As the state is on the cusp of losing major coronavirus federal relief funding and support from the Hawaii National Guard, the Hawaii Department of Health is planning to reduce the size of the contact tracing team because of overstaffing, top officials said Wednesday.

Dr. Sarah Kemble, the acting state epidemiologist, acknowledged that there could be more COVID-19 cases related to the holiday season but said she anticipated cutting members of staff employed by the DOH Disease Investigation Branch dedicated to tracking new COVID-19 cases and clusters of infection.

Pile of computer keyboards in an empty Hawaii Convention Center ballroom next to a operational Department of Health contact tracing ballroom with staff. Governor Ige earlier held a press conference in this room.

The Hawaii Convention Center ballroom has been a contact tracing headquarters for the state health department.

Cory Lum/Civil Beat

Kemble said the decision was not related to the upcoming expiration date for relief funding but rather on what they have determined to be true staffing needs, along with Hawaii’s specific case rate. It’s still not clear how many positions will be eliminated.

“We’re in a very different place than we were back in the summer,” she said during a Zoom meeting on Wednesday. “We now have a much larger trained workforce that has done a first round of contact tracing and case investigation and know the drill. I believe the ability to scale rapidly is much better now.”

When asked which areas she thought were overstaffed, Kemble said the team dedicated to making the first calls to people who test positive for COVID-19 is currently larger than needed.

“We are concerned and watching the surging trends nationally, but Hawaii is actually doing pretty well right now and we also have to look at our own case rates when determining staffing needs and not purely be reactive to what’s happening on a national scale,” she said.  “We don’t want people to fill seats without work to do, so it’s important to balance, flexibly adapt to the current needs and anticipate what’s coming.”

It was an echo of the department’s messaging earlier this summer. Former health department officials were criticized and ousted for failing to bolster the state’s contact tracing abilities before a wave of cases occurred during July, August and September.

A whistleblower also came forward, complaining of unsustainable workloads. A new health director, Dr. Libby Char, was appointed not long after, and the branch conducted a reorganization of its contact tracing process under new leadership.

Kemble said the department is aiming for a more appropriate ratio of staff to case investigation needs.

The existing Disease Investigation Branch team has faced hurdles to contact all patients who test positive. The department will begin this week to provide more information on its website about its case investigation performance metrics. During the month of October, 578 people were not reached, many of whom either had an inaccurate or missing phone number on their laboratory test results, or never returned contact tracers’ phone calls.

Contact tracers have had difficulty reaching everyone who tests positive for COVID-19, according to DOH officials.

Department of Health

“I actually believe that once we get over that 100 case per day mark, the emphasis on the health department reaching every case is of diminishing returns,” Kemble said. “So at that point, that’s really where we go into mitigation mode, public communications and working through our providers so people know what to do. Then the role of the department is to know what outbreaks are occurring, and what can we learn from them so the next outbreak can be avoided.”

Health department spokesperson Brooks Baehr told Civil Beat this week that the Department of Health has spent or encumbered about 70% of the CARES funds that expire on Dec. 30.

“The Department anticipates the prudent use of a majority of the remaining funds,” he said. “Any remaining funds will go back to the State Department of Budget and Finance. It is our understanding those funds will be used to repay federal loans for unemployment insurance.”

Kemble said there are “ongoing funding support streams” that last through December 2022 that could be used to assist contact tracing efforts.

In an interview with Civil Beat on Wednesday, Sen. Brian Schatz said he estimated at least $50 million in funding provided by the federal Paycheck Protection Program and Health Care Enhancement Act was made available to the state to bolster contact tracing beyond 2020. Those funds do not expire at the end of the year.

Schatz wrote a letter to Gov. David Ige this week urging him and health department officials to explain what the plan is to continue disease response activity in the coming months.

Schatz told Civil Beat that he has not yet received an official response to his questions about the staffing reduction size and what funding sources has DOH already used for the contact tracing program.

“The state’s inability to stand up and continue contact tracing has been a perennial thorn in our side when it comes to fighting COVID-19, so it’s time for them to figure this out and tell the public how they’re going to continue contact tracing in the new year,” he told Civil Beat.

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