A patchwork approach to contact tracing across state health departments is making it increasingly difficult to know where people are getting exposed to COVID-19.
While some states like Louisiana and Washington state publicly track detailed data related to COVID-19 cases in bars, camps, daycares, churches, worksites and restaurants, most states do not, creating obstacles to preventing future cases.
The extensive spread of the virus, combined with the country’s 50-state approach to pandemic response, has led to a dearth of information about where transmissions are occurring. Those shortcomings are in turn complicating efforts to safely open the economy and to understand the risks associated with certain activities and settings.
Experts know COVID-19 spreads in crowded indoor spaces, but more specifics could help state and local lawmakers strike a better balance between public health needs and those of the economy.
“If you want to take a more targeted approach to public health measures, the more information you have the better,” said Joshua Michaud, an associate director for global health policy at the Kaiser Family Foundation and an infectious disease epidemiologist.
“Rather than have a blunt, close-everything-down approach, you could be a bit more targeted and surgical about how you implement certain measures,” he added.
The Hill asked every state for information about the data they collect and share as part of their contact tracing programs, one of the main tools public health officials have to slow the spread of COVID-19.
Most states release information about outbreaks and cases at congregate settings like nursing homes, meatpacking plants, and prisons, which comprise the majority of cases. But there is less information publicly available about the numbers of cases or outbreaks tied to other settings commonly visited by people.
A handful of states including Arkansas, Colorado, Kansas, Louisiana, Maryland, Michigan, Ohio, Rhode Island and Washington track and publicly release data on the settings where COVID-19 outbreaks are occurring, according to responses from state health departments.
For example, Louisiana has tied 468 cases to bars in the state, but most of the new cases in the past week have been tied to food processing plants.
In The Hill’s review of publicly available state data, other settings for COVID-19 transmission include restaurants, childcare centers, gyms, colleges and schools, churches, retailers, weddings and other private social events. It is not clear how widely those settings contributed to infections because widespread transmission of the virus means many people who get sick do not get interviewed by contact tracers — over the past week, there has been an average of 42,000 confirmed cases, though many more are likely going undetected.
State health departments in Idaho, Illinois, Massachusetts, Mississippi, Missouri, New Hampshire, North Carolina, South Carolina, Tennessee, Texas, Vermont, Virginia and West Virginia told The Hill they don’t track location data.
Utah tracks outbreaks and cases tied to workplaces and schools, but not restaurants or bars.
Arizona, California, Delaware, Indiana, Oregon and Pennsylvania track infection locations, but don’t release it to the public.
“The number of people getting COVID-19 from isolated, identifiable outbreaks, such as those in long term care facilities, is decreasing, and more people are contracting COVID-19 from being out and about in their community, such as when visiting restaurants and bars,” said Maggi Mumma, a spokeswoman for the Pennsylvania Department of Health.
Bars, indoor dining and gyms are still closed in most of New York and New Jersey, so there is no current data to track for those settings.
But the state health departments also don’t release data on outbreaks or cases tied to other settings like childcare or retail stores.
For example, Minnesota lists nearly 7,000 cases as being tied to “community” exposure, but that includes settings like restaurants, bars and workspaces.
In Iowa, a state health department spokesperson said the agency is working on extracting and sharing this type of data on its website, while Maine would not say if they track by specific location.
The remaining state health departments did not respond to multiple requests for comment from The Hill and don’t have information about outbreaks or exposure settings on their websites.
Several states said local health departments may be tracking infection locations even if the state is not.
Experts said such a decentralized approach can miss outbreaks if local departments aren’t communicating with each other, meaning any data should be public.
“I do think it would be very valuable for states to make that information public,” said Crystal Watson, assistant professor at Johns Hopkins Bloomberg School of Public Health.
“It helps us collectively get a better understanding as policymakers, as people trying to help in the response. It can also help with personal decision making for people to understand … where it’s most dangerous to go related to getting infected,” Watson said.
The disparities between state health departments are partially due to a lack of federal guidance.
There are no federal requirements on the information contact tracers collect; guidelines vary from state to state, and sometimes from county to county.
Tracking data about where people are getting sick would allow states to take a “cluster busting” approach, experts said, by working backwards from confirmed cases to find where patients might have first contracted the disease, potentially stopping future outbreaks.
That approach requires a change in mindset for contact tracers, who typically focus on reaching close contacts of confirmed cases who might have been exposed to the virus. But research shows between 10 and 20 percent of people are responsible for about 80 percent of new infections, mostly through so-called super-spreader events.
“We know that the way this virus has transmitted is highly clustered groups and anytime you have settings where a lot of people are together in one place,” said Kaiser’s Michaud.
