Nevada’s Covid contact tracing misses the mark

Las Vegas Uber driver Derek Washington went to the hospital in January with symptoms of COVID-19. 

“I ended up in what looked like a MASH unit during wartime and got diagnosed with flu and pneumonia,” he says, but he’s pretty sure he had “what was going on in China.” 

He became sick again in April and went for a COVID-19 test.

“God only knows how that affected my Uber passengers,” Washington said.  “No one ever did any tracing even after I told them I had Uber’s official records.”  

Washington is one of half a dozen COVID-19 patients  – and an untold number of others who have been in contact with people who have tested positive  —  who confirm they have never heard from contact tracers, the health officials charged with immediately reaching out to those who test positive to identify close contacts in the days preceding the onset of symptoms. 

It’s a key component of the state’s plan to keep casinos and other businesses open during a pandemic. 

“These strategies support Nevada’s three public health goals of testing at least 2 percent of Nevada’s population each month, having a contact tracer reach out to every Nevadan who tests positive for COVID-19 within 24 hours of the confirmatory lab report being received by the health authority, and reaching out to close contacts of those testing positive within 24 hours of identification,” says state health official Shannon Litz.

Las Vegan Caryn McGee says she and her husband both tested positive for COVID-19 in late March.

“SNHD called my husband once,” McGee says.  McGee, an office assistant at High Desert Correction Center, says she was not contacted.

“We are a little slow but we are working,” says Clark County Commission Chairwoman Marilyn Kirkpatrick, who says the county currently has 90 tracers and is getting “a bunch from Nevada State College and UNLV.”

“It is taking about five days to contact folks just based on the volume,” she says.

Health officials say they have investigated every positive COVID case from the beginning of the outbreak.

“We have a system that provides an automated alert to new cases after we receive a positive lab report that includes a phone number. If the case report is complete, then the case will receive a notification within 24 hours. If there is a delay in reporting or missing contact information, the notification can take longer,” says Southern Nevada Health District spokeswoman Jennifer Sizemore. “Disease investigators follow up with new cases as soon as possible. The timeline varies based on the information received and the volume of cases received.”

“On any given day there are about 20 case investigators and contact tracers combined,” says Washoe County Health District Epidemiology Manager Heather Kerwin. “The initial notification and interview can last anywhere from 20 minutes to 1.5 hours. Investigators usually conduct 3-5 case interviews per day.”

State and local health officials declined to say what percentage of COVID-positive individuals have participated in a tracing interview and what percentage of contacts have been notified by health officials.

Now, with the number of positive cases in the U.S. approaching 60,000 a day, Dr. Anthony Fauci who heads up the National Institutes of Allergy and Disease, is warning the nation’s contact tracing efforts are failing.  

“To just say you’re going to go out and identify, contact trace and isolate, that doesn’t mean anything until you do it,” Fauci said Friday. “Not checking the box that you did it, but actually do it. Get people on the ground. Not on the phone. When you identify somebody, have a place to put them to get them out of social interaction.”

Nevada has approximately 345 contact tracers and investigators, say state and local health officials.  That’s a little more than a third of the 938 tracers needed, according to the Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials (ASTHO).   

“Nevada’s vendor to support digital contact tracing and surge staffing, Deloitte, hired 250 positions for Nevada,” says Litz. “Our contact tracing contract allows us to scale up our response with a one-week lead time for onboarding and training. We already have thousands of applicants, hundreds of whom have been screened. At this time, we could significantly increase our investigations without needing to scale up our workforce.

Litz did not say why the state has not yet ramped up tracing to keep pace with the recommendation.  

CDC Director Dr. Robert Redfield testified last week that about 28,000 people are engaged in contact tracing in the U.S.  He later acknowledged that’s less than a third of the estimated 100,000 workers needed.

Tourist trap?

Mobility data companies scored Nevadans among those best at staying home when so-called “lockdowns” swept the nation in March. 

By Memorial Day and the end of Phase One of the state’s reopening plan, Nevada’s seven-day moving positivity rate for COVID was at 2.5 percent, under the World Health Organization’s goal of no more than five percent.  

But Nevada, with apologies to Tennessee Williams, is entirely dependent on the kindness of strangers.

Since the reopening of casinos, bars and restaurants in early June, positive cases have exploded. The seven-day moving positivity rate climbed from under 3 percent to 16 percent by month’s end.  

Intensive care unit hospitalizations, which peaked April 8 with 711 confirmed and suspected cases, fell to their lowest level of 316 on May 30.  By July 4, that number had soared to 750 confirmed and suspected cases in ICUs. 

“As I have expressed before, I have growing concerns with our current COVID-19 data trends,” Gov. Steve Sisolak said in a statement Friday, adding he “will not hesitate to take swift and decisive actions next week directed at targeted industries or areas that are experiencing concerning COVID-19 trends and non-compliance.”  

As President Donald Trump adopts a “we need to live with it” attitude, governors and local leaders in some states and municipalities are acknowledging they opened prematurely and are backtracking by closing bars and restaurants.  

But in Nevada hospitality fuels the economic engine.  Unlike other tourism-based economies, the Silver State is bereft of a secondary industry that contributes significant revenue to government. 

Lacking a national strategy for controlling the virus, and a population still struggling to recover from the initial closure, a retreat from reopening in Nevada seems unlikely.  Additionally, at least one health official has declined to link the spike in cases to the Phase Two reopenings of casinos, bars and restaurants.

“No common sources of exposure are linked to the recent increase in cases in Clark County,” acting SNHD Chief Health Officer Dr. Fermin Leguen said in a statement. 

State and local officials have not responded to requests for contact tracing data.