'There's only so many hours in the day': Rising COVID-19 cases challenge Kansas, county contact tracing efforts

Andrew Bahl
Topeka Capital-Journal

Yes, Kansas health officials are still contact tracing.

The practice, once considered a linchpin in the state and national response to COVID-19, has persisted in the background of the ongoing efforts to beat back a rise in virus cases, tied to the fast-spreading delta variant.

Many states have pulled back on their contact tracing efforts, including Kansas, as COVID-19 case counts fell over the spring and early summer. In the early days of the pandemic, the state assembled an army of 400 volunteer contact tracers, which it later supplemented with full-time staff. That number dipped to 100 tracers in October 2020.

But the rise of cases in recent weeks has forced state and local officials to scramble and resume their efforts.

The state's aim has always been to trace and investigate every case, a goal that has become harder and harder for local officials to reach, particularly as students return to schools, prompting outbreaks in local districts that require county health department aid.

"There is a lot of concern right now," said Dennis Kriesel, executive director of the Kansas Association of Local Health Departments. "And of course we're going to see additional cases now that school is back in session. It's a volume of work that the local health departments cannot sustain."

Empty chairs await people wanting COVID-19 vaccines at a vaccine clinic at the Oakland Community Center in late July.

Kansas may pick up contact tracing slack. Will it be enough to fight COVID-19?

Many other states have scaled back their contact tracing efforts amid an acknowledgement that it isn't feasible to trace every case.

Texas, for example, banned state funding from being used for contact tracing, starting Sept. 1. Alabama is still contact tracing but is limiting its focus to larger outbreaks, state officials say, relying on individuals to notify their friends and neighbors of potential exposure.

In Kansas, the state is theoretically aiming to trace every case, although that hasn't always been possible. At times, Kriesel said, individuals have exited their quarantine period by the time they get a phone call from a tracer.

"The disease investigation levels got so heavy when we were trying to do every single case, it just wasn't really practical," he said. "We were claiming that was the approach. But practically, it wasn't getting done."

The Kansas Department of Health and Environment is limited in its ability to pitch in and provide aid to counties, although some local officials say they do send some or all of their cases to the agency.

But counties say KDHE is weighing a more sweeping effort in the weeks to come that would dramatically expand its contact tracing capabilities, allowing it to take on any cases counties don't want to handle themselves.

The idea is the move would give worn-out county health departments the ability to spend more time testing for the virus, administering COVID-19 vaccines and other, non-pandemic-related, job duties. Currently KDHE caps the number of cases they can take per day from counties due to their own limited staffing, Kriesel said.

An expansion of state-level contact tracing wouldn't be a panacea. Counties would still need to route the cases to KDHE themselves, meaning some manpower would still be needed at the local level. 

But the hope is it would be a step in the right direction, Kriesel added.

"That was the number one issue I was hearing," he said. "So if they're able to onboard that I think it alleviates what my members had as their main concern."

Still, some counties say their experience with KDHE tracers hasn't been positive.

Pointing to the forms used by the Kansas Department of Health and Environment last year, Dianna Yates, clinical services team leader for the Shawnee County Health Department, explains the process her staff uses for contact tracing.

"We have tried — except when the surge has been too high — to keep most of our cases and send the low-risk ones to KDHE," said Jason Tiller, health officer for the Saline County Health Department.

Counties said it could be difficult to reach contact tracers with follow-up questions and that personnel didn't always actually handle the cases sent their way, requiring the counties to step in and handle the work.

"Those cases weren't getting worked," said Leslie Campbell, director of the Pottawatomie County Health Department. "And so we didn't want that to happen with our cases, no one ever contacted them, or, you know, explain them what they should have been doing."

It isn't clear which contractor is being used to handle contact tracer staffing. The state signed a $7 million, no-bid deal with Accenture last spring for IT work related to tracing work, but the firm didn't hire any tracers themselves.

But the high volume of cases has left some local officials with no choice but to hand cases off to the state.

In Sumner County, health officer Laura Rettig said 95% of tracing work is sent to KDHE, with a small minority of the most straightforward cases kept in-house. Plenty of other work remains to focus on, both on fighting the pandemic and taking care of the range of duties, such as childhood immunizations and , normally left to health departments.

"Honestly, we have not focused on it too much," Rettig said. "Once vaccines came out, we have done that."

Contact tracing in schools complicates pandemic response

Complicating things is the fact that many local health departments are being asked to play a key role in investigating and contact tracing cases in area schools, a prospect that has grown increasingly daunting as outbreaks have begun to crop up in recent days.

Wellington Unified School District 353 was the first in the state to briefly shut down due to a rise in virus cases and other school districts are trying to decide how to respond due to more and more students missing class.

While the exact procedure differs from district to district, Mark Tallman, a lobbyist for the Kansas Association of School Boards, said the normal procedure is for schools to figure out who may have been exposed to a student or teacher who tested positive, whether that happened in the classroom, on a bus or on the playing field.

That information will then be passed on to a local health officer, who takes the process from there. In some cases, a school district may give a family notice that they were deemed a close contact and should expect a call from their county health department.

"If there is a positive case, and they can, you know, identify people ... for example, are there other kids on the bus, if there is a sense that that might be useful information that can be reported to the county health department," Tallman said. "But it is essentially up to the county health department to to take action on any of that."

It is structured this way in large part because school districts don't have the authority to require students to quarantine — powers allocated to a local health officer.

But as the virus spread has increased in schools, so has the workload. In many cases, Rettig said contact tracing school cases were prime candidates to be passed along to KDHE, merely because of how labor-intensive they are to follow up on.

"One classroom could take one person all day to even get halfway done," she said. "I don't have that much staff to do that."

And keeping tabs on all students who might have been exposed is a tall task for schools as well, particularly for larger districts. Shawnee Mission School District in Johnson County, for instance, reported more than 100 COVID-19 cases in the first week of school alone.

I think the whole issue is well, how do they manage that? How they work with their health officials?" Tallman said. "I think people are simply trying to do the best they can."

Tracers struggle to get participation from COVID-19 positive individuals

In many cases, the hardest part of contact tracing remains getting individuals to participate.

Hard-and-fast estimates of how many people answer tracers' questions, such as whether an individual recently attended a mass gathering, are difficult to determine. At one point last year, the Shawnee County Health Department pegged the participation rate at less than 10%. Officials in Sedgwick County have given similar estimates.

"Cooperation is probably still quite high, but not as high as it used to be," said Tiller, the Saline County health officer.

Things could become even more complicated if the state takes over more tracing duties.

State lawmakers passed last year a provision making explicit that contact tracing participation is voluntary and limiting the types of question that personnel could ask. It was blamed by state and local health officers alike for a decline in contact tracing participation.

That language expired in May and county health workers are no longer bound by its limitations. But legislators renewed the provision in the state budget, meaning the restrictions are still in place for state-level tracers.

And there is also the simple fact that many individuals won't pick up their phone if a strange area code — particularly one linked to the state of Kansas — are calling them.

"Having someone locally, you know, having that local number ... they're more likely to answer than when it comes from a state number," said Campbell, the health department administrator in Pottawatomie County.

In the meantime, other local health departments are going back on a hiring spree to ensure their contact tracing bases are covered.

In Pottawatomie County, the county commission had recently received $100,000 to expand beyond a bare bones staff, with most of the support expected to come in investigating disease outbreaks.

And Tiller said four tracers were recently hired to return to the same staffing levels Saline County had during the peak of the pandemic.

"There's only so many hours in the day," he said. "And only so much individual people can do when they're trying to make all these phone calls, and also deal with a growing sector of the public that is just fed up with COVID."