Kentucky’s Contact Tracing Director On Program’s Challenges, Successes

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Kentucky spent $78 million of CARES Act funding to set up a contact tracing program to track the spread of the coronavirus. Now, some Republicans in the Kentucky legislature are unsatisfied with the program’s results and are calling for it to be defunded. 

Reporter Jared Bennett of the Kentucky Center for Investigative Reporting spoke to Mark Carter, the head of Kentucky’s contact tracing program, to learn more about contact tracing and the challenges facing the system.

Carter, formerly CEO of Passport Health Care, was appointed by Gov. Andy Beshear in May.

A portion of the interview, edited for clarity, is below.

Mark Carter at a daily coronavirus briefing on September 16.

Mark Carter, the executive adviser at the Kentucky Cabinet for Health and Family Services leading the state’s contact tracing efforts, at a daily coronavirus briefing on September 16.

You took over contact tracing in May. Tell me what you’ve been doing since then, what kind of progress we’ve made?

I joined in mid-May and have been embedded in the department for public health since then, really working with a lot of committed professionals there that have been focused on the pandemic. 

We’ve hired 1,200 disease investigators and contact tracers. We’ve implemented a statewide contact tracing information system, a lot of effort in educating the public around what contact tracing is and what it isn’t.

And then just basic day to day project management, and oversight of the process, trying to help folks break through barriers and keep doing their best to protect the public.

Can you tell me about some of the software challenges you’ve had? I know that was a big part of the project, developing the technology.

The interesting thing is, contact tracing and disease investigations are nothing new in public health. They’ve been around for decades, and maybe even since there was such a thing as public health. 

But public health has also been one of the most underfunded components of our health system. So if you look at the way they conducted contact tracing, it was always at the local health department level. They really didn’t have access to the kind of tools that a modern hospital would have.

So they were keeping these records on paper — sometimes Excel spreadsheets. There might have been a couple of instances where there was a survey tool that was used. It was very disjointed and different from place to place. And so part of what we did was to say, ‘Okay, well, we need a standard technology solution across all 61 health departments.’ The thinking behind that was not unlike Southwest Airlines choosing to only fly 737s, so every time the pilot gets in a cockpit, it’s the same cockpit, doesn’t matter which airplane it is. 

So, to keep that plane example, we had to kind of build the airplane while we were flying it, and that ain’t easy. And yet, as we speak here today, [the technology is] deployed throughout the Commonwealth, every health system is using it. Some are still in the process of onboarding, but it’s just a handful now. 

How does the contact tracing process work?

Essentially, there’s a positive test reported to the health department. That starts the process that is broadly called contact tracing, but it’s really a two part process.

The first is a disease investigation and the disease investigation consists of an RN or some type of clinician, who will call the person that has tested positive and basically discuss with that person the symptoms that they’re having, what they need to do to protect their health, how they can protect their family and loved ones in terms of their own self-isolation. 

And then a component of that call is to gather a list of close contacts that that person with the infection may have had. And then that triggers the last part of the process, which is the actual contact tracing process. So that’s handed off to a contact tracer.

Then we’ll call the people who were contacts, alert them to the fact that they may have been exposed to COVID. And then depending upon the nature of their exposure, what they need to do to protect themselves and their loved ones and, and friends and neighbors.

What has contact tracing taught us about the virus?

In terms of the contact tracing aspect of it, I think a couple of things. One is that, we really can contain this virus, or we had the opportunity to. And in Kentucky, we did a pretty good job of it. 

You can’t do it solely through contact tracing, contact tracing has to be conducted with masking, and hand washing, and testing, and social distancing. But if you do all those things together, you can contain the virus and the evidence shows that that occurred in the early, early months here in Kentucky. And so that was important, I think it’s a demonstrated success. 

The second is, I think, I think we’ve learned a lot about our people. Typically, at least anecdotally, from the contact tracers out in the field, most people by the end of that call are appreciative of the call and are cooperative. They do want to protect their family and friends. There are some that are uncooperative, obviously, but they tend to get a lot of the coverage. But the overwhelming number of Kentuckians have welcomed the call by the time it was finished.

There has been some criticism lately of contact tracing, particularly the money spent on it (including from Kentucky Senate President Robert Stivers from Manchester, who called for the program to be defunded). The criticism is centered on the lack of publicly available statewide data. Can you explain what the challenge is in producing data and why the program is useful absent that reported data? 

The first part is just the technical challenge that I described earlier. Our system has only been fully in place since around the first of October. It’s just new, and there is still a considerable amount of the data that’s decentralized and housed in the local health department. 

The second issue is just the type of data. We are producing a lot of data. But it’s more useful to the Department of Health in terms of managing the process. So it’s things like the number of contacts per case, per person. If somebody is infected, how many contacts do they have? How many of those really require follow up? 

The overall goal of contact tracing is to contain the spread, it’s to prevent people from getting sick. And we are doing that. It’s shifted a little as we’ve gone through this, but we are preventing the spread of disease, and that’s saving lives. It’s saving hospitalizations, it’s probably saving a lot of long term health impacts for people. So that makes it worth it. And we are working on some data to try to show an estimate of what we think we have prevented. 

The virus in Kentucky, and nationwide, is in a very different phase than when contact tracing started. What is the role of contact tracing in this new phase where containment is, if not impossible, much harder to do?

As I mentioned before, you can’t contact trace yourself out of this, you can’t test yourself out of this. You have to have these interventions all working together. You have to have testing, ubiquitous testing, you have social distancing, masking, and contact tracing. And all those things have to work together to contain the disease. If you have a failure in any one of those, it’s going to make it hard to keep the disease contained. 

We’ve let our guard down as a community. We haven’t done as good a job of social distancing and masking and because of that, the disease has spread. And it’s spreading now at almost an exponential rate. So what that means for us now in terms of contact tracing, is that it’s gone from a containment tool or strategy to a mitigation tool or strategy.

We have not contained the disease. So, we can mitigate its impact.

What are the challenges that you are looking for over the next few months before widespread vaccine vaccinations?

As we get folks inoculated or vaccinated over the coming months, we can see the light at the end of the tunnel. The problem is, you know, we’re probably talking mid-summer, at best case, and probably in late 2021 before we can all breathe a real sigh of relief. So we’ve got to try to stay healthy between now and then. 

We really need to depoliticize this whole thing. That virus doesn’t choose who it strikes based on their voter registration. We need to wear masks, and we need to social distance. We need to just hang in there a little bit longer so we can get to the point where the vaccinations can really do their magic. 

We’re in the fourth quarter. And we just got to play a little bit harder to try to get to the end of the ballgame and across the goal and and I think if we all pitch in and do that, we will be in a better place.

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