Spokane health district hires group to do contact tracing, as cases continue to surge

Jul. 19--Spokane public health officials have hired a California-based company to help them find and notify Spokane residents who have been exposed to the coronavirus.

Enlisting the help of private-sector contact tracers became necessary amid the surge in local cases of COVID-19, said county health officer Dr. Bob Lutz.

The $1.4 million contract the Spokane Regional Health District struck with Public Health Institute runs through the balance of this year and will be paid with federal funds.

Health district epidemiologists and staff will continue to conduct the initial case investigations, Lutz said. When a Spokane County resident's test results come back positive, a health district staff member will call first to ensure the person can safely isolate. The staffer will then ask about symptoms and collect a list of names they have had contact with in recent weeks.

That list will then be given to the contact tracers at Public Health Institute.

"They will not just be out there in a void, but they will be coordinating closely to ensure the work we're doing is seamless with the work they're doing," Lutz said.

Public Health Institute is hiring about 20 people to support the health district. That's about two teams with room to hire more contact tracers if needed.

Contact tracing is a vital part of not only slowing the spread of the virus but eliminating the escalation of cases, said Dr. Marta Induni, research program director at Public Health Institute.

Experts estimate that for every person who has the virus, that individual gives it to at least more than one other person on average.

"If we can change that to just one, at least we would be flat on the transmission," Induni said. "It's not just about not overwhelming hospitals, but that's a lot of it, but it's also making sure that people, when they do get sick, have the resources they need."

More than 500 new cases were confirmed in Spokane County last week.

Most of Public Health Institute's hires will be from Spokane or people living on the West Coast. The contact tracers will call residents with local phone numbers, Induni said.

Earlier in the pandemic, the Washington Department of Health offered National Guard and state Department of Licensing workers who were trained to do contact tracing to various health districts and departments. Spokane has more robust public health staff compared to many counties around the state. A handful of counties in Eastern Washington have joint health districts that cover lots of geographical ground, like in the Northeast Tri-County Health District or the Benton-Franklin Health District. Other counties, which are smaller in population, have equally small public health staff. When the pandemic began, the state department of health offered support to many smaller jurisdictions.

State Secretary of Health John Wiesman said the state's role was intended to be a temporary backup to local jurisdictions.

The state health department is looking for a more permanent fix for local health districts, however.

"We have been working towards building a more sustainable approach, which is a combination of funding local public health with resources to hire a number of contact investigators," Wiesman told reporters July 15.

Wiesman said he is in discussions with the governor to look for funding opportunities to support local health jurisdictions to hire more contact tracers. He said many health departments initially used other staff that would typically do restaurant inspections.

As businesses and service reopened, however, many staff had to return to their primary job responsibilities for vital public health efforts like treating and tracing hepatitis cases, offering immunizations and tracking other infectious diseases.

"We know we've got to have this surge capacity because we can't always know how many cases we will have," Wiesman said. "One county might be harder hit than others, so we've been working to identify a contractor for surge capacity."

Earlier in 2020, when the "Stay Home, Stay Healthy" order was in effect, a person testing positive might have one or two close contacts, or maybe just have contact with people in their household. This made contact tracing, once it began, much easier.

Today, the list of a person's close contacts can be quite lengthy, especially if they have been socializing with more than five people outside their household a week, as Phase 2 requirements dictate. A close contact is a person who is within a 6-foot perimeter for 15 minutes.

The magnitude of contacts per confirmed case quickly overwhelmed the Spokane Regional Health District a few weeks into Phase 2.

When 98 cases are confirmed on one day, that means at least 98 additional people need to be contacted if each person who tested positive had contact with just one other person. With summer gatherings and businesses opening up, a list of contacts could be as long as 30 people, Induni said.

The goal is for Public Health Institute staff to conduct active daily monitoring, checking in with contacts on a daily basis until they no longer need to be in isolation or quarantine. There are ways to be in contact without being called, like receiving texts, or using other technology to do follow-ups.

Lutz said Public Health Institute teams will likely begin their tracing work this week.

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