Contact tracing among concerns for local health depts as delta variant spreads

Some local health officials expressed concerns this week over contact tracing, the inability to enforce public health measures, and the politicization of COVID-19 as the delta variant continues to take a grip over Montana and they struggle to keep the spike in cases under control.

For the first time since May, Gallatin County recorded a COVID-19 related death on Friday. County health officer Lori Christenson said it was an “unfortunate reminder that COVID is still dangerous.”

There were 26 new cases reported in Gallatin on Friday, bringing the active case count to 161. Statewide, 449 additional cases were reported on Friday, with 3,473 active cases and 200 hospitalizations.

Aligned with other health departments and organizations across the state, Christenson said the department encourages its residents to take all precautions to stop the spread, like social distancing, masking indoors and staying home if you are sick.

Centers for Disease Control and Prevention guidance recommends people who are not fully vaccinated and aged two or older wear a mask in indoor public places. And vaccinated people in areas of substantial or high transmission are also advised by the CDC to wear masks.

“We do have high transmission, so take all precautions you can to limit the disease spread in the community,” she said. In Montana, 52 of 56 counties are considered areas of substantial or high transmission by the CDC.

Despite the rising cases and high transmission designation, Christenson said her department has been able to meet contact tracing demands so far but is trying to bring in more resources.

“Just like when we saw spikes last year, we become really limited with what we can do in a day. Right now, we are keeping up the best we can,” she said.

Cascade County reported 53 new cases on Friday. And when cases climb, pressure on contact tracers increases, said COVID-19 education liaison for the Cascade City-County Health Department, Ben Spencer.

“It’s always a struggle to keep up when caseloads start getting high,” he said. Adding, “we want everyone vaccinated … we are recommending people wear a mask indoor in public places regardless of vaccination status and outdoors when social distancing isn’t possible.”

The county has three full-time and six part-time contact tracers to deal with the 644 active cases in the county, Spencer said.

Flathead County Health Officer Joe Russel said the department is also struggling to keep up contact tracing.

“We are slammed doing contact tracing,” he said, adding the department is focusing its case investigation efforts on healthcare workers and school-aged children.

The county added 78 new cases Friday and leads the state with 708 active cases, and 41 percent of the eligible population is fully vaccinated, lower than the statewide average of 49 percent.

While the other departments encourage people to mask up and get vaccinated, Russell said his department is primarily focused on the latter.

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“We’re primarily messaging around getting more people vaccinated, it’s clearly working. We’re not messaging around some of the other stuff,” he said. “I don’t want to sound like a defeatist, but this is Flathead County. Our fair is running like there is no COVID … We’re doing the best we can … but some of the recent legislation really tamper our abilities around COVID response.”

But, he said, the department is working behind the scenes with organizations hosting upcoming events and gatherings in the county “to try and adopt some public health mitigation strategies.” Russell declined to comment on the specifics of the events and organizations.

Cindy Farr, Missoula City-County Health Department’s COVID-19 commander, shared similar frustrations with the recently passed legislation limiting the ability of both the governor and local health officials to put into place mandatory public health measures.

“We really don’t have a lot of mitigation measures we can institute at this time, so pretty much the only thing we are able to do is quarantine and isolation,” she said.

The county reported 59 new cases Friday, and 62 percent of the eligible population is fully vaccinated. In the last 48 hours, the department onboarded 15 people to help with contact tracing, Farr said. On Friday the department released a statement urging residents to shrink their social circles in an effort to stop the spread and provide some relief to contact tracers.

“The contact tracing team is racing to notify close contacts as quickly as possible, but with roughly 60 new cases per day on average in Missoula County, our backlog of close contacts who need to be notified is growing quickly,” the statement read.

The department said the delta variant is more infectious, and people testing positive are reporting an average of 10 to 25 close contacts, compared to the surge last winter when infected people only reported an average of six contacts.

While the department cannot enforce mask mandates, it said because of approval from the Missoula Board of Health the department can mandate people who tested positive for COVID-19 to isolate and unvaccinated or symptomatic vaccinated close contacts to quarantine.

As designated by recently passed legislation, health departments must have approval from their local governing bodies to implement public health mitigation mandates. But Yellowstone County, Barbara Schneeman, Vice President of Communications and Public Affairs for Riverstone Health, said it is not that simple.

“Don’t ask me who our local governing body is,” she said, explaining that Riverstone Health is a multi-jurisdictional health service district created by Yellowstone County, the City of Billings, the City of Laurel and the town of Broadview.

“It makes it very hard to issue any kind of orders, and so right now, we don’t issue orders for isolation or quarantine. We make recommendations,” she said.

Schneeman said her department is also behind on contact tracing. The county saw 88 new cases Friday and has 408 active cases but only three full-time case investigators.

The county health department is united with other counties and organizations encouraging people to get vaccinated and mask up indoors. But even with consistent messaging from health professionals, she said she is discouraged by the department’s inability to mandate public health measures to slow the infection.

“What is unfortunate is that public health is caught in the midst of a culture war,” she said.