Multnomah County audit finds COVID-19 contact tracing capacity overwhelmed

Multnomah County Auditor Jennifer McGuirk today released the results of her office’s audit of contact tracing, case investigation and service delivery to people who have contracted COVID-19. .

The audit examined the period from the start of the pandemic to February 2022.

Early in the pandemic, Multnomah County, like public health agencies across the country, aggressively pursued contract research as it has historically done with communicable diseases that afflict a much smaller percentage of population.

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But officials quickly recognized they would not be able to keep pace with COVID-19.

“The county’s COVID-19 contact tracing program failed to contact all people infected with COVID-19 and their close contacts, particularly when case numbers were high,” the audit found. “Contact tracing is less effective when a disease is widespread.”

And COVID, of course, has become very prevalent. Although the county never reached state-recommended staffing levels for contract tracers, the virus spread so quickly and widely in the community that the shortage likely didn’t make much of a difference.

“To be effective, contact tracing must be done quickly,” the audit found. “Due to the nature of the disease and the high number of cases, very few cases and contacts were traced quickly enough to disrupt transmission.”

With each outbreak of the virus, the county contacted a smaller percentage of those who contracted COVID-19 and, in accordance with state and federal guidelines, eventually phased out contact tracing.

Through January 2022, Multnomah County has had 70,000 positive COVID-19 test results. Of that number, county investigators interviewed about 30,000 people.

The audit noted that because the other 40,000 were not surveyed, they were less likely to receive the “wraparound” services provided by the county.

The county had money to help those unable to leave their homes or jobs: “up to a month’s assistance with groceries, utilities, and rent/mortgage” or, if needed, assistance to find a place to isolate themselves.

There were also technical issues, the auditors found. For example, county employees uploaded contact tracing data to a statewide database called ARIAS. But auditors found that neither they nor county officials could access this information.

“Therefore, we only had access to data collected from case investigation interviews of people with positive cases,” the auditors wrote. “We did not have access to data collected by contact tracers informing people of close contact exposure. Without this data, we don’t know how many public health people did or did not report an exposure. »

The county’s response suffered from other problems as well. For example, the county routinely told people with COVID-19 seeking services to call 211. But the 211 system would then direct callers to contact the COVID call center.

“Calling 211 seemed like an unnecessary step,” the listeners wrote. “This extra step may have contributed to caller fatigue and unnecessary complexity during an urgent and stressful time.”

The audit included seven recommendations for improvement, primarily focused on ensuring that contracts with service providers include transparency and accountability measures; that the county prepares to more effectively deploy in-house expertise in future emergencies; and that senior officials look back on the pandemic to learn lessons so the county can be better prepared for future events.

Multnomah County Chair Deborah Kafoury said in a written response to the audit that she agrees with the recommendations.

“We recognize our responsibility to the public and take an approach of continuous quality improvement,” Kafoury wrote.