Minnesota’s COVID tracking retooled amid surge, variants

A person holds a phone up above a crowd.
A visitor takes a picture with the Dual rear-facing cameras located on the back of a smartphone. Two tools designed to tamp down COVID-19’s spread in Minnesota got revamped amid the latest surge in cases.
Josep Lago | AFP via Getty Images 2017

Two tools designed to tamp down COVID-19’s spread in Minnesota got revamped amid the latest surge in cases.

A smartphone alert system that had been seeing limited use underwent a recent update to boost notifications. Not long before that, public health officials narrowed contact tracing efforts to focus on the most-concerning patterns.

Both moves are on full display as the fast-spreading delta variant continues to feed case growth and the newly emergent omicron variant causes uneasiness as health experts race to learn more about its severity and transmissibility. 

Minnesota officials announced Thursday that the new COVID-19 variant had been detected in the state, involving a man who had been vaccinated and got a booster shot and who traveled to a widely attended convention in New York. More positive test results are under examination to see if they were caused by the new variant.

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“It's important that we adapt to the phases of the pandemic, and that we continue to make our surveillance relevant," state Department of Health Infectious Disease Director Kris Ehresmann said in an interview this week.

A woman takes off a face mask at a podium.
Kris Ehresmann, the state's infectious disease director, takes off her mask during a press conference.
Christine T. Nguyen | MPR News 2020

While the health department concentrates on virus detective work, a state technology agency has been working to increase use of the COVIDaware MN phone application that allows people to anonymously alert others through Bluetooth technology of potential coronavirus exposure.

Since its debut almost a year ago, nearly 1.8 million people have downloaded the application or otherwise signed up to receive alerts.

DFL Gov. Tim Walz made a big deal of the technology when it went live in November 2020.

“You don’t have to put the code in your phone and you don’t have to notify others around you. I would strongly encourage you, if not beg you, please do so. It’s random,” Walz said then. “People deserve to know if they’ve been exposed to COVID-19.”

But in the first 11 months, COVIDaware had relatively low use in comparison to the number of subscribed devices and cases of coronavirus.

Data from Minnesota IT Services, the state agency that oversees the program, shows that just shy of 43,000 codes were generated through October 2021. Far fewer — about 7,900 — were taken to the next step when a person with a positive test punched in the code to trigger an alert. That’s in the context of more than 550,000 test-confirmed cases over that span. 

As it turns out, the codes needed to initiate the alerts weren’t universally sent to people with positive tests. That is — until about three weeks ago when MNIT changed course.

“We now proactively send out the codes to individuals at the front end of the case investigation,” said Tarek Tomes, MNIT’s commissioner.

He added that they’re now sent via text message, using the number people give when getting a test through a certified provider. Rapid antigen tests done at home do not qualify.

“Simplicity is key,” Tomes said. “One of the changes that was made is providing a link with the code that you can just select the link, and it automatically activates it, so that a person doesn't have to transpose the code.”

The result? Notifications are way up after the switch on Nov. 12.

Since then, roughly 4,500 codes have been activated in connection to more than 57,000 known new cases. More than 50,000 codes were generated in November, so the follow-through rate is still less than optimal.

Graph of COVIDaware codes as share of new cases
Until a change to the program in November 2021, Minnesota's COVIDaware program to notify people of COVID-19 exposures had become minimally effective due to its reliance on an overwhelmed contact tracing program.
David H. Montgomery | MPR News

Patrick Stephenson, 38, got an alert in mid-November as the Minneapolis resident checked his phone first thing in the morning. He saw a red symbol and a notice that he had been near someone who had tested positive within the prior week.

“I was barely awake. And I was like, what?” Stephenson said as his whereabouts in the preceding days spun through his head. He suspected it was a birthday party — where masks were required — and soon learned others there got the same phone warning.

Close up of phone screen
The state's COVIDaware app was revamped in November.
Screengrab of COVIDaware MN

Stephenson knew what came next.

“I got to get tested,” he said. 

That test came back negative. It offered Stephenson a sigh of relief.

“Which was really nice,” he said. “It was kind of like very quick closure.”

Before the update to the COVIDaware code-distribution process, they were given out in conjunction with interviews done by public health officials of people with confirmed infections.

“Because of the implications for people, we have to have a confirmed test to be able to provide the code,” Ehresmann said. 

Connecting it to a contact tracing interview was often a roadblock because some people ignored the outreach, she said. 

“What we have seen over time with ‘COVID fatigue’ is that more and more individuals are, one, unwilling to pick up the phone, when there's a call from public health,” Ehresmann said. “And then, if they do, they're unwilling to identify who their close contacts might have been.” 

That’s a motivating factor for another recent change.

Case investigation, also known as contact tracing, is no longer standard after a positive test. 

Now the Health Department focus is on cases in those under 18, people with vaccine breakthroughs, cases with severe outcomes and emerging variants. 

“We wanted to be able to redirect our energies, to be able to look at things that we're becoming more important, to be able to be born nimble in our response,” Ehresmann said, describing what the department has dubbed “Epi 2.0.” 

That includes the stepped-up surveillance that uncovered the omicron variant.

The state has a well-regarded public health lab that’s central to disease surveillance. Lab professionals had been on the lookout for the omicron variant since the world first learned of it around Thanksgiving, and it was discovered here after a positive COVID-19 test with tell-tale indicators was genetically sequenced. 

Once that process revealed the variant, case investigators sprung into action to learn more about the movement history and contacts of the man.

But people are less likely now than at other stages of the pandemic to be contacted if they test positive.

Olmsted County is among the places that has ended routine COVID case investigations and handed off tracing to the state. Public health nurse manager Sarah Stevens said department staff has been freed up to complete other key tasks.

“We're still here in the community. We still answer questions. We just tried to be much more targeted with where we are putting our effort,” Stevens said. “Vaccination is a big one.”

Olmsted’s public health unit did nearly 12,000 case investigations over the course of the pandemic. Nurse Tamara Eissa was in on a lot of them — tracking exposures, offering tips on managing the illness and connecting people with food, medicine and other assistance.

Although there were prickly encounters as people complained about intrusive questions or other aspects of medical privacy, Eissa said most interactions were pleasant.

“I absolutely loved doing the case investigation and talking with all of these wonderful people — you know, their stories, being able to reassure them. I loved the work. I really did,” she said. “It was really hard when it shut down. I'll be honest.”