Tracing efforts fall on local officials
After state system stumbles, cities make their own plans
As apparent glitches delay full operation of the Lamont administration’s ambitious plan for a hightech, statewide contact tracing system, cities and towns are making tracing plans of their own to contain an anticipated increase in coronavirus infections as businesses and other institutions reopen through June and into summer.
Local health directors said last week they continue to have trouble mastering the software at the heart of the state system, designed as a front-line, epidemiological tool to isolate and contain new infections. There also are early reports as the system gears up that those infected by the virus and those who have been exposed are deleting automated alerts from mobile telephones, mistaking the health department messages as spam.
Hartford is putting together a contract tracing program of its own, recruiting medical school volunteers from UConn and applying for grant money. During a conference call late last week, health directors from about 40
Greater Hartford towns talked about creating a stop gap contact tracing system and staffing it with volunteers who could shift around the region should the need arise. New Haven already is operating its own contact tracing program, and Bridgeport is considering options.
Building enough capacity to identify the newly infected and reach out to those they’ve had contact with was one of Lamont’s six criteria for the first round of business reopenings on May 20. On May 18, Lamont declared the system was ready to go, but since then local health officials have voiced concerns.
Municipal and regional health directors always have been at the leading edge of any contact tracing program and several said they remain optimistic about the state’s effort — an enormous undertaking to design, in a matter of weeks, a state-of-the-art, viral-containment system covering nearly 4 million people.
But several health directors predicted the state Department of Public health may need weeks more to resolve problems with software operation and recruitment of volunteer contract tracers. As a result, they said, the system may not be fully operational for some time. More important, they said, is for the state to have an efficient system by autumn when many experts warn of a viral resurgence that, if not contained, could once again threaten hospital capacity and the economy.
“I think if the state wants to step back and try to fine tune its contact system so that it can be fully rolled out in the fall with vetted volunteers, that would be fine,” said Wendy Mis, Glastonbury’s health director. “What it doesn’t do is help address any cases that come up as the state reopens. As organizations are able to open, I think we are going to continue to see people being identified as positive, so we do need a stopgap in between. And whether it is an electronic platform that makes calls or whether it is a bunch of people with paper and pencil on the phone, we will need to do something.”
The state officials developing the program said they have made substantial progress. They said they have registered more than 600 contract tracers, and at the close of last week it was being used to trace hundreds of cases and contacts in 11 of the state’s approximately 65 health districts.
“We embrace the feedback on how we can enhance the training and add new features to make the system even easier to use,” said Av Harris, a spokesman for the state Department of Public Health. “Our team is also starting daily ‘office hours’ to answer questions from users and help accelerate adoption, and we are bringing in additional staff to answer questions more quickly.
Contact tracing programs are gearing up around the country as states emerge from self-isolation. It is the traditional method of fighting widespread infection through a comprehensive testing program followed by the rapid identification, containment and, ideally, elimination of new cases of infection as they emerge. What has changed with the coronavirus pandemic is the application of computer software to an old-school, epidemiological tool.
There has been debate elsewhere about intrusive tracing plans that use location technology to track patients. Some states are hiring consultants to recruit contact tracers and operate their programs.
Lamont has chosen what he has called an unintrusive and largely voluntary program. Volunteer tracers recruited from medical schools and guided by computer will contact those who test positive for COVID-19 as well as anyone with whom the infected patients had recent close contact. The infected person and the contacts will be asked to self-quarantine, a request that can be reinforced by the computer software through automated telephone messaging.
The software is Microsoft Corp.’s At Risk Investigation and Alerting System, or ARIAS. Positive test results from medical labs and health providers are entered into the state health department’s electronic disease surveillance system, a continuously updated data bank of reportable diseases such as COVID-19. The positive results transfer automatically to the ARIAS platform and are distributed to appropriate health directors.
Once alerted to a new infection, local health directors have the option of notifying a patient of a positive test result by personal telephone call or allowing ARIAS to send an automated message, according to Jennifer C. Kertanis, director of the 10town Farmington Valley Health District.
“Every local health department can make that determination,” she said. “Our cases get populated into the system, and if there is a phone number, we can make a call or we can trigger a text message.”
On a personal call, a contact tracer can learn from the patient about recent close contacts and follow up with those contacts. Alternatively, an automated call can ask the patient to reply with information about close contacts. Kertanis believes personal calls result in better results.
“I think the bottom line is the fist contact has to be a phone call,” she said. “You have to reach the person You have to explain what you are doing. You have to make that warm connection: ‘This is who we are. This is why we are asking you to do this. And by the way, there is this electronic system that could be helpful.’”
For the relatively small number of new positive cases to reach her office last week, Kertanis said she and two staff members she has working with her on contact tracing have been trying both personal calls and automated messaging — along with handwritten letters.
“Usually we trigger the text message if we can’t reach them by phone,” she said.
Harris said local health directors “will remain on the front lines” of contract tracing. They can recruit local volunteers if they choose and make personal calls rather than triggering automated messaging if they think it is more effective.
While using the automated ARIAS notification system, one health director reported receiving one reply from among about 20 text alerts over the first week of the system’s operation. The single reply acknowledged receipt of the text alert but included none of the requested information about contacts. When following up in person, the director was told that recipients were reflexively deleting messaging that identified the sender as “COVID-19 ARIAS.”
Bronin said Hartford’s plan to develop its own contract tracing was not the result of any delay in the state system, and whatever system the city creates will employ the ARIAS software.
“I think that in so many different areas of the pandemic response, fighting on multiple fronts is necessary and it is the right thing to do,” Bronin said. “So, as the state looks to expand testing, we are pushing hard to expand local testing initiatives here. As the state works to build a contract tracing platform, we are working hard to make sure we have people in place locally who are helping us to do the best that we can.”
New Haven has obtained software from a different development company for its contact tracing program and is using volunteers from the Yale School of Public Health, an institution from which the state hopes to recruit.