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In one of her first moves as the newly appointed public health director, Dr. Terry Cullen developed the expanded contact tracing plan as a way to continue minimizing the spread of coronavirus throughout the county. The plan, which included requests for an increase in workers and resources, were approved by County Administrator Chuck Huckelberry last week. Proposal requests will be issued to local organizations to help fill these needs.

The cost of the expanded contact tracing effort is expected to be reimbursed through federal emergency COVID-19 funding, Huckelberry said.

“It’s clear from many different public health experts, including the CDC, that contact tracing is a critical part of trying to stop the pandemic and stop the spread of the disease,� Cullen said. “The county has done a very good job with this so far. But we recognize that we need to increase our level of effort.�

Before the pandemic began, the Health Department’s investigation team was made up of six epidemiology staff members.

Once COVID-19 presented itself in Pima County, the department assigned 17 additional staff members to the effort and enlisted the help of 11 retired health-care volunteers and students from the University of ÃÛèÖÖ±²¥, which equates to the work of 24 full-time employees.

“Our increased staff is currently unable to meet the increased CDI needs of COVID-19 in a timely manner. Our goal is to significantly expand our ability to achieve timely and effective contact tracing to ensure the goal of the current pandemic,� Cullen wrote in the plan. “To meet this goal ... we have estimated the overall need for 16 ‘managers’ and 140 contact tracers for a 6 month period.�

According to Cullen, 29 of these positions will be filled by department staff and volunteers. To find out just how many more people and resources they needed to track the virus, the Pima County Health Department used a workforce calculator developed by public health experts at Johns Hopkins through the Resolve to Save Lives Initiative.

With the current number of contact tracers, Cullen said the department is able to initiate case reports for 68% of cases within a 2 day period. By increasing staff, they aim to conduct initial interviews with 80% of cases within 48 hours of receiving the positive report. In addition, they hope to be able to identify and notify contacts of exposure and test at least 75% of symptomatic contacts within 48 hours.

In addition to an increase in staff, the plan also includes improvements in protocols and will require contact tracers to take up to 20 hours of training, where they will learn to ask more in-depth questions when conducting their interviews.

The plan also addresses the unique needs of long-term care facilities and other congregate settings, who have been the most impacted by the virus in Pima County.

“We’ve got to ask more probing questions than we have been,� said Dr. Bob England, acting Pima County health director, in a public health update. “We’ve got to identify clusters of cases quicker so that we can intervene more efficiently in workplace outbreaks or congregate setting outbreaks.�

Cullen said she also wants this plan to focus heavily on data and transparency and is hoping to be able to develop a metric that will show how many of the positive cases have been contacted daily.

“I come from a big data background and we’re going to figure out what data would be helpful to people and get on some type of routine with that,� she said.

Even with an expanded plan, there are still a number of challenges when it comes to contact tracing, according to England and Cullen.

By the time Pima County receives the report from a provider or facility, the contact tracer has to reach out to those places to obtain the patient’s phone number and other identifying information if not already provided. Then, the contact tracer has to actually get a hold of the patient, which provides a challenge on its own.

“We need people that have been identified as potential contacts to understand that our discussions with them are really to help assess for them, whether they’re personally at risk, if they have any signs of that disease and if they need a referral pattern to get tested. But it’s also the educational part and letting them know what those symptoms are and what we need them to watch for. And ideally, we would check in on every person, every day for 14 days.�

Cullen said this really depends on people actually picking up the phone or responding to mailed letters. To help with this effort, a number of investigators will also be assigned to make house visits when they aren’t able to reach someone by phone.

Delays in testing still remain a significant challenge for contact tracing efforts as well. Cullen said the Health Department is continuously looking for ways to improve that process.

“This isn’t going to be perfect,� England said. “You just got to expect there’s going to be leaking around the edges no matter how well we do this and how hard we try.