Health investigators overwhelmed by ‘avalanche’ of COVID-19 cases

The recent surge of COVID-19 cases has overwhelmed public health investigators in Clark County, who are now forced to prioritize who among those testing positive will be notified by a phone call and interviewed about their contacts.

Investigators with the Southern Nevada Health District are charged with contacting people who have tested positive for the coronavirus, in some instances notifying them of their testing status. It’s also the job of investigators to ask infected people to isolate themselves and to provide the names of their close contacts. These contacts will be notified that they may have been exposed to COVID-19 and asked to self-quarantine to avoid infecting other people.

To best curb the spread of disease, it is ideal to contact positive individuals within 24 to 48 hours of lab results, said Devin Raman, a senior disease investigator for the district. The current volume of cases, however, has made that impossible, she said.

In a week, the district’s 64 investigators can locate, contact and interview an estimated 2,000 new cases, Raman said. However, with 5,300 new cases in the county in the past seven days, the agency now has a backlog of thousands of cases.

She likened the workload to “trying to stop an avalanche with our bare hands.”

Automated system

A saving grace, Raman said, is that the district has launched an automated system that will automatically text or email a patient testing positive who has provided complete contact information. A “high percentage” of people are successfully contacted within 24 hours of a lab delivering results.

People reached in this manner are then asked to provide contact information for those with whom they’ve been in close contact. Public health authorities have defined a close contact as someone who was within 6 feet of an infected person for 10 minutes during the time when they likely were contagious.

“Individuals who received a positive test result can enter contacts into the automated system, and many do,” Raman said. But she noted “more contacts are provided when a positive case is interviewed by a case investigator.”

To receive a personal call by an investigator, Raman’s team is prioritizing cases that could affect the most people or have the greatest impact, such as that of health care provider or a first responder, or one involving a homeless shelter, day care center, school or hotel.

“We’ll get that assigned out immediately,” she said.

Individuals who were tested at a mass testing site also may be able to get their results by logging onto a website. Or they may receive notification from the physician who ordered the test.

Until the past few weeks, a district team overseen by Raman was charged not only with contacting those who’d tested positive but also their close contacts. Now the state is overseeing this function.

Reinforcements

Some 500 “contract tracers” employed through professional services firm DeLoitte have been tasked with calling or texting the contacts. State officials have said that 20 percent of Nevada’s positive cases were identified through contact tracing.

During a media telebriefing Wednesday, Julia Peek, a deputy administrator with the Nevada Department of Health and Human Services, acknowledged a backlog of cases in Clark County.

“I don’t know what it (the backlog) is right now, but as long as they (the health district) have correct information, they are reaching out through that electronic medium at a high capacity in a shorter period of time,” she said. “It’s just the whole investigation that’s taking a little bit longer.”

Raman said her team has no opportunity at present to return to older cases, focusing instead on new cases where they can still make an impact.

“A big part of what we do is providing education and then also identifying the parameters of the isolation,” she said, by explaining how and for how long a COVID-19-positive person should stay away from other people.

Soon the ranks of her team will be bolstered by 20 employees on loan from Clark County. She also anticipates that grant funding will provide another 50 investigators, though it’s unclear in what time frame. Some staffing was lost when district pool inspectors and sexually transmitted disease investigators who were filling in returned to their regular positions, she said.

“It’s frustrating seeing this backlog and not being able to really do the job that we want to do for our community,” Raman said. “There’s just no light at the end of the tunnel right now.”

Contact Mary Hynes at mhynes@reviewjournal.com or 702-383-0336. Follow @MaryHynes1 on Twitter.