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From the archives 2020

How Pa. plans to keep track of the coronavirus after reopening to prevent another outbreak

by Aneri Pattani of Spotlight PA |

Brenda Carll, a retired public health nurse, fought for years against cuts to Pennsylvania's community health system by governors and legislators from both parties.
ROBERT FRANK / For the Inquirer

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HARRISBURG — One week after Gov. Tom Wolf said his administration was struggling to come up with a plan to increase its contact tracing capabilities to help prevent another coronavirus outbreak, officials with the Department of Health unveiled new steps they say will allow the state to safely reopen.

On Friday, as Wolf announced the first 24 counties that will reopen next week, state health officials said the plan will rely on a combination of partnerships with local hospital systems, voluntary tracking technology, and federal funding to hire additional staff.

They stopped short of specifying the number of individuals needed to complete this work and did not provide a timeline for the new hires. The plan also offered few details on how this critical work would be accomplished in populous regions, such as the southeast and southwest, when those areas move from the red closure phase of Wolf’s reopening plan to the less restrictive yellow phase.

“I don’t have a specific number we’re going to hire,” Secretary of Health Rachel Levine said at a news conference. “I’m sure we’ll need more people [to do contact tracing] as more and more counties go from red to yellow, and we’ll be hiring as necessary.”

“We’re going to take that on a county-by-county basis,” she added.

The announcement comes a week after a Spotlight PA special investigation found that governors and legislators of both political parties have for years treated the state’s team of contact tracing nurses as expendable, repeatedly cutting their budget and thinning their ranks, leaving only a skeleton force.

While there have been calls for the federal government to assist in creating a new national tracing force, it has so far left action to the states. As of last week, the state Department of Health employed 131 public health nurses, down from 177 nurses in 2012, which is as far back as the state’s online payroll data shows.

Officials said an additional 16 employees from the department’s epidemiology and hospital-acquired infection teams are assisting with tracing.

As of last week, there were 31 public health nurse vacancies. These nurses are responsible for overseeing 60% of the state’s population — or about one nurse for every 56,000 people — including rural areas and populous suburbs like Delaware County.

Only six counties and four cities have their own health departments and contact tracers. However, the state nurses can get called in to support those local health departments, too, as has been the case with Montgomery County, which has been overwhelmed by the coronavirus.

As the state begins reopening, the nurses will also reach out to people who have come in contact with infected individuals and inform them that they should quarantine as well, Levine said. Without this work, asymptomatic individuals could spread the virus to many more people, leading to another outbreak.

The state’s contact tracing system quickly became overwhelmed when the coronavirus first arrived in Pennsylvania. Nurses reported making hundreds of calls to infected individuals each day, without ever being able to catch up with the deluge of new cases.

It’s unclear if the plan announced Friday will provide sufficient staff to bolster the nurses’ ranks.

Public health experts say about 2,000 contact tracers are needed in Pennsylvania. Levine did not commit to hiring a particular number of people, instead saying, “We want to have a balance between getting all the people we need, but we want to be fiscally conscious as well.”

The health department has received a $18.7 million grant from the Centers for Disease Control and Prevention for COVID-19 response, “a portion” of which it said has been earmarked for contact tracing.

In the first counties to reopen, those in northwest and north-central Pennsylvania, the department said the existing public health nurses, along with the Erie County Health Department, will be able to handle contact tracing. No additional staff will be hired.

In the northeast, the state plans to partner with the Lehigh Valley Health Network and has also applied for a grant to hire 110 more tracers. In south-central Pennsylvania, 40 volunteers from the Penn State College of Medicine will assist.

In the populous southeast region, the department said it will recruit volunteers through PennServ/AmericCorps and ServPA, and will seek to work with local health leaders and universities. Similarly, it is seeking partnerships in the southwest.

Yet no details were announced on how many volunteers will be recruited in those regions or how soon — a question that could become critical as Wolf suggested counties in the southwest could be next to reopen.

For places prone to larger outbreaks — such as nursing homes, prisons, and food packing plants — the department said it has a special team of epidemiologists, masters and doctoral students of public health, and an advisor from the CDC.

Across the state, contact tracing efforts will be supplemented with technology, the department said.

Nurses will use a web-based tool to send out daily emails, texts, and phone calls to people who test positive for COVID-19 and those who are identified as their close contacts. This will allow the nurses to monitor both groups for symptoms and collect more detailed demographic data, as well as the number of asymptomatic and symptomatic cases per region.

The state is also looking into a voluntary, opt-in app that asks people to self-identify if they’ve tested positive, and then uses bluetooth technology to alert those who have been in close contact with them. The technology maintains the anonymity of all users, the state said. When fully developed, it will have the capability to alert exposed individuals with instructions such as self-quarantining, testing, and other next steps.

On Friday, Levine emphasized that the contact tracing plan may change as Pennsylvania’s reopening process continues.

“When we need to hire more people, we will hire them to make sure the case investigations and contact tracing moves forward,” she said. But “we’re going to be taking this in a very measured approach.”

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