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As Alaska cases of COVID-19 go up, so does demand for contact tracing

Anchorage School District nurse Bethany Zimpelman works in a borrowed office in the Municipality of Anchorage public health department building in April. She was on the COVID-19 contact investigations and monitoring team, which was made up of nurses from the municipality and the Anchorage School District. (Loren Holmes / ADN)

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As COVID-19 cases rise in Alaska, the state’s network of contact tracers are busy and public health officials are trying to bring on a crop of new epidemiology detectives.

“We do feel like we are nearing, if not at our capacity right now,” said Tari O’Connor, deputy director at Alaska’s Division of Public Health.

That’s based on what she’s heard from staff, though it’s hard to say exactly. The division is trying to stretch its current staff and is bringing in a large group of new contact tracers currently being hired and trained through a partnership with the University of Alaska Anchorage, O’Connor said.

An official with the Anchorage health department also described the city’s contact tracing capacity as “close to the max,” but said it is working with the state to build its capacity.

Alaska had 267 active cases of the virus on Saturday, according to state data, which the highest number of cases to date.

Investigating a COVID-19 case is detailed. Not only do people who test positive need monitoring, but so do all of their close contacts, with daily phone calls to ask about symptoms and whether they’re still quarantining.

Before the pandemic, a group of public health nurses and people from the Anchorage Health Department comprised the state’s 70 contract tracers, O’Connor said.

Since then, the state has expanded the workforce to 130 by hiring more people at the state and working with partners like the Maniilaq Association and the North Slope Borough, she said.

In Anchorage, the health department incorporated school nurses as contact tracers, and the state is also onboarding a group of school nurses from the Kenai Peninsula Borough School District, O’Connor said. Recently, the state began enlisting help from members of the Alaska National Guard, she said.

How long the state can maintain its tracing capacity depends on how many cases there are and how many people workers need to contact.

“I can’t say like, ‘We have this number and we can only handle that number,' ” O’Connor said. “Those numbers are too squishy to be able to say that, but in terms of the feedback I hear from staff, it seems like we could certainly use the additional capacity right now.”

Originally, O’Connor said the goal was to have more people on board by the end of last month. But things are somewhat behind schedule as they roll out a new contact tracking application and train new tracers. That’s part of the reason they brought in members of the National Guard, she said.

The state is still contacting nearly all of the people who test positive for the illness within two hours of their result, O’Connor said. And she’s not aware of anyone who hasn’t been contacted.

As of last week, 385 people had registered for an online contact tracing program run by the University of Alaska College of Health, said Gloria Burnett, director of the Area Health Education Center.

The goal is to have 500 people ready by the end of June, Burnett said, to work on behalf of the state.

“We’re trying to get them through these trainings quickly so that we could deploy them as needed by the state because it’s sounding like that’s going to happen sooner rather than later.”

Members of the National Guard, school nurses and people recently hired by the state will also go through the training, she said. All contact tracing is done through the state health department’s Division of Public Health, she said.

The newly trained tracers will work on behalf of the state, but technically for the university because it received funds to hire the new team, Burnett said. They’ll be paid at an hourly rate based on past experience and how they do throughout the course, and receive a $100 stipend for completing it successfully.

The group will go through a training and hiring process first. And then they’ll be on standby, Burnett said. At weekly check-ins with the state, she’ll find out who is needed and where.

The new workforce through UAA will work remotely, she said but they’ll still consider the location of the tracers if they do get called up.

“No one knows that community better than people that live in it and no one is going to get people from that community to speak to them better than people within it,” Burnett said.

With the prospect of hundreds more tracers, the state is trying to build up an infrastructure that can accommodate the large group, O’Connor said — through a more coordinated system for tracking cases statewide.

It’s hard to estimate exactly what the state’s capacity is for contact tracing right now given their current system, O’Connor said. She said the estimate they have currently is 10 - 15 cases and or contacts per staff member, but the new tracking system will help give a more accurate picture.

They’re implementing an app purchased by the state called CommCare, which will help to manage information around all of the contacts and cases, O’Connor said.

The Anchorage Health Department was monitoring close to 400 cases and contacts on Friday, which means they were “pretty close to what would be considered our capacity,” said department director Natasha Pineda.

“We’re pretty close to a max but we are working to build more capacity and the state is working to bring on some tools and more support,” Pineda said. “So we’re hoping this is a temporary period.”

The job of effectively monitoring is a “a tremendous amount of work going on day and night,” said Dr. Bruce Chandler, the department’s chief medical officer.

“It’s taking a toll on the psyche of many of the people who are doing it,” he said.

The southern Kenai Peninsula had seen 72 cases of the virus by Wednesday, according Lorne Carroll, public health nurse III at the Homer Public Health Center which serves the southern part of the peninsula.

Among the four staff members, three are public health nurses. When they get notified of a new positive, the goal is to begin the case investigation within a half an hour. The initial phone call can take up to two and a half hours.

“It doesn’t take too many cases to overwhelm that one little piece of public health nursing service delivery,” he said.

But so far, things are going well. Carroll said they’ve coordinated with tracers from all over Alaska and worked locally in order to conduct swift tracing.

There’s serious coordination among the different public health nurses.

“So Fairbanks, they could call us up anytime and say, ‘Hey, we’ve got a case and we can’t really get started within 30 minutes because we’re overwhelmed. Can you help us?' ”

And then nurses in the southern Kenai Peninsula would help out.

In order to track cases, Carroll said they’re using a secure and central spreadsheet tool. CommCare will help keep track of that information, and relieve some of the steps needed to be completed by hand, he said.

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