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

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.

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.

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.

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. 

Comments (39)

  1. Submitted by Pat Berg since 2011 on 05/07/2020 - 10:39 am.

    Does anyone know what the definition of “close contact” is for purposes of contact tracing?

  2. Submitted by Robert McManus on 05/07/2020 - 12:02 pm.

    Funny how the “big government” paranoia of a country like the US of A has delayed and handicapped our response while “socialist” countries like Norway, Denmark, Finland, New Zealand(all with female leaders by the way) have been most successful in containing covid 19.

  3. Submitted by Brian McLaughlin on 05/07/2020 - 12:06 pm.

    If I’m reading this correctly, the State can ask you who you’ve been in contact with (if you show positive), and then quarantine those people for 14 days, and continue to quarantine the “tree” of infected.? Man, I’d want to suit someone who reported me in their “contact list” if they forced me to be inside for 2 weeks. And what are the legal consequences of breaking said “quarantine”. Talk about scaring people from wanting to get tested.

  4. Submitted by joe smith on 05/07/2020 - 12:06 pm.

    Since I am paying for this program, I have a couple questions. After we test everyone and find out that the average age of death in Minnesota is 85+ and 98% of people dying from COVID 19 have at least one comorbidity, will we then put 80% of our resources towards long care facilities? With 10’s of millions of our tax dollars being spent, what are we going to learn that we don’t know today after 2 months of data? If you got tested on a Tuesday, are deemed not to have COVID 19 but get infected Wednesday, are you going to get tested again on Sunday? If you are not testing the same folks weekly, how are you to know who has recently contracted the virus?
    Will there be a bidding process the public can see that determines who gets the private contracts associated with this project? With tens of millions of tax dollars being spent, I sure would like some basic questions answered. I am afraid we will get the Big Government typical response, “be quiet and keep paying us, we know what is best for you”!

    • Submitted by ian wade on 05/07/2020 - 03:02 pm.

      “what are we going to learn that we don’t know today after 2 months of data?”
      Yeah…”Science” pfffffft.

    • Submitted by Harris Goldstein on 05/07/2020 - 04:48 pm.

      First, I don’t know where your number comes from, but the median age for Covid-19 death in Minnesota is 82, so half of those dying are under that age.

      But more importantly, you are looking at the initial cases in Minnesota which is heavily weighted toward nursing homes and assisted living. Other states in the east coast were hit there first as well.

      If you look at the most recent data for New York and Massachusetts, you see about 1/3 to 1/2 of the deaths in the under 80 age group.

      • Submitted by Dick Lindmark on 05/07/2020 - 08:39 pm.

        In case you haven’t noticed, MN is not anything like NY City. Even Buffalo isn’t anything like NYC. Those comparisons are absurd.

        • Submitted by Jackson Cage on 05/08/2020 - 09:19 am.

          Actually, they’re not. What we’ve learned from NYC and nursing homes is the rampant spread if people are put in close contact with each h other. Which is why people wanting to “reopen” are the absurd ones.

        • Submitted by Pat Berg since 2011 on 05/08/2020 - 09:58 am.

          And specifically what would you consider to be the relevant differences with respect to the demographics of Covid-19 mortalities?

    • Submitted by Matt Haas on 05/08/2020 - 07:30 pm.

      You mean the comorbidities that something like 70 million citizens share? Maybe we just mandate mega doses of vitamins like you’d prefer, that’ll solve it, I’m sure.

    • Submitted by Matt Haas on 05/08/2020 - 07:40 pm.

      So just to be clear, you want to “protect the vulnerable” so the rest of us can go about our normal lives, but don’t want to actually test anyone who may be infectious to determine if they might be a threat to the “vulnerable”. Yep, sounds like normal conservative logic alright.

  5. Submitted by BK Anderson on 05/07/2020 - 12:43 pm.

    Buried deep in the piece is the (entirely predictable) uniform rejection of the bill by our always-helpful, problem-solving Repubs. This despite the fact that the major cost of the plan (the workers) is already covered by federal money, the plan is temporary, the implementation of the plan is the (responsible) route to their cherished Liberation of the Economy, and employers (Repubs’ chief constituency) seek “increased testing and health screening”.

    Perhaps Repubs had additional concerns other that the thread-bare, lame and ridiculous one (“Big Gubbermint bad!”) voiced by Franson. But most likely their lock-step obstruction is just another demonstration of the knee-jerk extreme ideological partisanship of today’s “conservatives”, which basically borders on unthinking nihilism.

    • Submitted by Dick Lindmark on 05/07/2020 - 08:57 pm.

      There is so much wrong with this post I don’t know where to start. What is so typical of the Leftist love of big government programs is the belief that if it is federal money it comes from an unlimited fund rather than from us. And the belief that it is temporary. Isn’t this the same Dept that did such a bang up efficient job of developing the Minncare insurance system with an outside DFL vendor?

      Beside the fact that we have never done this kind of program for any infectious disease, would the reaction have been as enthusiastically supported if this had been proposed for the early days of the AIDS epidemic?

      • Submitted by BK Anderson on 05/08/2020 - 11:12 am.