“Collecting good information on this — the cluster busting approach — is a good way to find out where your prevention efforts can have the best bang for your buck,” he said.
At the same time, some state programs are still not operating at full force and are struggling to keep up with widespread infections.
“I think that many parts of the country, especially outside of the Northeast … simply have too many cases to use contact tracing as the primary public health measure to control cases,” said Stephen Kissler, a research fellow at the Harvard T.H. School of Public Health.
“It’s just not enough,” he said. “We just don’t have enough resources, and in a lot of these places enough contact tracers, to follow up on all of the cases.”
IS YOUR CULTURE holding you back? Are the signals you are broadcasting as a leader, creating the culture you want—you need?
Culture experts Jeff Grimshaw, Tanya Mann, Lynne Viscio, and Jennifer Landis say in Five Frequencies that to make a good culture great, leaders must deliberately transmit strong and steady signals. Leaders create culture for better or worse, through the signals they are consciously or unconsciously broadcasting over five frequencies. To change a culture, you need to broadcast a strong, steady signal on each of these frequencies:
Their Decisions and Actions
Example is everything—especially when it is inconvenient and costs you something. If it is truly a “value,” what are you willing to pay for it? Think in the long-term. “Go long-term greedy.” “This can mean avoiding ethical shortcuts, hiring people smarter than you, delegating more, and helping prepare high performers for success beyond your team.”
What They Reward and Recognize
Reward the behaviors you want to see more of. “You are responsible for the dysfunctional behaviors that so bother you.” Everyone brings their emotions to work. “Understand and leverage the emotional algorithms that motivate your people.” Understand that it is all relative, scarcity and timing matter, and everyone appreciates being appreciated.
What They Tolerate (Or Don’t)
“Leaders are ultimately defined by what they tolerate.” Be sure the boundaries are clearly defined as well as the consequences. And don’t make excuses because you don’t want to feel bad or you can’t hold a particular star performer accountable, or because it’s really no big deal. It’s all-important, and consistency is vital.
What you tolerate or don’t tolerate is a balance. “When you decide to become more tolerant of some things (like where people work), you must become, if anything, less tolerant of other things (like the work not getting done). As Harvard professor Gary P. Pisano puts it:”
A tolerance for failure requires an intolerance for incompetence. A willingness to experiment requires rigorous discipline. Psychological safety requires comfort with brutal candor. Collaboration must be balanced with individual accountability.
How They Show Up Informally
When you show up, you “bring the weather.” People notice a leader’s tone, mood, and focus. They are weather in any organization. What do kind of weather do you bring?
When considering how you show up, the authors advise you to relinquish your raft. They introduce the concept with a story:
A traveler on an important journey comes to a raging river. It seems there’s no way to cross. And that’s terrible news because this is an important journey. Fortunately, she spots a rickety old raft on the bank, off in the brush. With trepidation, she pushes the raft into the water, hops on, and amazingly, uses it to reach the other side. She’s able to continue her important journey. She thinks: I may encounter other raging rivers down the path, so I must keep this raft. So she carries the raft on her back as she continues her journey. It’s a heavy raft, and it slows her down. When fellow travelers point this out, she’s incredulous: “You don’t understand,” she says. “If it wasn’t for this raft, I wouldn’t be where I am today!” And she’s right. That’s literally true. The problem is: If she doesn’t put down the raft, she may not get to where she needs to go on her important journey.
It’s your baggage. It’s your reactive tendencies that may have worked for you in the past that are no longer getting you where you need to be. Reactive tendencies like going with the flow, control, the need to be the hero, or being overly protective of your ego, eventually bring you diminishing returns.
Their Formal Communications
Formal communications don’t work on their own, but they serve to reinforce the other four frequencies. Approach your communications as a story to make it memorable. And say it over and over. “Go past the puke point because that’s often the turning point where employees are just starting to truly get it.”
Have a backstory. Know where you came from. “Look for stories of people demonstrating the behavior you want to see more of, especially when it’s not easy for them to do so.” Fill the communication vacuums. “Don’t push your people to the black market.”
Know, Feel, Do
To establish a reliable culture, you need to measure where you are and where you need to go. The authors call it Know, Feel, Do: what employees know, what they feel, and what they do.
The authors advise us to work backward and forwards. Looking forward, they ask, “What is the culture that makes this outcome possible and probable? What will employees consistently KNOW? FEEL? DO?” Looking at each of the five signals, what will you need to broadcast to your employees in each of the five signal areas?
It is also necessary to look backward and see where your current culture came from. What did each of the signals contribute to your current culture? It will help you to know what to change in order to close the gap from where to are to where you want to be.