 new cases per day to as many as 130 per day, it may no longer be able to reach everyone who tested positive for COVID-19, asking people to help do their own case investigations to inform potential contacts using resources on its website while the health department’s response was slowed.
Demand for tests and delays in results coming back resulted in a buildup of cases that arrived at the county for investigation and contact tracing almost at once, said Dan Jensen, Olmsted County’s COVID-19 operations chief.
“[There were] delays throughout the whole chain, from the point of not feeling well or getting tested, all the way to handing it off to us,” he said.
On Friday, Nov. 13, Olmsted County had about 130 cases in its interview queue. By midday Sunday, when a backlog of data made it into the queue, there were 751.
While Jensen rated Olmsted County’s contact tracing efforts as gold standard before the spike in cases, “very quickly, we slipped to silver, bronze, and then we ended up at an aluminum foil and duct tape phase. We really didn’t like that,” he said.
The county, which typically handles case investigation, contact tracing and cluster work, which deals with cases that are grouped, refocused around case investigation and implemented technology that could help with the contact tracing piece, allowing the county to focus on high-risk cases.
Among other uses of tech to streamline operations, when Olmsted residents find out they’re infected with COVID-19, they can fill in their close contacts online, triggering an automatic text message to those people.
With these quick adaptations, Jensen said he thinks Olmsted County is back to a silver standard in contact tracing, working its way toward gold.
He’s been impressed by the public’s support in the week since Olmsted County said it was struggling to keep up.
“The community response was amazing. I was very proud to be a member of this community with the response we were getting. People became empathetic, they get it and were very supportive of us,” he said.