        It’s temporary because doctors think the Covid pandemic is temporary. The federal money has already been appropriated, so crying about “our money!” is water under the bridge. Or should MN refuse to use the funds out of some sort of principle?

        As for “we’ve never done this before”, well, have you ever seen the sort of global pandemic that the world is now dealing with? All sorts of government responses to Covid-19 are unprecedented—you hadn’t spotted that yet?

        The bigger objection is whether such a plan can even work, and is a necessary component of combating the virus, as Mr Udstrand observes. I surely don’t know. I do know that the infectious disease pros are clearly advocating for it, and the MN Repubs have given their usual blanket rejection of it, apparently for a reason no more cogent than their genetic rejection of all action by government.

      • Submitted by scott gibson on 05/08/2020 - 11:21 am.

        Why keep on bringing up the AIDS/HIV epidemic? Yes, people then would have been loathe to do similar ‘contact tracing’ then because their actions would have prompted a public stigma. They may have been engaging in unsafe sex practices and/or intravenous drug use on the ‘down low’. No such concerns for this virus. Your lack of curiousity displays a fatalism that I don’t want to participate in.

  6. Submitted by Tory Koburn on 05/07/2020 - 01:53 pm.

    “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?”

    What ever happened to “if you have nothing to hide, you have nothing to worry about?” I’m sincerely curious about why people who have gotten COVID would refuse to disclose who they have been in close contact with, when that knowledge will actually help put a stop to this crisis. Not simply mitigate, but END it.

    I would expect all such principled skeptics of big government to forfeit their relief checks immediately.

    • Submitted by Dick Lindmark on 05/07/2020 - 09:10 pm.

      Contract tracing will NOT end it only a vaccine would and there has never been a vaccine for a coronavirus. Why would anyone not want to divulge? That is an incredibly naive question. There are a variety of reasons some legitimate and others very personal. There is very little known about asymptotic transmission because the testing has been haphazard and not statistically based. The data generated tells us little about even things like death rate because of the way the testing has been done.

    • Submitted by Ole Johnson on 05/08/2020 - 07:46 am.

      Nice. You take the money from the tax payers, then tell them if they want it back they need to comply with government orders.

  7. Submitted by Paul Udstrand on 05/07/2020 - 04:34 pm.

    This plan is daft. It will take year just to get it up and running, and the idea that some contractor will run it is ridiculous. The other problem, as many are eluding to, is that this whole thing relies on the compliance of those who are “contacted” but not tested, no symptoms,or even tested positive. Without high levels of compliance this whole exercise is a waste of time and money.

    This is the first serious misstep our state has taken, it’s not science or data driven. Something like this might have worked three months ago, but a year from now?

  8. Submitted by Alan Straka on 05/07/2020 - 04:39 pm.

    I am willing to quarantine myself if I test positive but I will not do it just on the basis of someone who tested positive claiming to have come into contact with me. If I do test positive, I am not going to rat on my friends with whom I have been in contact. I will contact them myself and let them decide how to proceed. Are we going to quarantine health care workers if they have been in contact with someone who tested positive? That would pretty much shut down all the hospitals. What about the clerks at the grocery store? The liquor store? I don’t think so. Pretty soon you have the whole population under quarantine. You have people getting shot over social distancing. I wouldn’t want the job of being a contact tracer and I sure as hell don’t want to be the one sent out to enforce this.

    • Submitted by Dan Landherr on 05/12/2020 - 02:01 pm.

      People who have been in contact with someone who tests positive don’t need to be quarantined forever, just until they get tested. If they test negative they can go about their daily business again. Rapid tests have recently been developed that take as long as a rapid strep tests.

      Contact tracing is as simple as telling a person “You have been in contact with someone who tested positive for the virus. We recommend you either self-quarantine for 14 days or get a COVID test that takes 15 minutes to find out if you are positive.”

      • Submitted by David Ziffer on 05/26/2020 - 05:52 am.

        I suspect that we’ll find that the “self-quarantine” is not voluntary, and that it will be potentially applied multiple times (for example if you frequent a gym that will undoubtedly constantly have users who could conceivably transmit COVID to you). You could effectively be under house arrest for weeks or months.

  9. Submitted by Delbor Raymondo on 05/07/2020 - 04:45 pm.

    Gee, did we do contact tracing during the HIV epidemic, back in the day? What if the contact doesn’t cooperate? Or the person that is positive? Will they be arrested? Taken from their home if it doesn’t meet standards for isolation?

    • Submitted by Ole Johnson on 05/08/2020 - 07:55 am.

      To be fair, it is probably easier to remember and name recent sexual partners than all the people you might have passed in the grocery store.

      But maybe not, maybe you are better looking than me. 🙂

    • Submitted by scott gibson on 05/08/2020 - 11:11 am.

      Well, since transmission of HIV is a bit more, shall we say, ‘intimate’ I don’t think this hardly applies. And I’d bet anything that the hospitals treating HIV patients did, indeed, do contact tracing of their HIV patients at the time. But I’m sure you knew that. Pretty easy for the vast majority of us to avoid HIV. Not so easy to avoid Covid-19. I can be completely minding my own business and contract novel coronavirus.

