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What to know about the plan to massively expand contact tracing in Minnesota

Minnesota’s Department of Health wants to hire as many as 4,000 contact tracers as part of a massive effort to identify and isolate those who have COVID-19 — and those who’ve been in contact with the infected.

A paramedic taking a patient from an ambulance to an emergency arrival area at Elmhurst Hospital in the Queens borough of New York City on Monday.
REUTERS/Eduardo Munoz
Once positive tests are identified, controlling further spread of the virus requires both those infected — and those they had close contact with — to be isolated.
Minnesota’s Department of Health is asking for tens of millions of dollars to build a massive — but temporary — apparatus for finding and isolating those who have tested positive for COVID-19 as well as those who have come into contact with infected people.

A workforce of up to 4,200 people would work for as long as 18 months in a campaign to stem the spread of infections. That level of employment would be two and a half times the current staffing level of the state health department.

The tracing element would attempt to follow up on a state initiative announced last month to work with the University of Minnesota and the Mayo Clinic to increase testing. Once positive tests are identified, controlling further spread of the virus requires both those infected and those they had close contact with to be isolated. Along with testing, Gov. Tim Walz has called tracing a key factor in allowing more workplaces and public spaces to reopen. 

Wednesday, officials from the Minnesota Department of Health told members of the Legislature’s House Health and Human Services Finance committee that to properly implement contract tracing, the department would need those workers and a new computer system it would purchase from a private vendor. Officials said they would also need more support for local and tribal public health departments. Money for the initiatives would likely come from cash already received from the federal government under the CARES Act.

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A bill before the Legislature, House File 4579, would give MDH the ability to contract with a private company to hire, train and manage the new workers. The state would also contract with an information technology vendor to build a computer system to help collect and store data and connect it with existing MDH computer systems.

The same bill provides additional money to local public health departments and tribal government health departments to pay for what are termed “wrap-around services” for those in quarantine: alternate housing, food delivery and delivery of medications. The money would also purchase personal protective equipment for tracers and pay for interpreters to help interview non-English speakers.

The ‘next step’ in battling coronavirus in Minnesota

Margaret Kelly, the deputy commissioner of MDH, called contact tracing phase two of the state government’s next steps in battling the coronavirus, following the ramp-up in testing. 

The state is currently testing health care workers and first responders as well as those who are showing symptoms, and has been testing heavily in virus hotspots, such as meat processing plants. But MDH wants to increase testing of what it terms vulnerable populations: those in shelters, the uninsured and those with little access to health care.

Margaret Kelly
Margaret Kelly
While the department would encourage those with symptoms and those who had contact with infected and symptomatic people to get tested, it can not require it. The state can require quarantining, however.

The department has been conducting contract tracing from the first days of the crisis, with a workforce devoted to the task initially at 20 people and now at 200. Kelly said the department will increase that staff by using workers from local health departments and University of Minnesota public health students; it will also redeploy state workers from other agencies and even volunteers.

But those sources will only allow about 500 tracers, many of whom will have to return to previous jobs and assignments. That is why the department is seeking authority and money to hire a new workforce, Kelly said, which could include laid off or furloughed health care workers, including doctors and nurses.

The larger estimate for the number of needed tracers is a dramatic increase from two weeks ago, when an MDH official told a Senate committee that there would be a need for up to 500 contact tracers, a number that could be achieved without outside hiring, officials said.

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That changed “partly as we have learned more about the effect of asymptomatic spread and therefore the need to test more broadly beyond symptomatic only patients,” said state Health Commission Jan Malcolm during the department’s daily press briefing Wednesday.

Malcolm also said the higher number reflects “the interest employers are showing in increased testing and increased surveillance, increased health screening for their employees and potentially customers.” The department has also had to respond to the large outbreaks at both food processing facilities and in long-term care facilities.

How contact tracing works

What do tracers do? Assistant MDH commissioner Daniel Huff told the Senate Health Finance Committee last month that they reach out to people infected to both help them manage the disease and to see how it might have spread.

Health Commissioner Jan Malcolm
Evan Frost/MPR/Pool
Health Commissioner Jan Malcolm
“We ask them who they have been in close contact with so we know who they might have shared the disease with,” Huff said. 

Then tracers follow up with all those people, check to see if they have symptoms, and then arrange for them to be tested if they do. But whether tested positive or not, people exposed will have to quarantine for 14 days, he said.

“These are not just quick phone calls,” Huff said. “There are a lot of questions that need to be asked. You’re telling someone they have been in contact with someone who has tested positive for COVID so that can be an emotional conversation with folks.” 

The tracer must then ask who that person has been in contact with, must inform them what they must do for quarantine and ask them what support they might need. “We don’t want someone to sit in quarantine and not be able to eat or get their medication,” he said. Tracers need what he called “soft skills.”

“We want someone who is compassionate and understanding,” he said, but also have some technical knowledge or at least be able to be trained in some aspects of public health and the characteristics of the disease.

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Lawmakers question some aspects of the program 

House health finance committee chair Tina Liebling, DFL-Rochester, said the money in the bill was a placeholder and that more exact numbers will come. Of the $250 million in the bill, $25 million would come out of a special account created by the Legislature in March. The other $200 million would come from the $1.87 billion the state received from the federal government under the CARES Act.

State Rep. Tina Liebling
State Rep. Tina Liebling
The bill passed out of the House committee on a party-line vote, with DFLers in support and Republicans opposed. 

The bill was amended, however, to contain another health department requested not related to tracing but connected to the coronavirus. The department asked to delay implementing new regulations for lightly regulated assisted living facilities by one year. 

Battling COVID-19 has taken department time and resources away from implementing those new regulations, which include first-ever licensing, and the amendment would push state regulation back from August of 2021 to August of 2022. DFLers on the committee said they reluctantly supported it, but the committee’s minority GOP members voted against both the amendment and the bill. 

Some on the committee also raised questions about the contact tracing program. One section would protect furloughed workers who sign up for tracing jobs from being sanctioned by their previous employers who might prefer them to be quickly available for recall. And Rep. Mary Franson, R-Alexandria, said she worries that the state could force infected people out of their homes.

“What if someone chooses not to share with who they have been around?” she said. “Maybe they don’t want big government knowing who they have spoken to or been around with. What are the repercussions?” 

Franson said she thought the bill was well-intentioned but that she was uncomfortable with unknowns, including whether there will be “forceful actions that take place.”

Greta Kaul contributed to this report.