Contact tracing overhaul tracks where COVID is really spread or stopped

Coronavirus

HONOLULU (KHON2) — The head of the state’s contact tracing program, who took over just before a Department of Health leadership shakeup, has already made big inroads in overhauling the system. Dr. Emily Roberson spoke for the first time with Always Investigating. Under Roberson’s new system, the health department is now collecting key data that shows what kind of settings and activities are spreading COVID, and where and how it is being safely blocked.

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“We can be able to advise the politicians and the decisionmakers a little bit more about what the risks are and what the risks are not,” Roberson told KHON2.

Roberson joined the health department this summer just as leadership was coming under fire for a shortage of, and lack of transparency about, the number of contact tracers and the lack of data about mounting cases.

“In the past (we had) these open-ended questions where people could just kind of say, ‘Oh well I went here and I went there,’” Roberson explained. Investigation staff were also working constantly to handle all aspects of each case themselves.

As Roberson launched into an overhaul plan, she ran into pushback that prompted her to take a stand — and a brief leave — until the chain of command could be sorted out. Dr. Bruce Anderson announced retirement, Dr. Libby Char was named his successor and Dr. Sara Park took leave. Talking to KHON2, Roberson didn’t want to dwell on that, and instead focused on what is getting done by her contact tracing teams that now have 256 personnel and growing.

“They are reaching out as soon as people test positive,” Roberson said, “to make sure they have the information they need in terms of education and to make sure we’re able to screen for any specialized follow-ups that may be needed.”

“First contact callers” are dialing up every positive person with 24 hours and screening for whether specialized follow-ups are needed.

“We have about 50% of the people we attempt to reach within 24 hours, either they have a bad number, they have no number or we are just not able to get them on the phone,” she said.

Of those they can reach, the callers sort the cases among eight specialized investigation teams led by a disease investigator and supported by the National Guard and a cadre of contact tracers.

Additional targeted support such as nurses, community workers, monitors and even translators can jump in when needed.

On top of that, the city is soon to add 80 tracers and build up to 250 more.

“Hopefully by the end of the day we’ll have an agreement approved by the State of Hawaii to hire contract tracers,” Honolulu Mayor Kirk Caldwell told KHON2 on Monday. “When this agreement is signed we’ll be able to hire 80 contact tracers almost immediately.”

Caldwell says the city is working with local market research companies in Hawaii.

“Many of them are not busy right now, but they have an army that’s trained, an army that knows how to make calls, an army that knows how to report the information they gather from the calls and they have the infrastructure to do so,” Caldwell said. “We would be looking to hire 80 folks immediately as a first step and then this model would be repeated with other market research firms. Our goal is to get up to 250 minimal contact tracers being provided.”

The city hires would be trained by Roberson’s unit and would report their data to and through the state.

Roberson’s other overhaul efforts include changing the forms, scripts and procedures to rapidly collect more detailed data.

That addresses a problem first exposed in an earlier Always Investigating report that showed the intake forms did not align with categories state and county policymakers said they were monitoring for what to shut down or keep open. It was a hot topic again on Sept. 14 at the biweekly hearing of the State House Select Committee on COVID-19 Economic and Financial Preparedness.

“It would be a monumental failure on our part as a community, when we see that next surge, if we’re not poised to make decisions in a more deliberate fashion,” said committee member Ray Vara, President and CEO of Hawaii Pacific Health.

Now, Roberson tells Always Investigating that her team has collected weeks of data that gets down to business.

“It does include questions about gyms, personal care services, congregate settings, schools, correctional facilities and a whole bunch of information about that, restaurants for example, bars,” she explained.

KHON2 asked: What is the new data revealing so far?

“There are a lot of times where we might have clusters that involve a specific type of employee or a specific workplace, but when we really investigate them further we find out that the transmission is taking place outside of that location,” Roberson said, adding that social after-work parties, lunch-break hangouts, smoke breaks, or roommates who happen to work together becoming infected at home appear to be the actual source of spread.

“It could be there’s transmission happening technically around the work building but it’s not so much associated with the work itself, it’s more when you’re on your break, or you’re hanging out with your friends,” Roberson said. “Even though there were this many cases at this workplace, it seems everyone got it when they went to this party. It’s not a case where they put their customers or, in health-care their patients, at risk as much as people relax when they are with their friends and it’s spreading socially.”

That is consistent with what small businesses and organizations have been saying about their own contact tracing, finding off-work social spread, not on-the-job, in-store or in-restaurant where masks, barriers, distancing and sanitation regimes are followed to the tee.

“As a business, we’re already doing that, so we know it’s not coming from us,” Tina Yamaki, President of the Retail Merchants of Hawaii, said at the House economic hearing. “If a majority of the numbers are coming from funeral homes or private parties or care homes, we need to take that into consideration, too, instead of a full shutdown.”

Roberson says cloth masks appear to be working better than she ever expected they would, and they are looking at reporting whether masks were used in case data similar to how police report whether seatbelts were worn in a crash.

“Maybe before this whole pandemic I would not have expected the cloth mask to have been as effective as it appears it was,” Roberson said. “masks really do seem to be working.”

KHON2 asked Caldwell if any of this can be taken into account to reopen businesses and public spaces sooner, as a safe off-ramp from the blanket stay-home order that expires on Sept. 23 but does not yet include a reopening plan of who will be allowed to go back into business on Sept. 24.

“Much of this is unfair, I apologize for that…it’s not all equal as much as we’d like it to be,” Caldwell said. “We’re hoping by the end of this week we will be announcing a new order that will open-up things and retail will be one of the first things to open.”

As for public recreational use, the mayor said, “I think at this point we keep the order in place until next Wednesday and on Thursday of next week, should we get approval of the governor, we’ll be opening up our parks, trails and beaches to gatherings not just of 2 but of 5.”

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