Hard-hit Maricopa County isnt following CDC guidelines for COVID-19 contact tracing – AZCentral

Many favorable cases in Maricopa County do not receive a phone call from public health workers. As of Friday, Maricopa County had 39,626 recognized cases, per state data. More than one-third of all the countys cases have actually been reported in the last week.
In a case investigation, public health staff reach out to a client to help them remember everybody they have been in close contact with. Public health employees would then begin contact tracing by reaching out to these contacts who were exposed to the positive case.

Maricopa County public health officials arent performing COVID-19 case examinations or contact tracing that meet federal guidelines, as cases in the county and state continue to rise and Arizona ends up being a brand-new nationwide hotspot..
The countys efforts to track cases count on text messaging instead of direct telephone call for favorable people. Those who evaluate favorable and receive a text are then asked to submit a form that asks them to remember anyone they touched with rather than the county conducting a live interview.
Just about 20% of case examinations are being completed through this procedure, authorities verify. Those who do not complete the type receive a call from a private investigator to complete the investigation and identify contacts.
The pared-down process has actually drawn criticism from U.S. Rep. Greg Stanton, D-Ariz., who said it leaves individuals susceptible. He concerns why more federal money offered to the county for responding to the pandemic wasnt committed to tracing efforts early on, prior to the major spike hit.
” The County squandered this precious time,” Stanton wrote. “It acted gradually and only began to prepare in early May– and for a level of staff that was far below what professionals anticipated would be necessary to safeguard a population the size of Maricopa County.”.
County health authorities, who now are dealing with among the most significant case spikes in the U.S., stated they are prioritizing older and high-risk people with direct contacts and ensuring all positive cases are informed so they can start informing individuals they might have been around.
When an individual in Maricopa County evaluates favorable for COVID-19, they receive an automatic text message from public health officials asking them to submit a form.
” Maricopa County Public Health recently learned that a person with this phone number checked favorable for COVID-19,” the text reads. “Public Health will be calling you if you are at high risk for severe health problem from COVID-19 or if you live/work in a high threat setting.”.
Favorable individuals, a number of them sick with the illness, are asked to submit a type that information their living situation, if they work or live in congregate settings, if they have symptoms, if theyve been hospitalized, or if they have hidden conditions..
Theyre also asked to enter information for their close contacts, explained on the form as anyone they have actually been within 6 feet of for longer than 10 minutes throughout the time they were contagious, that includes the two days before they established any symptoms.
With this contact details, public health will then connect to these close contacts and provide information.
” Please consider providing the names and phone numbers of your close contacts for this purpose only,” the kind says.
Numerous positive cases in Maricopa County do not receive a telephone call from public health employees. Neither do most close contacts of these positive cases. The county stated it makes calls to only high-risk and older people who evaluate positive..
Only about 20% of favorable cases in fact complete the texted form, the county validated Friday..
” Its far better than absolutely nothing, but I believe that its far from ideal,” said Stephen Kissler, a postdoctoral research study fellow at the Harvard T.H. Chan School of Public Health, of the countys contact tracing method.
The method the county is running isnot precisely how case examinations and contact tracing are supposed to work, according to standards from the U.S. Centers for Disease Control and Prevention and public health experts.
In a typical situation for an infectious disease, the favorable case and all of their close contacts would receive telephone call from public health workers. The very first telephone call to a positive case can be lengthy, as they overcome the places theyve gone and individuals theyve seen. Contacts would be well mindful that they had been around a favorable case..
Contact tracing is viewed as an important part of slowing the spread of the disease. They can remain house and prevent spreading to others if contacts of positive cases are informed quickly that they have actually been exposed. In some Arizona counties, this conventional practice seems taking place.
Maricopa County intended to perform fuller case investigations and contact tracing– county public health authorities have said as much over the past few months. Their operation has actually not met CDC guidelines for complete contact tracingfor months, even when the number of cases was much lower than it is now..
County authorities said they were prepared to investigate about 500 cases per day. The last few weeks have often seen more than 1,000 or even 2,000 brand-new cases per day in the county.
As of Friday, Maricopa County had 39,626 recognized cases, per state information. Identified cases have increased by about 300% since June 1. More than one-third of all the countys cases have been reported in the recently.
The countys investigations and contact tracing process drew a strong reaction from U.S. Rep. Greg Stanton, who wrote a scathing letter to the Maricopa County Board of Supervisors detailing the different methods the countys practices are falling short.
” The scenario is a catastrophe. It is costing lives. It is untenable,” Stanton composed.
County spokesman Fields Moseley stated in an email to The Arizona Republic that the board of managers “appreciates the congressman sharing his viewpoint about Public Health operations.”.
” Our Department of Public Health is dealing with the disease spread in real-time and making pragmatic decisions based on the ever-expanding body of understanding about this new virus and the explosion of new local cases,” Moseley said..
What CDC suggests for examinations and tracing.
