Kentucky's Contact Tracing Director On Program's Challenges, Successes
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.
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.