Hard-hit Maricopa County isnt following CDC guidelines for COVID-19 contact tracing – AZCentral

Numerous positive cases in Maricopa County do not get a phone call from public health employees. As of Friday, Maricopa County had 39,626 known cases, per state data. More than one-third of all the countys cases have been reported in the last week.
In a case examination, public health personnel reach out to a patient to assist them remember everyone they have been in close contact with. Public health workers would then start contact tracing by reaching out to these contacts who were exposed to the positive case.

Maricopa County public health authorities arent conducting case examinations or contact tracing that fulfill federal guidelines, as cases in the county and state continue to increase and Arizona becomes a brand-new national hotspot..
The countys efforts to track cases count on text messaging rather than direct phone calls for positive individuals. Those who evaluate positive and receive a text are then asked to submit a form that asks to recall anybody they were in contact with rather than the county carrying out a live interview.
Only about 20% of case investigations are being completed through this process, officials confirm. Those who do not fill out the kind get a telephone call from a private investigator to finish the examination and identify contacts.
The pared-down process has drawn criticism from U.S. Rep. Greg Stanton, D-Ariz., who said it leaves individuals vulnerable. He questions why more federal cash provided to the county for responding to the pandemic wasnt committed to tracing efforts early on, prior to the significant spike hit.
” The County squandered this valuable time,” Stanton wrote. “It acted gradually and just started to prepare in early May– and for a level of personnel that was far listed below what specialists forecasted would be required to secure a population the size of Maricopa County.”.
County health authorities, who now are handling one of the greatest case spikes in the U.S., said they are prioritizing older and high-risk people with direct contacts and ensuring all positive cases are alerted so they can begin notifying people they might have been around.
When a person in Maricopa County checks favorable for, they receive an automatic text message from public health officials asking to submit a type.
” Maricopa County Public Health just recently discovered that a person with this telephone number checked favorable for,” the text reads. “Public Health will be calling you if you are at high threat for severe illness from or if you live/work in a high risk setting.”.
Positive people, a number of them sick with the illness, are asked to fill out a form that details their living scenario, if they work or live in congregate settings, if they have signs, if theyve been hospitalized, or if they have underlying conditions..
Theyre also asked to enter info for their close contacts, described on the type as anyone they have actually been within 6 feet of for longer than 10 minutes during the time they were infectious, that includes the two days prior to they developed any signs.
With this contact details, public health will then connect to these close contacts and offer info.
” Please consider providing the names and phone numbers of your close contacts for this function only,” the kind says.
Numerous positive cases in Maricopa County do not get a phone call from public health workers. Neither do most close contacts of these favorable cases. The county stated it makes calls to just high-risk and older people who evaluate favorable..
Only about 20% of positive cases in fact complete the texted type, the county confirmed Friday..
” Its better than nothing, but I believe that its far from perfect,” stated Stephen Kissler, a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health, of the countys contact tracing technique.
The method the county is running isnot precisely how case investigations and contact tracing are expected to work, according to guidelines from the U.S. Centers for Disease Control and Prevention and public health professionals.
In a typical circumstance for an infectious disease, the favorable case and all of their close contacts would get telephone call from public health employees. The very first call to a positive case can be lengthy, as they resolve the places theyve gone and the individuals theyve seen. Contacts would be aware that they had been around a positive case..
Contact tracing is viewed as an important part of slowing the spread of the disease. They can stay home and prevent spreading out to others if contacts of positive cases are notified rapidly that they have been exposed. In some Arizona counties, this traditional practice seems happening.
Maricopa County intended to conduct fuller case investigations and contact tracing– county public health officials have actually stated as much over the past few months. However their operation has actually not satisfied CDC standards for full contact tracingfor months, even when the variety of cases was much lower than it is now..
County authorities stated they were prepared to examine about 500 cases per day. The last couple of weeks have actually frequently seen more than 1,000 or even 2,000 new cases per day in the county.
Since Friday, Maricopa County had 39,626 recognized cases, per state data. Recognized cases have actually increased by about 300% considering that June 1. More than one-third of all the countys cases have actually been reported in the recently.
The countys examinations and contact tracing procedure drew a strong reaction from U.S. Rep. Greg Stanton, who wrote a scathing letter to the Maricopa County Board of Supervisors detailing the various methods the countys practices are falling short.
” The circumstance is a disaster. It is costing lives. It is untenable,” Stanton composed.
County representative Fields Moseley said in an e-mail to The Arizona Republic that the board of managers “values the congressman sharing his viewpoint about Public Health operations.”.
” Our Department of Public Health is dealing with the illness spread in real-time and making pragmatic decisions based on the ever-expanding body of knowledge about this new infection and the surge of brand-new regional cases,” Moseley stated..
What CDC recommends for examinations and tracing.
The CDC outlines how case examinations and contact tracing need to work. In a case examination, public health staff connect to a patient to help them remember everyone they have actually been in close contact with. Public health workers would then start contact tracing by connecting to these contacts who were exposed to the favorable case.