The CDC details how case examinations and contact tracing ought to work. In a case examination, public health personnel connect to a patient to help them remember everyone they have been in close contact with. Public health employees would then begin contact tracing by connecting to these contacts who were exposed to the favorable case.
This need to be done “as quickly and sensitively as possible,” the CDC says. Contacts are only told they have been exposed to a favorable case, not who the case is.
Contacts ought to be offered “info, support and education to comprehend their danger.” They need to be notified on how to keep an eye on for signs and motivated to stay house and keep social distancing for 14 days after direct exposure to the favorable case, the CDC says.
” To the degree possible, public health staff need to inspect in with contacts to make certain they are self-monitoring and have actually not established signs,” the CDC says.
On a Maricopa County website where positive cases are directed, the county says individuals will receive a call “within a few days” of sending the form to follow up on responses and get more information.
The county confirmed Friday that just high-risk people and those over age 65 are presently getting phone calls.
Information of what the county does now.
When positive tests results come in to the county, every case is sent a text message from the public health department asking them to fill out a survey. Favorable cases quickly receive an automatic telephone call too.
Everybody older than 65 is called directly by a public health detective, according to Sonia Singh, county health department spokeswoman. Others just get the text, she stated.
Public health employees examine the surveys and if any cases are high-risk, such as people who reside in a congregate setting, they are directly contacted by a case investigator, Singh stated. The others do not get a call..
The survey asks cases to list close contacts and their telephone number. Those contacts are then contacted to register in the Sara Alert System, a public health app where individuals can keep an eye on their symptoms and public health will be alerted if they establish COVID-like symptoms..
Contacts and cases are also offered a contact number they can call if they need resources to self-isolate..
” This process permit( s) for low danger people to be tracked in the system rapidly and efficiently and enable Public Health to focus on those who have the highest threat of serious illness and those who pose the most risk of infect public health,” Singh stated..
Singh stated the text system was rolled out in late May and considering that more cases have remained in more youthful age groups, theyve been more responsive to texts than calls, she said..
” Only very just recently did we add a choice for cases to opt out of a phone call and then started focusing on high risk individuals for a follow up phone call,” Singh said..
However, few people actually respond to the survey and offer public health the info it needs to map the illness and comprehend its spread..
Singh said more than 20,000 people have gotten a text message with the survey. More than 35% of people open the questionnaire, and nearly 20% complete it, Singh stated. A case investigation via text and contact info is collected for less than one in five cases..
Singh included that in addition to the texting procedure, people who dont complete the survey receive a phone call from a detective to finish the investigation and recognize their close contacts. Its not clear how rapidly that call happens.
County prepared to do more, however didnt.
Aside from in the earliest weeks of the pandemic, Maricopa County has actually never ever been at the point of conducting case investigations and contact tracing to CDC standards..
On April 23, when Arizonas stay-at-home order was in location, Maricopa County guaranteed the public it was increase its contact tracing efforts to be able to perform full traditional case investigations and contact tracing for every single favorable case and their contacts. The county planned to call all those people..
The county revealed it would broaden capability by approximately 10 times its then existing staff of 25 disease detectives. Officials stated details were still in the works..
Part of the point of the stay-at-home order was to buy time to broaden capacity and prepare things like contact tracing so the general public health system would be prepared for a prospective rise of cases.
Maricopa County explained in late April that it had been performing “case-mediated contact tracing,” a less extensive form of the public health practice. Besides at an early stage in the pandemic, when case numbers were reasonably low, the county had not been calling each and every contact..
Rather, public health workers talked to each case and then asked the case to reach out to their contacts themselves and supply info on possible exposure and symptoms to view for. Public health did not get in touch with the cases contacts, as conventional contact tracing requires..
The county was scaling up employees so that it could go back to “traditional contact tracing examinations,” Dr. Rebecca Sunenshine, medical director of illness control for the Maricopa County Department of Public Health, said at the time. Some financing for that would be from CARES Act dollars, she said..
” Right now, what we desire to do to have more total security of the disease in our neighborhood is we personnel up, we put this strategy in location and we will have more people so we return to directly getting in touch with everyone who is a potential contact,” county representative Fields Moseley stated in late April. “So more comprehensive contact tracing.”.
But that appears to never ever have actually happened. Rather, case numbers became overwhelming and the practice devolved further, so that numerous cases never even received that preliminary telephone call from public health, not to point out any public health workers connecting to the contacts..
” Investigators are part public health, part detective and part social employee trying to establish connection with this person that theyve never ever satisfied, and trust, and at the very same time attempting to cover as much details as possible without judgment,” Sunenshine said in late April..
Sunenshine said in late April that interviews could take in between one and 3 hours. However now, unless a person is considered high-risk, interviews are by and big not taking location at all..
Stanton: County has no extensive plan.
The way the county has actually carried out contact tracing since late March violates core CDC concepts for this procedure, Stanton wrote to the county managers Thursday.
” More uncomfortable is that County public health officials have no strategy to completely contact trace all favorable COVID-19 case, and do not yet understand what it would take to put the countrys fourth-largest county in a position to do so,” Stanton composed.
