With Hawaii facing a surge in COVID-19 cases, the state’s effort to trace close contacts of someone who has tested positive has been overwhelmed – a situation that a number of state and local officials warned about months ago when the virus was still under control.
Nearly three months after state and local officials called for the Hawaii Department of Health to hire hundreds of additional public health contact tracers to help target and contain community spread of the COVID-19 virus, the state’s epidemiologist told a state Senate panel Thursday that the department still has only 105 contact tracers actively working.
And that isn’t enough, said State Epidemiologist Dr. Sarah Park.
To be effective at keeping cases confined to small clusters, contact tracers generally need to reach all potentially infected people within a day or two. Now, with the state facing a surge of more than 100 new cases a day, it takes three to four days for the workers to track down all of the people those infected with the virus have been in close contact with, Park said.
It’s exactly the situation that officials such as Honolulu Mayor Kirk Caldwell raised alarms about back in early May, when Hawaii was reporting only a few new cases per day and was preparing to reopen the economy.
At the time, officials such as Caldwell pointed to criteria published by the National Association of County and City Health Officials, saying the state needed to hire a small army of contact tracers to get ahead of a possible surge in cases that could happen once businesses started reopening and restrictions on gatherings relaxed.
According to those standards, a locale with a population the size of Hawaii would need about 420 contact tracers during a pandemic. Although Park pushed back at the time by saying the department could bring on trained contact tracers quickly if they were needed, advocates like Caldwell warned that if the department waited until there was a surge, it would be too late.
And that’s exactly what appears to have happened.
Hawaii House Speaker Scott Saiki said it was predictable.
“We said months ago that we needed to be prepared,” said Saiki, who co-chairs the House Select Committee on COVID-19 Economic and Financial Preparedness. “We knew there would be a surge some time over the summer, and we knew that we needed to be prepared.”
Contact tracing is essentially epidemiological detective work that entails a public health worker tracking down, usually by phone, all of the people who might have been exposed to an infectious person over a two-week period. The standard for a so-called close contact is someone who was within 6 feet of an infected person for at least 15 minutes.
The idea is that if close contacts can be tracked down quickly, they can be isolated into clusters and keep the disease from spreading widely in the community. Contact tracing is so central to Hawaii’s plan for responding to the virus – and to safely opening the economy and businesses — that it was designated one of four “pillars” of the state’s response plan, along with screening, testing and isolating those who were sick.
But during Thursday’s testimony before the Senate Special Committee on COVID-19, Park downplayed the importance of contact tracing, saying that some states no longer even do it. Park ultimately blamed the public for the surge in cases. She cited beach and house parties and other gatherings that people should have known not to engage in as causes for the surge in cases that quickly overwhelmed the system.
“What we could not have predicted, quite frankly, is how badly our community would behave,” she said.
After months of hearing health officials and others talk up the importance of contact tracing, some senators were taken aback by Park’s apparent change of position. Park at one point got into a heated discussion with Sen. Donna Mercado Kim, a former Hawaii Senate President and Honolulu City Councilwoman known for asking tough questions.
After Park accused Kim of mischaracterizing Park’s earlier remarks, Kim said she was merely holding Park accountable for earlier statements.
“We’re not saying and I have never believed that contact tracing is the panacea,” Kim said.
After the meeting, Sen. Donovan Dela Cruz said he was shocked by Park’s apparent backpedaling on contact tracing. He said that months ago, when some people were calling for more aggressive testing, health department officials were pointing to contact tracing as the key.
“When people were pushing testing, she said it was all about these other things,” Dela Cruz said.
He said that Park’s reactive response was “symptomatic” of the administration of Gov. David Ige, which he said does not act unless there is overwhelming public pressure.
While Park downplayed the importance of contact tracing, she did acknowledge that the surge in cases had pointed to the need for more contact tracers. And she noted some of the challenges that tracers face, chiefly that some people don’t want to share personal information with government officials because of the fear of a stigma or concern that a relative could suffer financially if forced to quarantine.
“We’re dealing with people,” she said. “We’re not dealing with robots.”
She also said contract tracers simply could not trace contacts of all the people infected at mass gatherings.
Park said the department has another 198 trained contact tracers who are not working and plans to bring on board 30 to 40 more contact tracers next week. She said the department lacks managerial capacity and physical space to bring them aboard faster.
While Park blamed the public for the disease’s surge, Saiki, the House Speaker, blamed the department for not sharing more information to let the public know how the disease was spreading.
On Thursday, he wrote a letter to Department of Health Director Bruce Anderson asking for information so the public could know what activities not to do. Saiki said the department could avoid violating privacy by not reporting names or other identifying information.
“The narrative could be very simple, e.g., the asymptomatic, unmasked individual attended a graduation party at Lanikai Beach on Memorial Day with approximately 25 other unmasked individuals, 12 of whom subsequently tested positive possibly as a result of attending the event,” Saiki wrote.
In an interview, Saiki reiterated that members of his committee had warned that the state needed more contact tracers. And he said the public has a right to know how the disease is spreading.
“The health department needs to be careful because at some point it will be responsible for creating this surge,” he said.
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