This must be done “as rapidly and sensitively as possible,” the CDC states. Contacts are just told they have been exposed to a positive case, not who the case is.
Contacts must be offered “education, assistance and info to understand their danger.” They should be notified on how to keep an eye on for symptoms and encouraged to stay at home and preserve social distancing for 14 days after direct exposure to the favorable case, the CDC says.
” To the degree possible, public health personnel should sign in with contacts to ensure they are self-monitoring and have not established symptoms,” the CDC states.
On a Maricopa County site where positive cases are directed, the county states people will get a call “within a few days” of sending the type to follow up on responses and get more information.
But the county validated Friday that only high-risk individuals and those over age 65 are presently getting call.
Details of what the county does now.
When positive tests results come in to the county, every case is sent out a text message from the public health department inquiring to complete a survey. Favorable cases quickly get an automatic phone call.
Everybody older than 65 is called directly by a public health private investigator, according to Sonia Singh, county health department spokeswoman. Others only get the text message, she said.
Public health staff members examine the studies and if any cases are high-risk, such as people who reside in a congregate setting, they are straight called by a case private investigator, Singh said. The others do not get a telephone call..
The study asks cases to note close contacts and their contact number. Those contacts are then gotten in touch with to enroll in the Sara Alert System, a public health app where people can keep an eye on their symptoms and public health will be informed if they establish COVID-like signs..
Contacts and cases are likewise given a contact number they can call if they need resources to self-isolate..
” This process allow( s) for low risk individuals to be tracked in the system quickly and efficiently and enable Public Health to prioritize those who have the greatest threat of serious illness and those who position the most risk of infect public health,” Singh said..
Singh stated the text system was presented in late May and because more cases have actually remained in younger age groups, theyve been more responsive to texts than calls, she stated..
” Only really just recently did we include an option for cases to choose out of a phone call and after that began prioritizing high risk individuals for a follow up telephone call,” Singh stated..
Couple of individuals really respond to the study and supply public health the information it requires to map the disease and understand its spread..
Singh said more than 20,000 people have gotten a text with the study. More than 35% of people open the questionnaire, and almost 20% complete it, Singh stated. A case examination via text and contact details is collected for less than one in five cases..
Singh added that in addition to the texting process, people who dont complete the survey get a phone call from a private investigator to complete the examination and determine their close contacts. Its unclear how quickly that call takes place.
County prepared to do more, however didnt.
Besides in the earliest weeks of the pandemic, Maricopa County has actually never ever been at the point of performing case examinations and contact tracing to CDC requirements..
On April 23, when Arizonas stay-at-home order remained in place, Maricopa County guaranteed the public it was increase its contact tracing efforts to be able to perform complete standard case examinations and contact tracing for each single favorable case and their contacts. The county prepared to call all those individuals..
The county revealed it would expand capacity by up to 10 times its then existing staff of 25 illness private investigators. Authorities stated details were still in the works..
Part of the point of the stay-at-home order was to purchase time to expand capability and prepare things like contact tracing so the general public health system would be prepared for a prospective rise of cases.
Maricopa County discussed in late April that it had been carrying out “case-mediated contact tracing,” a less intensive form of the public health practice. Other than early on in the pandemic, when case numbers were reasonably low, the county had not been calling each and every contact..
Instead, public health workers talked to each case and after that asked the case to connect to their contacts themselves and offer info on prospective direct exposure and symptoms to expect. Public health did not call the cases contacts, as standard contact tracing requires..
The county was scaling up employees so that it could go back to “standard contact tracing investigations,” Dr. Rebecca Sunenshine, medical director of disease control for the Maricopa County Department of Public Health, stated at the time. Some financing for that would be from CARES Act dollars, she said..
” Right now, what we wish to do to have more total surveillance of the disease in our neighborhood is we personnel up, we put this strategy in location and we will have more people so we go back to straight calling everyone who is a possible contact,” county spokesperson Fields Moseley stated in late April. “So more comprehensive contact tracing.”.
But that appears to never ever have actually taken place. Rather, case numbers ended up being overwhelming and the practice devolved even more, so that numerous cases never ever even received that preliminary call from public health, not to mention any public health workers connecting to the contacts..
” Investigators are part public health, part detective and part social worker attempting to establish connection with this person that theyve never ever met, and trust, and at the very same time attempting to cover as much info as possible without judgment,” Sunenshine stated in late April..
Sunenshine said in late April that interviews might take between one and three hours. Now, unless a person is thought about high-risk, interviews are by and large not taking location at all..
Stanton: County has no extensive strategy.
The method the county has conducted contact tracing since late March breaks core CDC principles for this procedure, Stanton wrote to the county supervisors Thursday.
” More unpleasant is that County public health officials have no plan to completely contact trace all positive case, and do not yet know what it would require to put the nations fourth-largest county in a position to do so,” Stanton composed.
