Contact tracer is not a new job for the Minnesota Department of Health. When the department receives a report of someone with any of several dozen communicable diseases, case investigators follow up as a way to stem the spread.
COVID-19 is one of those diseases.
But a fledgling plan to increase the number of tracers — from a few dozen to four thousand or more — has become a flashpoint in the increasingly political debate over the state’s response to the coronavirus pandemic.
While DFLers in the Legislature are backing the plan put forward by Gov. Tim Walz and his Department of Health, some Republicans are questioning the need for the expansion, accusing Walz of changing his initial strategy and raising concerns over privacy and the specter of government compelling people to participate.
What the House bill would do
Contact tracing is part of U.S. guidelines for safely reopening the country. Dr. Anthony Fauci, the nation’s top infectious disease expert, warned Tuesday of increased deaths and suffering should states not follow federal advice.
In a statement released before his testimony to the U.S. Senate, Fauci said states shouldn’t skip robust contact tracing and what he termed “sentinel surveillance” which is the testing of asymptomatic people in vulnerable populations. “If we skip over the checkpoints in the guidelines…then we risk the danger of multiple outbreaks throughout the country,” Fauci wrote. “This will not only result in needless suffering and death, but would actually set us back on our quest to return to normal.”
But while the expectation that increased tracing would go along with increased testing, it has also become a partisan issue, if only very recently.
In Minnesota, even if the plan to expand tracing gets hung up in the final week of the 2020 session of the Legislature, Walz may already have the legal authority both to create the program and devote money from the federal CARES Act to pay for it.
But it could remain a political issue once the session ends and election season begins.
That Walz can do it without legislative help is one tool legislative DFLers are using to convince Republicans to go along. A bill currently being considered at least gives the Legislature a chance to suggest how the money is spent, though the measure hadn’t convinced any GOPers as of Monday, when the House Ways and Means Committee passed the bill, House File 4579, on a straight party-line vote.
The bill directs up to $228 million to be spent to contract with a private vendor to hire, train, and support temporary employees to contact those who test positive and follow the trail of possible infection. Also included is $30 million for an information technology system; $30 million for local health departments and community health boards to support tracing, case investigation, and follow-up efforts; $5 million for a public relations campaign called “Answer The Call”; $4 million for Minnesota’s 11 treaty tribal nations; and $3 million for a short-term expansion of the current tracing effort within the department.
“It does little good to test if we don’t follow up with public health measures to control the virus,” said Rep. Tina Liebling, a DFLer from Rochester who’s the prime sponsor of the House bill. She said it would help restore confidence in the public that they can venture out and not confront people who are infected.
Margaret Kelly, deputy commissioner of the Department of Health, said the plan is for a large expansion of what the department has been doing on a much-smaller scale since the first infections became known. Tracers contact those who test positive to tell them how long they need to self-isolate, to offer assistance like food delivery and medications, to let them know what to do if symptoms appear or worsen and to find out who they might have infected.
If the number of COVID tests ever reaches 20,000 to 30,000 a day — and if 25 percent of those tests are positive — the state estimates it would need up to 4,200 tracers contacting those residents. Because test results can lag, the state would also like to contract people in vulnerable populations, the elderly and those with underlying health problems, for example, as soon as they are tested to be prepared should the test come back positive.
Using a contract vendor will allow the administration to avoid hiring state employees, and the vendor could add or reduce staff as caseloads demand. The jobs would likely last a year to 18 months.
“The whole idea with aggressive case investigation and contact tracing is to intervene as quickly as possible with an individual who has been tested, to communicate with them right away to assure that they are isolating so they are not shedding the virus as they are out in the community,” Kelly said.
“What we are trying to do here is simply find a balance between protecting our most vulnerable, protecting our health care workers, opening the economy, allowing people to be social and assuring that we don’t overrun our health care system,” she told the committee.
Kelly said current law protects the health data of those contacted, and that no one in the state would be forced to be tested — nor would they be required to cooperate in case investigations, including identifying those they might have infected.
Liebling said she opposes the use of tracing apps that would use technology developed by Apple and Alphabet to identify people’s locations. A bill introduced by four GOP House members Monday would ban mandatory tracing and make it illegal for companies to require employees to use tracing apps.