    • Submitted by Dan Landherr on 05/12/2020 - 02:02 pm.

      That’s an emphatic yes.

      Contact tracing has been a tool used to contain HIV infection for decades. Here’s a link to an NIH paper from 1990:

      https://www.ncbi.nlm.nih.gov/pubmed/2305335
      Reply

  10. Submitted by Dick Lindmark on 05/07/2020 - 10:28 pm.

    The idea of contact tracing is absurd not to mention likely a HIPA violation. First, how far back do you contract trace? 14 day? What if I got it 3 days before the test? Then there are a whole lot of people that I was in contact with when I was not positive but they need to isolate. What about people from other states I’m in contact with, are they just ignored? What if they go on to meet with others in the state after I have contact with them and then leave the state but refuse to cooperate? Are we going to close the borders? Would we just keep non Minnesotans out or do we keep Minnesotans in? This like so many Big Government plans sound good as long as you don’t look at the details but in reality are poorly thought out, infringe on our rights and are glossed over until they lead to the abuses we now see in th General Flynn case.

    • Submitted by Paul Udstrand on 05/08/2020 - 10:29 am.

      Dick, I’ve noticed that you keep making a assumptions and statements that are out of you’re league. This has nothing to do with HIPPA, although there may be some State Data Practice concerns.

      However, I agree with you, this isn’t going to work, even if they manage to get it set up. This COVID virus is well established in our population and although social distancing has flattened transmission to some extent, we’re way passed being able to treat this as if it’s a matter of isolated “outbreaks”.

      To be honest, I think this is a just a Hail Mary move to provide cover for re-opening. They hope they can convince people that it’s safe to go back out again if this protocol is in place. I predict that these schemes will be so riddled with problems that by the time they try to roll them out the public won’t have any confidence in them anyways. And it won’t contain the virus.

    • Submitted by scott gibson on 05/08/2020 - 11:15 am.

      By including the extraneous Flynn case you are outing yourself. We can debate a lot of things about contact tracing, though. What I have heard is that they are only going back a short amount of time after you have been diagnosed. There are definable limits, otherwise I doubt it would have been proposed at all. Conservatives are now pivoting to the ‘less we know about the spread of this disease’ the better. See no evil, etc.

  11. Submitted by Ole Johnson on 05/08/2020 - 07:44 am.

    “Minnesota’s Department of Health is asking for tens of millions of dollars”

    Later in the story, the actual number is $250M in the bill.

    That is a lot of tens of millions. A wrong thinker might even say “asking for hundreds of millions” might be more accurate.

  12. Submitted by Matt Haas on 05/08/2020 - 07:36 pm.

    Wait, I thought the conservative line item was to “protect the vulnerable”? How pray tell, do you expect to do that if you aren’t even willing to keep track of whom might be infected? I’m really having a hard time seeing how the conservative response hasn’t become “damn the torpedoes, to hell with vulnerable” at this point. Any of you care to tell me how that’s untrue?

  13. Submitted by Michael Green on 05/11/2020 - 03:19 pm.

    Is it troubling that the most troubling part of this story is the $10 million price tag for a system developed by MN IT? The same people who couldn’t pump the brakes before throwing away $200 million on a DMV system?

  14. Submitted by Joel Stegner on 05/12/2020 - 03:28 pm.

    Massive threats call for massive actions. We were completely unprepared for the pandemic. Pandemics spread through contact tracing. Contact tracing helps us better understand a poorly understood threat and potential gets the infected help before they unknowingly infect others. Quarantining those who are newly infected breaks the chain reaction. This is not nearly as complicated or political as people are making it. The right to privacy does not trump the need to prevent illness and death.

  15. Submitted by Karen Sandness on 05/13/2020 - 10:43 am.

    Contact tracing is part of how smallpox was conquered.

    By the 1970s, it was no longer a First World problem, thanks to routine mass vaccination, but it persisted in the Third World.

    The World Health Organization embarked on a program of contact tracing during the outbreaks that were still occurring in poor countries. They isolated people who had come down with smallpox, traced their contacts, vaccinated any contacts who were not themselves sick, and vaccinated the contacts of those contacts.

    They exploited a weakness of viruses. That is, viruses cannot reproduce outside a living cell and will disintegrate if unable to find one. If everyone in a given area is either dead, recovered, or vaccinated, the virus has nowhere to go and disintegrates.

    The last cases of smallpox were in a remote part of Ethiopia, and the smallpox virus is now extinct in the wild. That’s one extinction we can all be happy about.

    The story of smallpox also casts doubt on the concept of natural herd immunity. It ravaged humanity for centuries, with the first mention occurring in Egyptian records from the 11th century BCE.

    In previously unexposed peoples, it had a mortality rate of 90% and was one reason why some of the smaller Native American tribes were wiped out or nearly so. But even among groups that had been exposed to it for centuries, societies in which most adults were survivors of smallpox, the mortality rate was 30%, especially among children and young people.

    It is true that covid-19 is most dangerous to the elderly, but not exclusively to the elderly. Would right-wingers be so blasé about it if it killed mostly children or mostly men between the ages of 25 and 50?

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