‘Very likely to re-surge.’ Overwhelmed MS health dept. gets aggressive to curb COVID-19
State Health Officer Thomas Dobbs took on a much bigger job than his health department was capable of handling when he announced March 26, at a news conference on the steps of the governor’s mansion, that more testing and contact tracing would be cornerstones of the state attack on COVID-19.
“This is something that we’ve been formulating for quite some time but, to be honest, we haven’t really had the resources to be able to be more aggressive,” Dobbs said. “We’re going to advance our mission to a more aggressive, a more offensive strategy.”
What he didn’t say: Budget cuts had greatly diminished Mississippi’s public health resources.
Strategic thinking, partnerships with hospitals and private laboratories, and cooperation from key agencies such as the Mississippi Emergency Management Agency, have helped Dobbs and the Health Department move toward his goals.
But they’re not there yet. An increase in cases with the reopening of the state could easily overwhelm the virus-fighting networks he is building. Residents must do their part by social distancing, avoiding crowds and wearing masks when they venture into public spaces, health experts warn.
Health departments nationwide were working with strained resources when the novel coronavirus swept in and spread, challenging their ability to respond.
“All across the country, and especially in Mississippi, the public health workforce has been cut in the last five years — by 40 to 50%, “ said Kaye Bender, executive director of the Mississippi Public Health Association and previous CEO of the national accrediting body for government health departments, the Public Health Accreditation Board.
“Dr. Dobbs is doing a really good job, I think, of getting the workforce trained and up to speed. He’s done, in my opinion, a really good job of managing the resources he has in order to keep up with it.”
COVID-19 testing ramps up
On the March day when Dobbs announced his strategy, only 2,766 of Mississippi’s 3 million residents had been tested for COVID-19. By Saturday, the number tested had climbed to almost 138,000, with the vast majority of tests from private facilities.
Memorial Hospital at Gulfport CEO Kent Nicaud believes early testing by his hospital definitely tamped down COVID-19 spread in Harrison County. Memorial was testing before the University of Mississippi Medical Center and state Health Department partnered on drive-thru testing.
Memorial set up seven drive-thru testing clinics, identifying 17 positive cases of COVID-19 for the week beginning March 14, his records show.
“We got to the public much quicker,” Nicaud said. “We quarantined people way before the state issued a stay-at-home mandate. I truly think that has helped us flatten our curve much sooner.”
Harrison County’s new cases have inched up slowly, from one on March 17 to a total of 230 on Friday.
The Mississippi State Health Department on Monday reported 13,458 cases statewide and 635 deaths.
The state currently ranks 16th nationwide for number of people tested per 100,000, according to the COVID Mapping Project, which gathers data nationwide.
Dobbs’ goal was to test 2% of the population a month, ensuring tests are capturing not just positive cases but also those who are asymptomatic. The MSDH reports 3% of the population was tested in April and, so far in May, the rate is more than 3%.
Bender said hospitals and other healthcare providers have put aside competition and are working together to test for the virus and process results.
Through Thursday, the University of Mississippi Medical Center has tested 8,282 people at drive-thru testing sites set up for a day in counties hit hardest by the pandemic and at its continuous testing site at the state fairgrounds in Jackson.
“The speed with which those (testing sites) were set up in our state, I think, is really a testament to how well the components of our health system can work together when they need to, the hospitals, the health department and the labs,” Bender said.
Building a contact tracing staff
Contact tracing also is essential to curbing COVID-19. Dobbs started with a core staff trained and knowledgeable in tracing, for example, a tuberculosis or HIV case.
“On a regular public health day, you have a relatively small number of staff who are trained and skilled in doing high-quality contact tracing,” Bender said.
A pandemic means hundreds of workers are needed. “You get contact tracing on steroids, so to speak,” she said.
She believes Dobbs has worked strategically to manage resources.
“He doesn’t overreact,” she said. “He tries to be very calculated, very strategic about what he’s doing. He’s very open to doing mid-course corrections when he sees the need.
“I think he’s not only a knowledgeable public health practitioner, but a very good strategist.”
Dobbs moved employees from other areas of the Health Department, and even recruited people from other state agencies, to work in contact tracing. New workers have to be trained.
The state’s number of contact tracers has steadily climbed. Liz Sharlot, the MSDH communications director, said Friday that 200 contact tracers are working and an additional 30 to 40 are being trained.
Demands of contact tracing
The job is time-consuming.
Dobbs said the MSDH wants to trace every case, but with 404 new cases Thursday, the second-highest number to date, the work could be overwhelming.
“Sometimes, working on a single infection could take a significant amount of time,” said Susan Hassig, director of the public health program in epidemiology at Tulane University’s School of Public Health and Tropical Medicine in New Orleans. “It could take a whole day.”
In addition, the MSDH is deploying testing and contact tracing resources to long-term care facilities, where COVID-19 outbreaks and deaths are hitting hardest. By Saturday, the state had reported 1,683 cases in the facilities with 315 dead — almost half the deaths in the state.
The time consumed on contact tracing depends on the complexities of the case. The work is often handled by phone.
The contact tracer has to develop a rapport with the infected individual before delving into their health issues and asking questions about who they’ve been around over the previous two weeks, the potential incubation period for COVID-19.
The case of an older person who lives alone and ventures out only for groceries, for example, would be much simpler and quicker to trace than that of someone who leaves home for work and socializes.
Once the sick person is interviewed, all the people they have come in contact with must be called and counseled about their potential exposure. The sick person, who must be quarantined, remains anonymous in these conversations.
Public must do its part to COVID-19 explosion
With contact tracing, speed is of the essence.
“The whole point is to try to chop the chain of transmission as short as possible,” Hassig said.
The goal is to curb the spread and get people back to their lives, which is also part of improving the public’s health, Bender said.
A return to normalcy is also dependent on the public’s behavior..
Hassig said people need to social distance, wear masks in public to avoid spreading germs, and wash their hands frequently. She advises avoiding crowds.
“When you’re having a barbecue in your backyard, you’re not only inviting 15 people, you’re inviting the 150 people they’ve had contact with as well,” Hassig said.
“We still need to recognize that the virus is out there and you can’t tell who is infected.”
Like many people, Hassig is concerned about a rebound of cases in the fall, when the flu and other respiratory illnesses will also be in play.
“This virus is very likely to re-surge,” she said, “and we need to have the contract tracing infrastructure in place to keep it from exploding again.”
This story was originally published May 26, 2020 at 5:50 AM with the headline "‘Very likely to re-surge.’ Overwhelmed MS health dept. gets aggressive to curb COVID-19."