During the Minnesota Department of Health’s Monday media briefing, Kris Ehresmann, the director of the department’s infectious disease, epidemiology, prevention and control division, said case investigation is “a core element of a public health response to a outbreak of an infectious disease.”
She said tracing might help identify vulnerable people or healthcare workers who were exposed to an infected person. But she said the department is starting to have problems with a lack of cooperation by residents. “We really need Minnesotans to participate in these interviews,” she said. “In order for our work to be effective, we do need people to respond when we reach out to them.”
Republicans on the Ways and Means Committee Monday objected to many aspects of the plan, from its need to its costs. Rep. Pat Garofalo, the Republican from Farmington who is the GOP lead on the budgeting committee, said he thinks the Walz Administration has changed its strategy. Rather than trying to stop as many infections as possible, Garofalo said the state should be trying to “manage the rate of infections.”
Deaths have been concentrated on “a very, very small percentage of society” and with at-risk populations, Garofalo said. “My understanding was that, in a measured and reasonable way, we want those non-protected people to be getting infected to build up immunity so they are less susceptible for spreading it in the future.”
Rep. Peggy Scott, R-Andover, said she was concerned with state government establishing “a massive database” of private health information of residents.
And Rep. Jerry Hertaus, R-Greenfield, said the plan would be the first time the state would quarantine healthy people. “People are going to have to accept the reality at some point in time that they have to make their own personal decisions as to whether it is worth the risk to go into a restaurant or go into a store,” Hertaus said. “Yes … everybody is afraid. Well I wonder why? All we’ve done is fed them with fear.”
DFLers responded by emphasizing the tracing plan is designed to help reopen the economy and that the impacts on otherwise healthy people are not benign nor are the long-term health effects known. “This is about facts, not fear,” said Rep. Mohamud Noor, DFL-Minneapolis. “It is about science.”
The partisan differences were also in evidence last week when the Senate’s Health Finance committee took up a similar bill.
Sen. Michelle Benson, R-Ham Lake, said she was working on a plan that would be less expensive than what the House was envisioning.
But even that drew opposition from fellow GOP members of the committee. “This idea of going lock, stock and barrel across Minnesota, I just don’t get it, I don’t think I can support it” said Sen. Scott Jensen, a Chaska Republican who is also a physician.
He said intervening in hotspots like meat processing plants is valid. And protecting vulnerable populations should continue. But the healthcare system already reports contagious diseases.
“It’s not like we need Big Brother to do this,” Jensen said, saying he has patients who won’t get tested because they don’t want the government to have their health data. “All I see is red flags. The data show that more and more, for people under the age of 65 with no significant comorbidities, the disease is not going to be much of an issue at all.”
Jensen’s comments brought a response from the Senate’s other physician, Sen. Matt Klein, a DFLer from Mendota Heights. “It is interesting to me that some of the most-strident voices asking us to reopen our economy oppose this tool in the toolbox that would move us forward in that regard,” Klein said.
And he disagreed that COVID-19 is a mild illness and said those who express that “are dangerous and wrong.”
“Young people do have to worry about this,” he said, based on both medical literature and what he has experienced as an emergency room physician. COVID-19 has mysterious and not-yet-understood complications, he noted, with clotting in the heart and brain and lungs.
“It’s true that in 85 percent of people, they seem to get through without a whole lot of fuss,” Klein said. “But 15 percent of an unvaccinated population is a really big number.”
Benson Monday said she still expects to have a tracing bill but thinks the money in the House bill is “a little rich.” For example, she questioned spending $30 million for an IT system that will be used for, at most, 18 months.
“If this is going to be a year of intense tracking, let’s get the numbers right, let’s make the personnel is only what’s essential and no permanent full-time equivalents to do something that is really a temporary need,” she said.
“The Senate Republicans are going to take a strong position that we support testing, it’s important for public health,” she said. “But also that we are going to expect the privacy rights of Minnesotans and their personal medical data be protected. Those two things need to go hand-in-hand to have a Minnesota-ready testing-tracking and tracing program.”