A third of Michigan residents testing positive for coronavirus refuse to tell public health officials who they have contacted, indicating widespread noncompliance with a system that epidemiologists say is crucial to curbing the pandemic .
Michigan Chief Medical Officer Dr. Joneigh Khaldun expressed concern about the problem during a press conference on Wednesday. Contact trackers can only reach about 70 percent of those who test positive for coronavirus within 48 hours of being diagnosed, he said, and only two-thirds agree to provide information about their contacts.
“This case investigation and contact tracing work is very important if we are to be able to successfully curb the spread of the disease in our state,” he said, adding that officials do not publicly share contact information.
Coronavirus cases have steadily increased in Michigan since mid-June, about two weeks after Governor Gretchen Whitmer lifted her stay-at-home order that blocked much of the state. On Wednesday, the state registered 891 new cases and 158 probable cases, the highest daily number since May 1.
As of March, Michigan has 71,197 total cases and 6,085 deaths, the 13th highest in the nation for cases and the 7th highest for deaths.
Whitmer has attributed that increase to non-compliance with security requirements, including a Recent executive order requiring people to wear masks inside businesses and outdoors if they can’t keep six feet away from others.
Poor cooperation with contact tracing doesn’t help either, Khaldun said.
Tracking contacts involves two steps: “Case Investigation,” in which public health workers interview newly diagnosed COVID-19 patients with whom they have come in contact in the past few days, and contact tracing itself , in which officials call those contacts to warn them they may have been exposed.
A “contact” is generally counted as someone with whom the COVID positive patient has had face-to-face contact for more than 15 minutes in the past 48 hours, said Susan Ringler-Cerniglia, spokeswoman for the Washtenaw County Health Department.
Epidemiologists say Large-scale contact tracing is crucial for identifying, tracking and controlling outbreaks in COVID-19. While a vaccine is not yet available, reaching infectious people early helps limit potential community exposure.
“This will be incredibly important as we prepare for a potential second wave,” Khaldun said.
Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services, told Bridge that there are now 422 trained volunteers making contact search calls for 16 of the state’s 45 local public health departments. Those departments comprise about 50 percent of the state’s total cases, including Detroit and Wayne counties, Kalamazoo, Genesee, Ingham, Saginaw, and others.
Michigan also has a pool of almost 10,000 smarter volunteers if the crawl needs to increase.
However, most contact tracing and almost all initial case investigations are handled by paid public health officials employed by local health departments. They practice infectious disease detection year-round and are well versed in contact tracking.
Ringler-Cerniglia, from Washtenaw County, which does not currently use the state’s Voluntary Contacts Tracking Corps, said that using local trackers makes it easy for them to compare notes, talk about cases and make connections that help identify sources of big shoots like a home party in Saline this month that led to at least 43 confirmed cases and 66 exposures.
“This is how we are putting all these pieces together,” he said. “The difficulty with having a volunteer base coming out of another location is that it can be really, really difficult to connect those dots.”
Other health departments, like one in Ingham County, are using volunteer trackers in coordination with local investigators, allowing employees to “focus on the things they are best at and not overwhelm them with the rest,” Ingham said. . Linda Vail County Health Officer.
“You can imagine the contact tracing that happened around what ended up being 185 Harper’s cases,” he said, referring to a bar in East Lansing that triggered a wave of cases after people packed up for drinks at the popular point of close access Michigan State University.
Michigan officials don’t know how many total contact trackers there are in the state, between the volunteer corps and local public health officials. And while some leading health organizations While it is recommended that Michigan have at least 3,000 contact trackers to begin reopening the economy effectively, Sutfin said a gross number of contact trackers “is not the appropriate metric” to measure the effectiveness of the programs.
“The state wants to make sure we have enough contact trackers to be able to contact all positive cases and their contacts as quickly as possible (ideally within 24 hours),” he told Bridge in an email.
She quoted an opinion piece written by Tom Frieden, former director of the Centers for Disease Control and Prevention, who argued that “what matters is the quality of the program.”
Angela Beck, a professor at the University of Michigan and director of the Mental Health Workforce Research Center, agreed that there is no reliable number of how many contact trackers are needed. She said it is not surprising that the state does not know the exact number given Michigan’s decentralized public health system.
Estimates of how many tracers are needed range from 30 tracers per 100,000 people to more than 90, he said, which means it’s more important to consider “situational factors” to determine the number needed. For example, more tracers are likely to be needed in densely populated communities and communal housing facilities “to contain any potential increase in cases before they increase too rapidly,” Beck said.
Rock Connections, the call center company that is part of billionaire Dan Gilbert’s business group in Detroit, has a contract of more than $ 1 million by the state to execute the voluntary effort to search for contacts. The company organizes training, communicates and schedules volunteers, and supervises volunteers as they work, Sutfin said.
Rock Connections’ latest bill to the state, to work in May, the first month of the contract, shows that 20 employees billed more than $ 66,000 in hourly work as of mid-month with a monthly “support fee” of $ 26,500 for supervising the program.
Under the contract, Rock Connections must be prepared to manage up to 6,000 volunteers, which means it now manages about 7 percent of the volunteers specified in the contract.
But even if more volunteers are hired, the state doesn’t expect the costs to exceed $ 1 million, Sutfin said, because “these are fixed supervision costs.”
The state also recently received $ 315 million through CDC as part of a federal stimulus package for COVID-19 testing and contact tracing. Part of that will go to local health departments to hire more contact trackers as state health officials prepare for the fall, when some health officials fear a second wave of cases when students return to school.
