Overwhelmed by cases, health departments struggle to trace virus' spread

woman stares at test tube while sitting
Stephanie Graves checks to see that she provided enough of a sample for her COVID-19 test at the Minneapolis Convention Center testing site on Monday.
Kathryn Styer Martinez | MPR News

Since the COVID-19 pandemic began, testing and tracing have been two key parts of the state's strategy for slowing the spread of the virus. 

Now that free testing sites have opened around the state, more people are getting tested than ever before — since the beginning of the pandemic, more than 3 million tests have been administered in Minnesota.

But as COVID-19 cases surge, the contact tracing side of that equation is getting overwhelmed. 

When someone tests positive for COVID-19, public health workers try to contact that person as quickly as possible. They have three goals: First, to make sure the person knows to isolate themselves, so they don’t infect anyone else. 

Then, to investigate the case — to try to figure out how the person got infected. 

And third, to trace who they may have been in close contact with while they were contagious, so they can reach out to those people, and advise them to quarantine and get tested. 

But as cases skyrocket across the state, public health agencies are having trouble keeping up.

“Exponential growth in cases over the past couple weeks has definitely created a backlog,” said Christine Lees, who supervises Dakota County’s disease prevention response.

The county partners with the state Health Department to do contact tracing. 

"What's really important is being able to get to people as quickly as we can, so that they know, we really need you to try and quarantine,” Lees said. 

But that's not happening as quickly as it was earlier in the pandemic. In Hennepin County, it's now taking two to three days to contact people once they receive a case from the state Health Department. It used to take less than 24 hours. 

“That's the risk, that the longer that takes, the more potential, especially for the contacts, that they don't know" that they have COVID-19, Lees said, and that they continue to operate as normal, unknowingly putting the people around them at risk.

A sign reads "Free COVID-19 testing today"
Signs behind the Duluth Entertainment and Convention Center in Duluth, Minn., alert people to a free COVID-19 testing site in September.
Derek Montgomery for MPR News file

Hennepin County now has a contact tracing backlog of about 1,300 cases. But they are hardly alone. In northeastern Minnesota, Itasca County announced earlier this week it is suspending contact tracing altogether.

"It was at a point where our staff were completely overwhelmed, unable to keep up with even the case investigations," said Kelly Chandler, Itasca County’s public health director. 

She said her teams were also having trouble keeping up with contact tracing. More than 400 people have tested positive for COVID-19 in Itasca County in just the past two weeks — that’s more than one-third of all the county’s cases since the pandemic began. 

And as the county registers more cases, and the community spread means more people don’t know how they’ve been infected, it’s become far more difficult to follow the web of people’s interactions.  

"Some of our patterns with COVID-19 are gatherings, larger events ... it's not someone coming in where they were exposed to one or two close contacts,” Chandler said. “They've been exposed to five and six, and seven and however many more. And that's a lot more phone calls."

For now, Itasca County health officials are asking people to let others they’ve come in contact with know that they’ve tested positive for COVID-19. And for those who haven’t: Anytime you’re around other people, assume someone has it, Chandler said.

'Everyone needs to realize that it can affect anybody,' says woman who got COVID
by Dan Kraker

It’s not just counties feeling the pressure as Minnesota continues its challenging march through the pandemic, breaking record upon record in the past two weeks.

The state Health Department is also feeling the crunch. They have a goal of contact tracing within 24 hours. But officials say there are now around 5,000 cases every day they're not able to contact within that time frame. 

But what's lost when contact tracing isn't done quickly, or at all?

First, public health officials aren't able to collect data to help pinpoint how the virus is spreading.

That's the kind of detail that helped inform Gov. Tim Walz's most recent executive order,  because contact tracing showed that the virus was spreading late at night in bars and restaurants. Now, among other things, they have to end in-person service at 10 p.m.

The other piece that's lost when contact tracing falls aside is reaching people who were exposed to the virus to encourage them to get tested and quarantine, said Graham Briggs, Olmsted County’s public health director. 

 "The whole idea there is now to get in front of this virus by keeping those people some of whom will become cases from infecting other people down the line here and that in essence is really how we interrupt transmission at a case-by-case level."

Health Commissioner Jan Malcolm says the state is redeploying 500 more people from other parts of state government to assist with case investigation and contract tracing. 

The state Health Department is also exploring ways to make contract tracing easier and quicker, like shortening its list of questions, and allowing people to answer questions online or by text message. 

But Malcolm said, with the unprecedented degree of asymptomatic transmission that’s happening statewide — and when many people don't know where they became infected — contact tracing becomes less important. 

A person wearing personal protective equipment stands at a car window
Nurse Amanda Hitchings uses a swab to take a sample for COVID-19 testing in May at St. Cloud Hospital.
Dave Schwarz | St. Cloud Times file

"So it doesn't mean that we don't need to keep on doing everything we can to keep pace with these cases,” she said. “But the ability to act on the contact tracing also gets a lot harder with this degree of unknown spread."

Still, county officials say it's an important tool, and are looking at ways to continue it, even if they can't contact every person who's infected or exposed. 

"That also allows us to continue looking at what risk factors are out there in the community and how people are transmitting this," said Briggs.

And as the pandemic has dragged on for months, he said, public health workers are having a harder time reaching people — and persuading them to participate in the contact tracing process.

"We are seeing a significant portion of our cases being uncooperative or hanging up on us or sometimes just being belligerent to contact tracers and case managers,” he said. 

Other county health officials say they’re seeing similar trends. In St. Louis County, Public Health Director Amy Westbrook said the number of cases classified as “lost to follow-up” — meaning public health officials aren’t able to reach them — has grown from 14 percent earlier in the summer, to 30 percent the past two months. 

“If I were to hazard a guess, I think some of it is that they don’t want other people to know they are ill,” said Erin Tufte, emergency manager for Stearns County, who said public health workers there are also having a harder time contacting people. 

“They’re looking at potential job implications, financial implications, kids that can’t go to school,” Tufte added. “And some of it too is that people are just not interested in sharing their information. That it’s nobody else’s business.” 

But the ultimate answer to slowing the spread of COVID-19 isn't more contact tracers, or shorter questionnaires, said Hennepin County Public Health Director Susan Palchick.

“We take our job and responsibility seriously but for us the story isn't about how we can't keep up, it’s that too many people are taking too many risks, driving exponential case growth,” Palchick said. “The answer isn't more epidemiologists; it's more caution and following the prevention steps.”

COVID-19 in Minnesota

Data in these graphs are based off Minnesota Department of Health cumulative totals released at 11 a.m. daily. You can find more detailed statistics on COVID-19 at the Health Department website.

The coronavirus is transmitted through respiratory droplets, coughs and sneezes, similar to the way the flu can spread.

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