Just hours before Alabama once again loosened its safer-at-home policies Friday, state Department of Public Health officials said they were “reviewing additional ways” to bolster contact tracing, a process that may help slow the spread of COVID-19.
The Calhoun County Unified Command System sent a proposal to the Health Department late last month offering to employ nurses from the county school system who would interview COVID-positive people from the community about their recent contacts — people who may have been infected through close contact with the patient — and notifying those people they should get tested and self-monitor. The county would supply the people, equipment and money to pay for both. The request has sat with the department for the last month, said Michael Barton, head of the county Emergency Management Agency and the Command System, without comment — not accepted, declined or even discussed, save for confirmation it arrived.
“Because they failed to act decisively, they squandered the month of May and having those resources paid for by Calhoun County,” Barton said Friday. “The nurses go off-contract at the end of May.”
Nurses with Calhoun County Schools are off-contract during summer months, and often find work for that time away from school. The 22 nurses — about half of whom had agreed to be part of the program, if it was accepted — might already have moved on to other work. Even if they’re still available, new contracts will need to be written, further confusing the process.
“All disasters are local, and utilizing local resources that can be state-supported and state-managed are always the best way to do it,” Barton said, “but local people know other local people and know local resources.”
According to the Centers for Disease Control and Prevention, contact tracing is a key component of reopening states.
“Identifying contacts and ensuring they do not interact with others is critical to protect communities from further spread,” reads a passage from the CDC website. “If communities are unable to effectively isolate patients and ensure contacts can separate themselves from others, rapid community spread of COVID-19 is likely to increase to the point that strict mitigation strategies will again be needed to contain the virus.”
After more than two months of restrictions set to keep people at home and out of the pandemic’s path, more businesses were allowed to reopen in the state Friday at 5 p.m., including theaters and day cares.
Dr. Karen Landers, the assistant state health officer, said the department is still considering its options for continued contact tracing; she told Alabama Political Reporter on Thursday that the state employs around 120 contact tracers. Friday afternoon, she wrote in an email that many of those employees are from varied fields within the organization — HIV, tuberculosis control, sexually transmitted diseases — and they would be returning to their regular work. Some tracing staff included students throughout the state, she wrote.
“ADPH is working on additional plans as we return our staff back to their work and has reviewed the plans from Calhoun County as a potential option,” Landers wrote.
While Landers replied to two emails, responses to specific questions were not provided, including why the proposal had as yet been ignored, whether 120 or fewer contact tracers are enough to cover the state, whether the organization would hire replacements for contact tracers who return to their original jobs, and why the agency was, as of the day the safer-at-home rules had been relaxed, still considering options.
“As the response to COVID 19 continues and staff returns to other duties, ADPH will implement additional steps to ensure that contact tracing continues,” Landers wrote.
Attempts to reach state health officer Dr. Scott Harris by phone and email Friday were unsuccessful. Harris had told Alabama Political Reporter earlier this week that the state had just 60 ADPH staff working on contact tracing — a number Landers had also provided to The Star in early May — and that the department would need to hire dozens, if not hundreds, of people to supplement its workforce. Harris had noted that the department was working with school nurses in some counties.
Meanwhile, in Maryland
The Command System plan had been unique when it was submitted, Barton said, but he has since learned county governments in other states have employed the same strategy.
More than 800 local contact tracers have been hired throughout Maryland — including school nurses in Anne Arundel County, according to a Washington Post story published Thursday — in addition to another 650 tracers hired directly by the state’s health department.
Maryland had about 43,000 confirmed cases as of Friday afternoon — about 4,000 more than when it held a similar state reopening last Friday — while Alabama had just over 13,500.
Landers wrote that one effort had been decided on, a smartphone app created by tech companies Google and Apple.
According to a guide released by both companies, though, the app is actually a set of application programming interfaces — called APIs, most commonly — that will let public health departments create their own smartphone apps, leaving development up to each individual department. The apps will use the same basic technology, beaming wireless Bluetooth signals between phones; if a user of the app indicates they have tested positive for COVID-19, others their phones have been near will be notified, though the positive person will not be identified.
That same guide notes that it will be months before the functionality is built into phone software without user input; current applications will require users to download the app and sign in, and send an alert that they have tested positive.
According to a Washington Post story published May 15, health departments won’t receive information from the app that would identify those who tested positive, or even where they made contact with others, which has led to complaints from health officials in other states and countries about the app’s effectiveness.
Asked whether ADPH still considers the potential smartphone application useful in light of those concerns, Landers did not answer directly.
“Additional technology is part of ADPH plan to ensure ongoing contact tracing,” Landers wrote. “ADPH expects that the app can be another enhancement, especially in younger persons.”