Stanton concerns why the county wasnt prepared to appropriately trace more cases, how officials are using funding from the federal government and why the county hasnt been forthcoming on its absence of readiness.
The county was given $399 million from the federal government as part of the CARES Act to cover expenses associated with the pandemic. A news release from the county shows $175 million was set aside for “future needs.”.
And $93 million approached the response to the health emergency, with $25 million for testing, $15 million for ” improved contact tracing and disease investigation,” $ 10 million for personal protective equipment and $ 5 million for long-term care centers.
Other funds went to supplying help to individuals and families, like rental programs and helping people who are homeless. Some went to helping little organisations, while some also went to upgrades to spaces to make them more secure, like handwashing stations.
Stanton stated the county spent $15 million, less than 4% of what it got through CARES, on case examinations and contact tracing, while a bigger piece of cash, $25 million went to balance out paid-time off for county staff members.
He shared price quotes from health companies that state the county should have more than 1,000 contact tracers, perhaps as numerous as 8,500, in order to effectively do the job.
The Sara Alert system, he wrote, is helpful, and other public health agencies utilize it as a supplement to assist contacts and patients track symptoms after theyve already spoken to public health employees.
Marcy Flanagan, the countys public health director, told Stantons workplace that she approximated the number of required contact tracers based upon approximately 200 cases each day during the stay-at-home order..
Basically, Stanton concluded, the county lost time during the stay-at-home order by not adequately preparing for its response when cases would increase. Flanagan informed Stantons workplace that the county began in early May, well into the stay-at-home order, to get ready for about 500 cases each day.
” This is an exceptional breach of the general public trust,” the congressman said.
The county has actually stated multiple times that it has a partnership with Arizona State University to assist with contact tracing. Flanagan informed Stantons workplace that more than 200 volunteers were contact tracing for the county as part of that collaboration, the letter says.
But, he composed in the letter, ASU told his workplace they do not have a contact with the county since Thursday, and ASU is refraining from doing contact tracing.
On Thursday, ASU professor Megan Jehn, who is dealing with the collaboration efforts with the county, told The Republicvia an emailed statement that the university is supporting the county with case examinations, but not call tracing.
The university is also helping the county with a big serological study effort and hotspot examinations, Jehn said..
” We are in the procedure of standing up a big case investigation group (mainly worldwide health, nursing and social work students) to provide surge assistance for the county. We anticipate that this will be a sustained and really large effort,” she stated..
ASU spokesman Joseph Caspermeyer said the university has been in “current discussions” with the county public health department about supporting a range of efforts, consisting of case examinations, screening, social support services, modeling and hotspot investigations.
” We expect a continual and extremely large effort,” he said. “Case investigations will start on Monday, June 29; increase to the countys asked for volume of 700 case examinations each week by mid-September.”.
Stanton called on the managers to put more cash toward case investigation and contact tracing. He said the county should create an immediate plan to trace every case.

Why isnt more being done?.
Flanagan protected the countys current contact tracing system at a Wednesday press briefing.
She said in May, the county had the ability to get in touch with 200 brand-new cases each day, but with additional staff, that capacity rose to approximately 500 new cases every day by June 10..
The county has actually frequently recorded 1,000 or 2,000 new cases in a day because then– certainly surpassing that contact tracing capability..
Flanagan explained that other than for the 5 to 7% of cases for which they never find contact details, the county makes contact with every person who tests positive. By and big, thats through a text message and most people do not in fact talk to a case detective or public health worker..
” We are connecting to each and every single favorable case that we have contact details for within 12 to 24 hours people getting that test outcome,” Flanagan stated Wednesday..
But the county is not “reaching out” in the standard sense of a through case investigation and contact trace where an experienced public health professional walks through all the details of a case and tells contacts all they require to know. Addressing concerns is a crucial part of that, needing a two-way discussion..
Kissler, the Harvard teacher, said its simpler to change individualss behavior and share details when individuals are called individually by a tracer rather of simply sent info..
He acknowledged, what the county is doing may be all thats possible at this time due to the fact that tracing is so resource-intensive.
One of the hopes was that, with physical distancing, the numbers of cases would be brought down to more manageable levels for contact tracing, he said..
” And we never truly reached that point, regrettably. I think that were kind of left with some of these stop-gap services in terms of contact tracing,” Kissler said..
Moseley stated the text and automated phone call system was implemented to adjust to younger demographics. Contacts will soon likewise be getting a call and text..
” Part of CDC finest practices is automating and digitizing the tracing process to reach thousands of cases more effectively and for the majority of cases, texting is their favored method of communication,” Moseley stated..
” The examination team is working 7 days a week and need to be sustained for a minimum of the next year,” Moseley stated. “It is essential to train a team constructed for sustainability which is precisely the method we are taking.”.
Reach press reporter Rachel Leingang by e-mail at or by phone at 602-444-8157, or discover her on Twitter and Facebook.
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