In the middle of April, roughly three weeks into stay-at-home orders that eventually would nearly stop the spread of COVID-19 in Hawaii, public officials, economists and community leaders were identifying contact tracing as a key element in the state’s plan to contain the virus as the economy reopened.
“This contact tracing is really where the action is,” Hawaii Department of Health Director Bruce Anderson said at the time.
Now, nearly four months later, with the virus spreading out of control on Oahu, Anderson and State Epidemiologist Dr. Sarah Park are being increasingly criticized for failing to provide enough staffing to conduct the tracing necessary to quickly track down and isolate the people who had been close to those infected with the virus.
Late Monday, the union that represents the public health investigators joined a growing number of critics when it said it had filed a grievance on behalf of overwhelmed health department workers who have said there aren’t enough of them to do the job.
That complaint came after a surprise visit to the health department on Friday by Hawaii senators trying to fact check statements made the previous day by Park. During testimony before the Senate Special Committee on COVID-19, Park downplayed the importance of contact tracing as a cause of recent spreading and said the department has 105 active contact tracers and planning to bring on about 20 more.
Park and Anderson blame the recent surge in cases on the public and the fact that people have been attending large gatherings and engaging in other risky behavior.
But critics including lawmakers and health professionals are increasingly concerned that Park and Anderson — as well as Gov. David Ige — are dismissing the importance of contact tracers and haven’t acted as quickly as they should have — and said they would — to get that leg of the response effort solidly in place.
The workers union, for instance, disputed Park’s assertion that the department has 105 active contact tracers and said that fast tracing could have at least mitigated the spread.
“The issue of the DOH being unable to adequately contact trace is now abundantly clear after State Senators on the COVID-19 committee visited the DOH on Friday to find very few contact tracers,” a spokeswoman for the Hawaii Government Employees Association said in a statement.
“The steady surge in cases over the last couple of weeks may have been mitigated if the DOH had brought on additional staff more quickly,” the statement added.
Meanwhile, health department documents obtained by Civil Beat show that, at least between March and July, the laborious work of finding out who each infected person might have accidentally given the virus to through close contact fell onto a core group of just 15 investigators. Each of them on average had to contact more than 300 people.
According to one document, 10 of these had to reach more than 200 people in an attempt to confirm or rule out new cases – with one dealing with some 588 people. Meanwhile, the document shows a roster of another 34 people, each of whom dealt with few or no cases. In other words, while the core group of workers were overwhelmed, dozens were just sitting around.
Janice Okubo, a spokeswoman for the department, would not comment on the document but issued a statement attributed to Anderson. It said the department is addressing the concerns of the union grievance.
According to the statement, the department also accepted help from the Hawaii National Guard; months ago when it offered to help, the department initially rejected the offer.
“It is important to note the situation is very fluid,” the statement said. “As the numbers of cases have risen, the workload of our contact tracers has increased.”
“Additional space is being procured and equipped,” it said. “Any overtime is being compensated. We continue our efforts to move assets, improve processes, and respond effectively to this extraordinary circumstance.”
How many contact tracers Hawaii would ideally have isn’t clear. According to a paper by the Johns Hopkins University Center for Health Security, other communities have enlisted widely varying numbers of contact tracers — from 9,000 for the city of Wuhan, China, with a population of 11 million, to 190 for all of New Zealand. In Hawaii, some state and local officials have pointed to criteria published by the National Association of County and City Health Officials, which calls for 420 contact tracers during a pandemic for a population the size of Hawaii’s.
But what is apparent is that Hawaii doesn’t have enough. Park admitted that during her Senate testimony. While it ideally should take one to two days to track down the close contacts of a positive case, Park said it now takes the department three to four days.
Often lost amidst the current flap over contact tracers is what’s at stake for Hawaii. Sumner La Croix, a University of Hawaii economist whose work informed Hawaii’s strategy for reopening the economy, said the state could probably get control of the virus again if people generally stayed home and practiced social distancing – even without the extreme lockdown imposed in April.
If the state can’t get the virus under control, he said, there’s no way businesses will rebound.
“There is no trade-off between controlling the epidemic and restoring the economy,” La Croix said. “The two go hand in hand. The only way for Hawaii to have a strong economy is to control the epidemic.”
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