Miami-Dade’s virus contact tracing still lags behind cases
Three weeks after committing $14 million for the Department of Health to boost the number of contact tracers for COVID-19 in Miami-Dade, the state has added 50 disease investigators to 300 already working to trace new infections in Florida’s hardest hit county.
Miami-Dade Mayor Carlos Gimenez, who signed an agreement with the health department on July 9 to hire many more — a total of 250 — said the process of adding staff has been slow. Applicants are hired by Maximus, a Virginia-based company that is contracting with the health department, and must pass state background checks.
“It’s going to take time for them to gear up and hire all 250 contact tracers that we’re paying for,” Giménez said Thursday in a video conference call.
But it’s unclear how effective contact tracing has been at containing local outbreaks, based on information from MiamiDade County that was gathered by the state. That information, provided to the Miami Herald, is aggregated data from a questionnaire starting July 6 about where a person was exposed to the coronavirus, such as the household, workplace or public transportation.
That information doesn’t include the kind of details that would allow public health experts to pinpoint places and events that led to infections. The county’s contract with the state — reached after two months of negotiation — calls for weekly reports to MiamiDade officials about the number of cases investigated, contacts of persons who tested positive and dethere mographic information.
This week, Miami
Beach’s mayor fired off a letter to the governor calling the local contact-tracing program “unprepared and understaffed.”
On Thursday, Gimenez downplayed the effectiveness of contact tracing amid Miami-Dade’s recent surge in cases, though he added that the health department has provided the county with some preliminary results from its contacttracing efforts.
“It appears that a good chunk of the people that are getting infected are getting infected at home,” Giménez said, echoing a statement he made on Tuesday that 30% of Miami-Dade’s COVID-19 infections were occurring within households.
When asked on the questionnaire to list their source of exposure to the coronavirus, 31.6% of respondents said “Don’t Know,” followed by infections in the household (30%) and the workplace (21%).
As of Thursday, just
2,943 people had answered the survey. Yet the health department reports that the county has nearly 116,000 cases of COVID-19, the most in the state. The county has averaged 2,883 new cases a day over the past two weeks, according to state numbers.
And deaths keep going up. On Thursday morning, the state reported 253 deaths, the highest in a single day, bringing the death toll for state residents to 6,586. Miami-Dade has had the most deaths in the state, with 1,515.
All of that makes contact tracing a critical concern. The state’s health department spokesman, Alberto Moscoso, confirmed in an email that there are “approximately 350 contact tracers” in Miami-Dade, with more to be added.
Moscoso said statewide are more than 4,400 workers tracing positive COVID-19 cases, including 1,800 contracted workers and 2,600 health department employees. He said the health department is able to shift contact tracers where they’re most needed, “ensuring that contact tracers are always assigned to communities experiencing the greatest need, including Miami-Dade County.”
In an effort to help identify and contain COVID-19 outbreaks, Miami-Dade recently created its own contact-tracing program that relies on people who have tested positive to volunteer information.
The Community Empowerment Program includes a survey about places the person visited in Miami-Dade and their use of public transportation in the weeks before they got their infection test results.
Jennifer Moon, deputy mayor who works on the county’s COVID response, said the county uses the voluntary surveys, plus data from local hospitals and health department maps and reports, to send extra help to areas that need it.
LOCAL LEADERS LEFT IN THE DARK
The dearth of data has frustrated local leaders who rely on the information to design emergency orders, including restrictions on restaurants and other businesses, in an attempt to contain the outbreak.
Miami-Dade mayors say they have received periodic updates from the health department on contact tracing — but not enough of it. In his July 27 letter to Gov. Ron DeSantis, Miami Beach Mayor Dan Gelber noted that contact tracers sometimes are reaching just 7% of people newly infected.
“It should surprise no one that the virus has spread so astonishingly in our county,” he wrote.
Gelber said local mayors have been briefed on the COVID-19 pandemic’s impact in Miami-Dade via video conference calls with the health department, and the calls have been taking place more often as new cases surged. But the health department does not distribute to the public all of the data its officials present to the mayors.
During one video call last week, Gelber said he took a screenshot of his computer to show 11 days of contacttracing data the state shared with the mayors.
The state’s chart shows the number of new COVID-19 cases, investigations closed or in progress, and the percentage of infected people reached from July 9-22.
From that information, Gelber concluded that contact tracers in Miami-Dade are reaching only a small fraction of those who test positive.
“When we came out of a shelter in place, had we been properly staffed with contact tracers, we would’ve fared much better than we have, which is horribly,” he said.
Gelber included the screenshot in his letter to DeSantis this week, and used the occasion to once again call for the state to pump more resources into contact tracing.
“Local mayors and commissions are being tasked with imposing the tough medicine needed to address this crisis [business closings, curfews, mask orders],” Gelber wrote in the letter. “Yet, ironically, the local municipalities or our county lack any health department as the county health officials actually only report to you and the state surgeon general.”
Miami Mayor Francis Suarez echoed the frustration, telling the Miami Herald that his interactions with local health department officials often yield more questions than answers. It took the mayors demanding a more sophisticated questionnaire to have contact tracers ask people where they work — something Suarez and Gelber believe the state’s health department should have been asking all along.
“We shouldn’t be struggling with developing metrics,” Suarez said Monday. “We shouldn’t be designing a contact-tracing program for the department of health.”
HOW EFFECTIVE IS CONTACT TRACING?
In the video press conference Thursday, MiamiDade’s mayor said the county is building its contact-tracing operation now for when the surge subsides.
“Contact tracing will be much more effective once we get the contagion down,” Gimenez said.
But public health experts say contact tracing is effective even in the face of a seemingly uncontrollable outbreak.
Ashish Jha, a physician and director of the Harvard Global Health Institute, said contact tracing is a useful way to start reducing new infections.
“Even if it knocks out 20% or 30% of transmissions because you catch enough people in that window — because even if you don’t get all of their contacts, you get some of their contacts — that still helps,” Jha said. “We shouldn’t look at contact tracing as an all or nothing. We should look at it as a tool in our toolbox and when you have a large problem and you can knock off 20% or 30% of it, that’s a good thing.”
Aileen Marty, an infectious disease specialist with Florida International University’s Wertheim College of Medicine, said effective questioning is part of what makes for successful contact tracing. Marty said she and other local public health experts have been helping the health department design better questionnaires.
“I can tell you that the Florida Department of Health folks here are doing the absolute best they can,” she said, calling the local efforts “undermanned.”
Marty said much of Florida’s and the nation’s contact tracing for COVID-19 has been hampered by insufficient testing and delayed results due to a rise in demand as the disease surged again.
She said she’s frustrated with the slow pace of Florida’s contact tracing, but said it’s expected.
“The bottom line is it takes time because we have a clunky system … background checks take time,” she said. “Yes, we’re behind the eight ball but we’ve been chasing this virus from the get-go in this country.”
The mayors said they’re able to help the health department — but they have to know what the agency needs. If contact tracers are struggling with getting people to cooperate, local governments can push out public service messages encouraging people to answer the phone and give honest responses.
“The two things the governor should do is get a management group of true experts who will demand all the bells and whistles of a top contact-tracing program and make sure there are enough people to carry it out,” Gelber said.