Multnomah County COVID contact tracing could not keep up with pandemic surges, audit finds

Even on their peak days, Multnomah County COVID-19 tracers only contacted 80% of people who reported positive tests during the pandemic, according to a Multnomah County Auditor’s Office report released Wednesday. . Amid the biggest surges of the pandemic, only 10% of people who reported positive tests were contacted by tracers.

While state guidelines directed county tracers to contact each person who tested positive for COVID, the audit notes that contact tracing – the process of calling and interviewing all COVID-positive people to gather information about other people they might have infected – ultimately wasn’t realistic or perhaps even appropriate during spikes in cases throughout the pandemic. However, the audit concludes that the Multnomah County Public Health Department can learn from the research team’s challenges to better prepare for future emergencies.

“We encountered a myriad of unknowns as we crafted a response to this brand new, potentially deadly virus that has quickly become one of the most contagious infections ever known,” Multnomah County Chairperson Deborah Kafoury said. in a written response to the audit. “And since the COVID-19 pandemic is not over, our interventions continue to meet the growing needs of our community, with specific care for our marginalized populations.”

COVID contact tracing became a state requirement in May 2020 when Governor Kate Brown necessitated the establishment of a contact tracing team for individual counties to “reopen” or roll back initial pandemic restrictions such as physical distancing and non-essential business closures. Brown required each county to have 15 COVID tracers per 100,000 residents, which equates to 122 tracers in Multnomah County. In early June 2020, Multnomah County assembled a team of 63 tracers with the goal of reaching 122 by the end of the month. In reality, the team never reached its goal, peaking at just under 100 tracers in October 2020.

According to the audit, the number of reported COVID cases in the county “frequently exceeded” the capacity of the Multnomah County Public Health research team to conduct universal case investigations. During the pandemic surge in fall 2020, investigators were able to interview about half of the people who reported COVID cases. In the summer of 2021, when the delta variant propelled the pandemic to new highs, investigators called 20% of people with reported cases. Then, when the omicron surge surpassed all previous pandemic caseloads by the end of 2021, tracers only interviewed 10% of people who reported testing positive.

Of the 70,000 COVID cases reported in Multnomah County from early March 2020 through January 2022, the audit found that contact tracers called 30,000. The report identifies staffing, budget planning and general conditions of the pandemic as limitations of the contact tracing team.

While general pandemic conditions have strained everyone’s workforce, interviews with county employees revealed that limited human resources training on things like workplace culture, union stipulations and general expectations slowed down the integration process. Employees told listeners that it would be beneficial to establish off-the-shelf onboarding materials for quick hires in emergencies.

Planning for future needs has also proven difficult for the public health service during the pandemic. Believing that the availability of vaccines and more easily accessible testing would slow COVID cases, Multnomah County health officials requested a reduced budget for the contact tracing team for the 2021-2022 fiscal year. When the delta and omicron surges erased previous pandemic highs, the county didn’t have the budget to expand its team of investigators. However, it is unclear whether a larger team would have produced better plotting results.

As COVID variants became more contagious and spread rapidly, the effectiveness of contact tracing during the pandemic declined nationwide. Contact tracing requires people to call COVID-positive residents, ask them about their whereabouts, who they have been in contact with, and advise them on how to quarantine. It is a painstaking task with the aim of ensuring that anyone who may have been infected by the COVID-positive person self-quarantines in case they are also infected, thus limiting the spread of the virus. However, as each variant became more transmissible and symptoms only appeared after a person’s most contagious phase of infection, contact tracers were unable to keep up.

In January 2022, county health officials knew that the spread of COVID was far exceeding research efforts and decided to end individual tracking in favor of tracking large outbreaks, such as a cluster of cases at a facility. group care or a school. A month later, the CDC stopped recommending contact tracing for COVID entirely.

While contact tracing has become a less effective tool in combating the spread of COVID, the report says county tracers failing to call 40,000 COVID-positive residents represent another problem. Residents were connected to the county’s overall COVID services — like programs that helped those exposed to or infected with COVID get grocery deliveries or rental assistance — through those phone calls with contact tracers. Although someone could technically request assistance with groceries and rentals in their own name, the audit found that the resources were not widely advertised to the public.

Because the pandemic has clearly demonstrated the limitations of contact tracing, the audit focuses its recommendations on broader structural and process concerns that could apply to future emergency response.

The audit makes seven recommendations for improvement, such as establishing a process for redeploying workers from the county to higher-demand programs in emergencies and training community organizations that work with the county in the event of an emergency. urgency on county reporting requirements and expectations. All recommendations must be completed by July 1, 2023, with some recommendations due later this year.

In a written response to the audit, County Chairman Kafoury agreed with all of the recommendations and said the county has already begun the recommendation to provide education on county processes to partners, such as nonprofits. community-specific charities who have hosted vaccination events or provided other COVID-related resources. Throughout the pandemic, county health officials have commended the collaboration that has occurred in response to the emergency, but also stressed the need to maintain and solidify these partnerships to build a healthier system. solid overall. According to Kafoury, the county is hosting outreach events to train potential partners on how to use the county’s internal systems and develop a process to ensure community partners’ tax compliance with county and federal government funding.

The Multnomah County Public Health Department is also conducting a comprehensive ‘After Action Review’ – an in-depth report following a major response to an issue – which will further detail how pandemic-related struggles can be used to inform system improvements. county health. .