Amid surging COVID-19 cases in Hawaii, state health officials are struggling to reach people who have been in close contact with positive coronavirus cases and are urging the community to help curb the rapidly spreading virus by getting vaccinated.

For the past six months, Hawaii health officials have consistently contacted more than 80% of close contacts of known COVID-19 cases, reaching more than 90% in some weeks. But in the last week of July, that figure dropped to two-thirds.

Data from the first week of August is not yet published, but this week the state reported record high coronavirus cases driven largely by the highly contagious delta variant.

The swelling case numbers and community transmission mean that even though restaurants, bars and other establishments might be collecting names of patrons for contact tracing purposes, not every person who has been in close contact with a positive case is being notified.

“We do have to prioritize at this point,” Chantelle Matagi, who co-leads the Pacific Islander contact tracing team at the Health Department, said Friday during a press conference. “We are in a crisis mode.”

She said her team has been working overtime and she believes they still manage to reach out to contacts for an estimated 95% of cases each day.

Brooks Baehr, spokesman for the Department of Health, said the agency is prioritizing vulnerable populations in its outreach, including people who may have been exposed in schools and prisons.

He said the state is trying to ramp up its contact tracing staff but that can only do so much.

“No matter how many we add I don’t think it’s going to be enough to reach every close contact,” he said.

On Hawaii island, Jason Dela Cruz from the Hawaii island Office of Public Health Preparedness said they’ve enlisted community partners to help spread the word when they’re unable to reach everyone who may have been exposed to the virus. 

The delta variant — which is responsible for more than 80% of recent cases in Hawaii — is much easier to transmit than previous strains of the coronavirus.

More than 60% of the state has been vaccinated but people who are vaccinated can still transmit the variant, although they are far less likely to get hospitalized or die than unvaccinated people.

Health Department officials say they’ve continued to define a “close contact” as someone who is exposed to the virus for at least 15 minutes. Some scientists have argued that as little as one second exposure to the delta variant could lead to transmission, although other scientists dispute that.

The Health Department is still only contacting people who have been exposed for at least 15 minutes, but even then, there are so many people to call that sometimes contact tracers run out of hours in a day to reach everyone, Matagi said.

“It is an all-hands-on-deck type of situation,” she said. “I have many members (of my team) who are staying beyond their five o’clock time to make sure that those calls are being made.”

Staffing Changes

As of Friday, the DOH has 269 contact tracers at work, down from 299 earlier this week, Baehr said.

“There are 30 fewer contact tracers than we had earlier this week,” he said. “We are trying to ramp up. We do hope to add contact tracers.”

Matagi said many contact tracers are on scheduled vacations but some have been called back amid the surge. She said the National Guard is still assisting with outreach.

Over the past year, the Health Department’s staffing has been upended. Top leadership resigned and local politicians last year raised concerns about contact tracing staffing levels.

During last summer’s COVID-19 surge, the health department hired Emily Roberson to lead the contact tracing program. She revamped the program, particularly to more effectively reach Filipino and Pacific Islander communities who were disproportionately getting sick. But Roberson resigned in April.

Baehr said Friday that he did not know if anyone had actually replaced Roberson at the Health Department following her resignation. He noted that Sarah Kemble, acting state epidemiologist, who replaced former state epidemiologist Sarah Park, is ultimately in charge of contact tracing.

Kemble is among the employees on vacation this week. Baehr said that in her absence, Ann Buff, formerly of the Centers for Disease Control and Prevention, is filling in.

The Health Department is also facing a lawsuit after terminating virologist Jennifer Smith in May. Smith was a whistleblower who alerted public officials about overwhelmed staffers last year.

Get Vaccinated

Health officials repeatedly said Friday that contact tracing is just part of the answer to stopping rising cases. Baehr urged people to take personal responsibility and get vaccinated, noting the agency has hosted hundreds of vaccination events a month to increase access.

Janet Berreman, Kauai District Health Officer, said people who feel sick should get tested, stop going to work and stop socializing.

“I’ve heard people say, ‘well there are things going around.’ Yes, the thing that’s going around in our community is COVID,” she said. “And it’s the delta variant, and it’s very highly transmissible.”

In July, nearly half of those who couldn’t be reached by contact tracers in Honolulu didn’t answer their phones. Fifteen percent didn’t have a phone number, and state workers called the wrong number 22% of the time. Twelve percent refused to be interviewed.

State data shows that in February, March and June, more than a fifth of the people whom contact tracers failed to contact refused to be interviewed.

Matagi said one challenge to effective contact tracing is misinformation.

“People are misconstruing science with political agendas,” Matagi said. “This is not a political issue. This has to do with illness and diseases.”