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As COVID cases skyrocket, State Department of Health is actually doing less to trace the spread

To reduce the spread of coronavirus in our state, the Inslee Administration set a goal of reaching 90 percent of people with a positive test within one day in order to begin gathering information about where the virus was contracted and who else may have been infected.

Now, the state’s most recent report on “Metrics for Case Investigation and Contact Tracing” is out and instead of reaching 90 percent of people within one day, the state is reaching only 6 percent. Six.

Worse, the Washington State Department of Health (DOH) is actually contacting fewer total people despite a dramatic increase in the number of cases.

At a time when the state should be increasing capacity and efforts to track the spread, its efforts have almost completely collapsed. The state is now essentially blind, substituting strict economic restrictions and airing scolding television commercials for effective public health strategy.

Knowing where and how coronavirus is spreading is key to reducing the risk in a targeted, and science-based way. As Amy Maxmen, senior reporter at the journal Nature noted recently, tracing is important because when there is an outbreak instead of government officials saying “let’s everybody shut down all businesses, shut down the schools, instead they’re able to really target their approach.”

The state’s contact tracing effort has two parts. First is simply contacting those who have received a positive test, called a “case investigation.” DOH notes, “When public health learns that someone has tested positive for COVID-19, an interviewer reaches out to talk to that person, usually by phone. This is known as a case investigation. When talking to the person who tested positive for COVID-19, interviewers work to determine their close contacts.”

After interviewing those with COVID, DOH then reaches out to anyone identified as being within close contact, to inform them of potential exposure. This is known as “contact tracing.”

The state has also announced the rollout of an app on smartphones that notifies people when they may have been exposed by someone nearby. The governor said, “Maybe it’s obvious, but we think an exposure notification tool that preserves our privacy is a great compliment to traditional contact tracing.”

As someone who has touted the power of smartphones and personal technology for improving environmental results, I think this is a positive development. The problem, however, is that the effectiveness of the app relies on DOH providing codes to those who’ve tested positive in a timely way. Unfortunately, the state is completely failing to achieve even minimal levels of success in that area.

Even when COVID rates were low, the state failed to come close to their case investigation target, reaching a high of only 65 percent of people testing positive within one day. Now, in the middle of a serious outbreak – when the state should be dramatically increasing its efforts – that number has plummeted to 6 percent.

The state’s report that includes this data says, without irony, “we expect to see improvement over time as we refine our processes for successfully contacting people.” Far from improving, the processes are completely failing.

The same is true of contact tracing. The state set a goal of reaching 80 percent of those exposed to the coronavirus within two days. It was having more success when the number of cases was low. Recently, however, it has also collapsed, falling from a high of 73 percent to only 19 percent in the most recent report.

The combination of these failures means DOH and the state have almost no useful information to track the spread of the illness. The state is only reaching six percent of those with COVID in a timely way. Then, they only reach 19 percent of people who have been exposed within a couple days.

This failure has more than a health impact. It means the state doesn’t have the necessary information to know how the illness is spreading and where to target economic restrictions. As a result, the only option to reduce contact among those with COVID is to cast a wide net, ensnaring many businesses and families at Thanksgiving and Christmas.

The excuse that will be offered is that the number of cases assigned to DOH increased rapidly, going from 485 for the week ending October 24 to 2,787 three weeks later. This is a poor excuse for several reasons.

First, DOH contacted 296 people who tested positive for the week of October 24. In mid-November, however, they contacted only 167 people. It isn’t merely that the percentage contacted is declining, the total number of people contacted is declining, even as the number of cases increases.

Second, it has been known for some time that another wave of COVID cases would occur. This was predictable and was, in fact, predicted. Yet, the state has not allocated or shifted the resources to deal with the increased case load. This is akin to failing to increase military spending during a war.

Further, this not due to a lack of resources. The overall state budget is on track to spend about 19 percent more this biennium than last and the most recent projections show the state will have a $1.8 billion reserve. The money is available. It is not being provided.

It is also clear that DOH management is not adjusting to the increased case load. What appears to be happening is that low staffing levels are causing the agency to contact as many people as they can once in 24 hours. When there were only 485 cases, DOH investigators could go through the list and then follow up with anyone they didn’t initially contact on that same day. The result of multiple contacts was a higher total contact rate.

Now, with so many cases, it appears the investigators are simply trying to call as many people as they can during the day. Because there are too many cases, they don’t even attempt to call many people. The report notes they only attempt to contact 11 percent of people in the first day. So, as COVID cases grow, and the need for case investigation increases, mismanagement of the limited resources the state is using to spend on COVID tracking means fewer total people are being reached.

The Inslee Administration’s failure to supply the necessary resources is being compounded by DOH’s failure to use those resources wisely.

It is true that part of the problem is that people who test positive don’t respond. This is where DOH Secretary Wiesman pointed the finger of blame. In a press conference on November 30, he said, “We need folks who are willing to answer phones and be able to, you know, return our calls.”

That, however, isn’t the issue. As noted above, DOH only attempts to reach 11 percent of people in the first day. Even if every single person responded, they would still fall far short of the 90 percent target.

Even though this is almost entirely a failure of state government, it is important to note that DOH interviewers “do not reveal the name of the person who tested positive for COVID-19 when speaking with close contacts.” I am as skeptical about government use of information as anyone, but I believe DOH is careful about this. Government can fail without being malicious.

A concern about anonymity, while understandable, shouldn’t prevent people from helping stop the spread of a serious illness. It is also important to note that people who have been exposed are not required to quarantine, so simply telling a DOH investigator that you were near someone doesn’t impose a burden on them.

Ultimately, until state government begins to take its responsibility to address the spread of COVID seriously, they will demand that everyone else pay the price for their failure. And, politicians and agency staff will continue to engage in finger-wagging lectures instead on focusing on their own irresponsible approach.

– Myers is Director, Center for the Environment, Washington Policy Center