The state met Gov. Ned Lamont’s ambitious deadline for launching a contact tracing program designed to prevent recurring coronavirus outbreaks, but health directors on the front lines of the pandemic said it could be weeks before the program is effective because of delays associated with software, training and recruitment of volunteer workers.
Lamont pushed to coordinate contact tracing with his phased reopening of the state economy beginning on May 20. The state Department of Public Health launched the program May 20, but acknowledged last week that more work is needed to get it running at full strength.
“Since many local health departments already have existing protocols in place for local contact tracing, we decided that it would make more sense for them to continue doing that until they are fully comfortable with the system,” said Kristen Soto, the state health department epidemiologist who has been the administration point person on contact tracing. “And then have a little slower rollout of the system just to get everybody to the place where they need to be without sacrificing the amount or the quality of the tracing that we are able to do.”
Contact tracing programs are gearing up around the country as states emerge from self-isolation. Many epidemiologists consider them essential to preventing resurgent infections that, if unchecked as society reopens, could threaten again to overwhelm hospitals and create more economic havoc. Contact tracing is a time-tested method of fighting widespread viral infection by identifying and eliminating new cases of infection as they emerge.
The first step is a comprehensive testing regime to identify new infections. Under the state’s plan, volunteer tracers recruited from medical schools and guided by a sophisticated computer software program locate those infected as well as anyone with whom the infected person has had recent close contact. The infected person and the contacts are asked to self-quarantine, a request that can be reinforced through the software by automated telephone calls, email or text messaging.
The state’s 64 municipal or regional health districts have always been the state’s front-line troops when it comes to contact tracing. As a group, the local health directors support the new, high-tech effort. But last week, several said the Department of Public Health, acting under enormous pressure to restart the economy and operating with a reduced budget, has been struggling to develop an ambitious program in an unrealistically short period of time.
Among other things, the directors said they are unable to properly operate the new software program, either because of lack of training or possible bugs in the operating system. Some said they hadn’t been trained. Others said the training was inadequate. One director said he was given a one-hour webinar presentation. Most said they had not been provided with software manuals.
All of the directors said they have not been given specific offers of assistance from hundreds of volunteers the department said it has recruited, or is in the process of recruiting.
The Lamont administration said it is working closely with local health directors to build “the first-of-its-kind statewide contact tracing program” and now hopes to be fully staffed by late June.
“We currently have more than 500 contact tracers registered on the platform and in the process of being trained,” said Av Harris, a spokesman for the Department of Public Health. “Residents of (Connecticut) have already started to receive contact tracing phone calls. We still have significant work to do to continue to refine the workflow and training, recruit additional contact tracers and get the system working at full capacity.”
Directors of districts around the state said they are trying to contact and trace new infections with limited staffs and without the benefit of the new computer software, since they are unable to operate it.
They said coordinating the implementation of contact tracing to the start of Lamont’s phase one reopening may have been overly optimistic
“Remember, this is a very ambitious program that they are trying to develop in a very short period of time,” Glastonbury health director Wendy Mis said.
Farmington Valley Health District Director Jennifer Kertanis said state and local health officials have been asked to develop a state-of-the-art virus containment and elimination program following a period of continuous budget cuts and the absence of investment in capital projects like computer systems. She said her health district has in recent years been funded at a rate that is 11% below the minimum level set by law.
“I don’t want any of my comments to suggest that I am throwing the state health department under the bus,” Kertanis said. “The bigger picture here is you can’t expect systems to just automatically click a switch and be prepared to deal with situations of the magnitude of which we are dealing with when you have disinvested in your public health system for eons.”
Soto said the Department of Public Health has been “developing Connecticut specific instructions for training purposes for our local health departments” and has been “sharing that directly with our contact tracers both in order to help them understand how contact tracing can be done here in Connecticut as well as how to use this specific contact software application.”
The software is Microsoft’s At Risk Investigation and Alerting System, which Soto said is being used by four other states. The system can be accessed by a large number of users, while discriminating among users who are permitted varying degrees of access to information. State health department users would have access to the greatest level of information, while health directors will be able to access data that fell within their jurisdictions and volunteers would have even less access.
Microsoft Corp. has made the software available to the state at no charge for six months. The state has agreed to pay $182,000 a year if it chooses to continue to use the program.
The health department has for years operated an electronic disease surveillance system, a continuously updated data bank of reportable diseases such as COVID-19. That system has always delivered the reported infections to the appropriate health agency — local or state — for contact tracing. Under the new scheme, the infection data will now also populate the Microsoft platform, which has the capability to make automated text and voice calls to mobile telephones.
Those who test positive will receive automated text messages informing them of the results and directing them to a confidential, online questionnaire which will ask, among other things, for information about people with whom they had been in close contact.
Contact tracers, presumably hundreds of volunteers recruited from university public health programs and other academic programs, would make follow-up visits to those receiving automated notifications. Health directors interviewed last week said they had yet to receive state guidance how volunteer help would be distributed or on the frequency required for follow-up visits.
“We wanted a system that would give us the option to communicate with people in as efficient and effective way as possible,” Soto said. “So by using this system we’re able to pick up the phone and call people and talk to them directly just as we have always done. But we can also leverage text messages or email messages for people who would prefer to communicate electronically, especially around daily check-ins for people who have been asked to stay at home because they are either sick or have been exposed to COIVID.”
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Soto said last week that the department was continuing to provide access to the new software program to all state health districts, with 55 of 64 local health districts obtaining credentials by Thursday.
“We have also provided training opportunities to them in the form of a web-based walk-through to get familiar with the contact system technology as well as some written documentation about the use of the system,” she said. “And we started loading statewide data into the system May 20, to correspond with the governor’s reopening initiative. But we are doing sort of a scaled rollout and planning to be operating at our full capacity by June 1.”
Lamont has said the state expects to recruit hundreds of contact tracers from among the offices of the local health directors, from within the Department of Public Health and from medical or health career students at a variety of academic institutions. Soto said the department had already identified and is preparing to give credentials to 200 students and hopes to recruit another 300.
“There is actually a pretty large number of academic institutions which we are engaging with,” Soto said. “We are working with all of the schools of public health in Connecticut, and we are also working with some of the nursing schools, medical schools and schools of social work that have had an interest in volunteering. And this point in time we are anticipating working with 200 volunteers from the Yale school of public health.”
The city of New Haven, which is operating its own contact tracing program and acquired a different software program, also has dipped into the Yale volunteer pool. New Haven Health Director Maritza Bond said the university provided 170 volunteers. So far they have made nearly 3,000 calls tracking down people who have been in contact with a person who has tested positive for the coronavirus.
Bond said most people who have tested positive have been cooperative when contacted and asked for a list of people they’ve been in contact with over the past 48 hours.