Nearly four months into the COVID-19 pandemic, city and county health departments in Missouri are working to expand contact tracing plans. But some say they’re still getting no direction or direct funding from the state.


Gov. Mike Parson has declared that increased testing will help Missouri’s economy recover. But without statewide plans for contact tracing, some counties wonder if they’ll be able to keep up with monitoring cases over the next few months.


The state "will be" using federal funds to develop an approach to contact tracing, according to Lisa Cox, spokesperson for the Department of Health and Senior Services.


No funds have been spent yet, she said. Local counties can also use federal CARES Act money to fund their contact tracing efforts, she said.


Randall Williams, director of the Missouri Department of Health and Senior Services, said in early June that the state was working on a contact tracing plan.


CONTACT TRACING EFFORTS


Contact tracing is a labor-intensive tool used by public health departments to prevent the spread of infectious diseases like COVID-19. It requires workers to interview people who test positive, track down people they may have had contact with and ask them to self-quarantine.


As stay-at-home orders are lifted, contact tracing gets harder.


For most of Missouri, stay-at-home orders expired in early May. Now, anyone who tests positive for COVID-19 will likely have significantly more contacts. This means health departments are going from contacting two or three additional people per case to many more, said Stephanie Browning, the public health director for Columbia and Boone County.


The amount of contacts can vary, Browning said. Some cases can have none and others can have as many as 50.


Browning said she’s been told throughout the past few months that the state was going to provide assistance for contact tracing. She said she was told the state would either offer funding to hire new workers or hire a team of people at the state level that could assist in areas with fewer case investigators.


"We were told that help was coming," Browning said.


Meanwhile, Missouri is seeing repeated new highs in single-day case counts. From Sunday through Friday, the health department reported 2,569 new infections, just 102 fewer than the entire previous week.


Over the past three weeks, 1,510 new cases have been reported in five local health jurisdictions in southwest Missouri, and the state is using a "box-in" strategy to curb the outbreak in McDonald, Jasper, Newton and Barry counties, according to a news release from the Department of Health and Senior Services.


The state is providing contact tracing support for the public health agencies in those counties, according to the release.


The Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials estimates that to reopen communities at least 100,000 contact tracers nationwide are needed to rapidly identify, contain, support and re-test individuals who are infected or have been exposed.


Missouri, with a population of just over six million, needs 1,870 contact tracers to have enough to contain the virus, according to their estimates.


It is unclear how many people are currently working as contact tracers in Missouri. But multiple public health departments said they’ve shifted staff previously in other positions to contact tracing roles.


’SEVEN DAYS A WEEK’


Saline County, with an estimated population of just over 22,700, saw a large spike in cases in late April and early May, going from 55 on April 22 to 256 a month later, making it a hotspot in Missouri compared to surrounding counties. At the end of May, 1.2 percent of the county’s population had been infected, the highest in the state at the time.


Since the end of May, Saline County has seen just 25 additional cases. The county’s public health department reported 292 confirmed cases and four deaths as of July 1.


The Saline County Health Department had three nurses on staff to reach all positive cases and whoever they may have been in contact with.


The nurses worked throughout April and May to keep up with the caseload, said Elizabeth Frerking and Karla Link, who are both public health nurses for the Saline County Health Department.


During that time, the nurses were receiving 20 to 25 cases a day. Each call took about 15 minutes, depending on who they needed to contact. They were busy and needed help.


"We were able to do all of it, but we worked seven days a week," Frerking said.


The clinic that provides immunizations, other tests and public health services was effectively shut down because the nurses could only focus on contact tracing.


As communicable disease nurses for the department, Frerking and Link both said it was helpful that they already understood how to do contact tracing.


"We couldn't have handled much more," Frerking said.


The department didn’t receive any funds from the state to help with contact tracing, even with the added stress of the amount of cases in their county.


Neighboring Benton County was able to send a few nurses twice a week to help them follow up with people already quarantining.


OTHER STATES SCALE UP


Over the last decade, local public health departments across the country have lost an estimated 56,000 staff jobs due to funding issues, according to a report from Trust for America’s Health, a nonprofit public health policy, research and advocacy organization.


"Everybody has been doing COVID-19 response in our office, no matter their position," said Sarah Czech, the health educator for Cass County. "Everyone — everyone is looking for guidance. From our locals wanting guidance from us, we're wanting guidance from the state."


According to an analysis by NPR, 37 states did not have enough contact tracers as of June 18. The U.S. Centers for Disease Control and Prevention says immediate action is needed.


"Communities must scale up and train a large workforce and work collaboratively across public and private agencies to stop the transmission of COVID-19," according to the CDC.


The CDC has specific directions for how to scale up staffing roles in case investigation and contact tracing.


Rex Archer, the health director for Kansas City, said the process should have started back in December.


"We should have had all of these positions on board by now so that we could try to manage the second wave over the summer, let alone what will come about when we have both influenza and COVID-19 come late fall," he said.


"And so we're hiring and trying to get 90 positions filled right now — to be able to handle the problems that we will be seeing this fall," Archer said.


Other states have rolled out statewide plans to hire more contact tracers.


Illinois is looking to hire 4,000 new contact tracers and an additional 600 in Chicago. California is training 20,000 new contact tracers from around the state by July. This is one of the largest efforts in the country.


Meanwhile, Texas is still short of its governor's goal to have 4,000 people contact tracing, with 2,800 workers at the end of June.


This story was produced by the Missouri Information Corps, a project of the Missouri School of Journalism. Have tips for us? Email: moinformationcorps@gmail.com.