Contact tracing is universally regarded as critical in safely relaxing pandemic-induced lockdowns. But Hawaii officials publicly disagree over how much tracing capacity is needed.
The process of contact tracking involves identifying and reaching anyone who may have come into close proximity with a COVID-19 positive individual. The goal is to locate others who may have become infected and either test or direct them to isolate.
It’s a labor intensive process, requiring tracers to identify and call potentially dozens of contacts in the process of chasing down leads. Some are obvious, like family members or cohabitants, but contacts can also be looser connections like grocery workers or transit operators.
The Hawaii Department of Health currently has around 30 people doing contact tracing, or less than 3 tracers per 100,000 residents. That’s less than one-tenth of the number now being recommended by the National Association of County and City Health Officials.
The group says health agencies should aim for 15 tracers per 100,000 residents in a non-emergency situation, but would likely need 30 tracers per 100,000 for the current pandemic.
Some senior officials in the Hawaii’s recovery task force are now publicly agitating for the state health department to significantly expand the number of tracers available. Major General Kenneth Hara, adjutant general of the Hawaii National Guard and head of the Hawaii Emergency Manangement Agency, serves as the governor's emergency response lead. He says authorities need to build that tracing capacity now, rather than waiting for a spike in cases.
“To be responsive, we need to anticipate needs. We need to organize, equip, and train the people, so that when we need it, we’re there,” Hara said.
Hara told a state House of Representative committee on Monday that he is frustrated by the health department’s lack of action to further expand the contact tracing program.
Hara offered to provide National Guard soldiers, many of whom are trained doctors, nurses, and EMTs to help, but the health departmrnt has apparently not taken up on his offer.
“We’re all aligned. It’s just kind frustrating trying to convince DOH that it’s important,” Hara said to the committee.
The revelation came in response to a question by University of Hawaii economist Carl Bonham, who asked why some of the approximately 5,000 local healthcare workers who have been laid off and furloughed could not be put to work contact tracing.
House Speaker Scott Saiki, who organized the committee in March, said it was “critical” that the health department be on board with the plan. Hara described rapid testing and contact tracing as the “missing link” in the comprehensive pandemic response and recovery plan.
Hara added that he had spoken with Gov. David Ige over the weekend and asked the governor to personally intervene, possibly with an official order. But at a press conference later in the day, Ige said the situation was a misunderstanding.
When asked about Hara’s comments, Ige stated that there are adequate resources to handle the current outbreak.
“We do have the personnel we need for the current case count. General [Hara] has been very active in planning for the worst case scenario, where we see hundreds of cases [per day], rather than the one or two or 10 we’re seeing now,” Ige said.
Health Director Bruce Anderson, who has repeatedly emphasized the importance of contact tracing, seemed similarly noncommittal, saying only that the department would likely expand capacity in the coming weeks.
“We continue to evaluate the needs of the department and probably will look to recruit additional staff,” he said.
Anderson pointed to New Zealand, which has successfully contained its outbreak using around 4 tracers per 100,000 residents. That’s still more than Hawaii has, and the numbers vary substantially around the world.
A report from the Center for Health Security at Johns Hopkins University states that while New Zealand used 4 tracers per 100,000 residents, Iceland used 7, Massachusetts is using 15, and Wuhan in China employed 81 contact tracers for each 100,000 of that city’s 11 million residents.
Hawaii’s ratio of 3 tracers per 100,000 residents does not account for tourists, who under normal conditions increased the state population by approximately 200,000 on any given day.