Stanton concerns why the county wasnt prepared to appropriately trace more cases, how officials are using funding from the federal government and why the county hasnt been forthcoming on its lack of readiness.
The county was given $399 million from the federal government as part of the CARES Act to cover expenses connected to the pandemic. A press release from the county reveals $175 million was reserved for “future needs.”.
And $93 million went toward the response to the health emergency, with $25 million for testing, $15 million for ” boosted contact tracing and disease investigation,” $ 10 million for personal protective equipment and $ 5 million for long-lasting care facilities.
Other funds went to offering support to people and families, like rental programs and assisting people who are homeless. Some went to helping small companies, while some likewise went to upgrades to areas to make them more secure, like handwashing stations.
Stanton said the county spent $15 million, less than 4% of what it got through CARES, on case examinations and contact tracing, while a bigger portion of money, $25 million went to offset paid-time off for county employees.
He shared price quotes from health companies that state the county should have more than 1,000 contact tracers, potentially as lots of as 8,500, in order to successfully get the job done.
The Sara Alert system, he wrote, is handy, and other public health companies use it as a supplement to assist contacts and clients track symptoms after theyve already spoken with public health employees.
Marcy Flanagan, the countys public health director, told Stantons workplace that she approximated the variety of required contact tracers based on an average of 200 cases per day during the stay-at-home order..
Basically, Stanton concluded, the county squandered time throughout the stay-at-home order by not properly preparing for its reaction when cases would increase. Flanagan informed Stantons workplace that the county began in early May, well into the stay-at-home order, to get ready for about 500 cases each day.
” This is an extraordinary breach of the public trust,” the congressman said.
The county has actually stated multiple times that it has a partnership with Arizona State University to help with contact tracing. Flanagan informed Stantons office that more than 200 volunteers were contact tracing for the county as part of that collaboration, the letter states.
He composed in the letter, ASU informed his office they do not have a contact with the county as of Thursday, and ASU is not doing contact tracing.
On Thursday, ASU professor Megan Jehn, who is dealing with the partnership efforts with the county, told The Republicvia an emailed statement that the university is supporting the county with case investigations, but not call tracing.
The university is likewise assisting the county with a big serological survey effort and hotspot examinations, Jehn stated..
” We remain in the procedure of standing up a large case examination group (mostly worldwide health, nursing and social work students) to provide rise assistance for the county. We prepare for that this will be a very big and continual effort,” she said..
ASU spokesperson Joseph Caspermeyer stated the university has actually remained in “current conversations” with the county public health department about supporting a variety of efforts, including case examinations, screening, social support services, modeling and hotspot examinations.
” We anticipate a really large and sustained effort,” he said. “Case investigations will start on Monday, June 29; ramping up to the countys requested volume of 700 case examinations each week by mid-September.”.
Stanton called on the supervisors to put more cash toward case examination and contact tracing. He said the county must come up with an instant plan to trace every case.

Why isnt more being done?.
Flanagan safeguarded the countys present contact tracing system at a Wednesday press briefing.
She said in May, the county had the ability to contact 200 brand-new cases each day, but with extra personnel, that capability increased to up to 500 brand-new cases every day by June 10..
However the county has often tape-recorded 1,000 or 2,000 brand-new cases in a day because then– definitely exceeding that contact tracing capability..
Flanagan described that other than for the 5 to 7% of cases for which they never discover contact details, the county makes contact with each and every single individual who tests positive. By and big, thats through a text message and most people do not really speak with a case investigator or public health worker..
” We are connecting to every favorable case that we have contact details for within 12 to 24 hours of us receiving that test result,” Flanagan said Wednesday..
However the county is not “reaching out” in the standard sense of a through case examination and contact trace where a skilled public health expert walks through all the information of a case and informs contacts all they need to understand. Addressing concerns is a crucial part of that, needing a two-way discussion..
Kissler, the Harvard teacher, stated its easier to change individualss behavior and share information when people are gotten in touch with separately by a tracer rather of just sent information..
But, he acknowledged, what the county is doing might be all thats possible at this time since tracing is so resource-intensive.
Among the hopes was that, with physical distancing, the numbers of cases would be lowered to more workable levels for contact tracing, he stated..
” And we never actually reached that point, regrettably. I believe that were kind of left with some of these stop-gap options in terms of contact tracing,” Kissler stated..
Moseley stated the text and automated phone call system was carried out to adapt to more youthful demographics. Contacts will soon likewise be getting a call and text..
” Part of CDC finest practices is automating and digitizing the tracing process to reach thousands of cases more efficiently and for most of cases, texting is their preferred approach of interaction,” Moseley said..
” The examination group is working 7 days a week and should be sustained for at least the next year,” Moseley said. “It is very important to train a group developed for sustainability which is exactly the approach we are taking.”.
Reach press reporter Rachel Leingang by e-mail at rachel.leingang@gannett.com or by phone at 602-444-8157, or find her on Twitter and Facebook.
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