At Wednesday’s Clark County Board of Health meeting, Clark County Public Health Officer Dr. Alan Melnick ran through criteria for entering Phase 3 of Washington’s COVID-19 recovery plan.
As he briefed the Clark County Councilors, they looked at metrics in Melnick’s Powerpoint presentation. Nearly every statistic was trending positively in Clark County, according to Melnick.
The county rests comfortably below the state’s threshold for newly diagnosed cases over the last two weeks. The county also has tested at less than a 2 percent positive rate recently, and hospital bed capacity is in good shape. The county fares well in a handful of other metrics, too.
But in the middle of Melnick’s presentation, he paused on one slide where Clark County has so far fallen short of the state’s Phase 3 targets.
One Phase 3 goal is that public health workers reach 90 percent of those with confirmed cases by phone or in-person within 24 hours of a positive lab report. The county is at 61 percent in that area. Another goal is that public health workers reach 80 percent of close contacts of a confirmed case by phone or in person within 48 hours of receipt of positive lab test report.
The county was still gathering its own data on that metric, Melnick said, at the meeting.
“We’re continuing to ramp up there,” he told the council. “We are a bit below the metric … but we are improving our ability there.”
As local health departments have had their budgets slashed dramatically since the 2008 Great Recession, public health agencies have lost close to a quarter of their overall workforce, close to 60,000 workers nationwide. That means local health departments, the front line of outbreak response, are impacted in their ability to do the necessary groundwork of investigating outbreaks.
“We need public health infrastructure to do this work,” Melnick told The Columbian earlier this month.
Help is on the way
While Clark County Public Health is not yet meeting the state’s contact notification metrics, Public Health has boosted its workforce and investigative capacity in recent weeks and will continue to do so as the county progresses in reopening.
Outbreak investigation and case notification are necessary components of the COVID-19 response, because cases and close contacts can be identified and isolated, mitigating the spread of coronavirus.
After weeks without active monitoring because of a lack of needed workforce, Public Health implemented active monitoring earlier this week. That means Public Health is calling confirmed cases and close contacts every day to monitor symptoms.
Public Health is able to do this work now because Clark County has contracted with Public Health Institute, a California nonprofit, to supply the county with more workers. The number of people working varies each day, but Public Health Institute has supplied 20 contact notifiers, plus one supervisor, one manager and one resource coordinator, according to Clark County Public Health Public Information Officer Marissa Armstrong.
Public Health Institute has another eight contact notifiers starting Monday.
Public Health is using 14 nurses as temporary employees to conduct case interviews. Another five nurses will start work in the coming weeks.
Marta Induni, the Senior Director of Research at Public Health Institute, said the nonprofit hires locally for these positions, so folks know the community they are working with.
“It’s the county work that makes all the difference,” Induni said.
Empathy is key
Induni said trust is important to case investigation and contact notification. Public Health Institute also places an emphasis on hiring workers who are bilingual. That’s important in Clark County, where more than 30 percent of cases have been Latino, according to Public Health data.
The key is being an active listener, and an empathetic person. Sara Schroeder, an environmental health specialist with Clark County Public Health, worked the response for last year’s measles outbreak and this year’s pandemic.
Schroeder said notifying people that they have been exposed to measles or coronavirus is important, but so is listening to people’s concerns and giving them helpful information. Schroeder stressed that this process is done not to track people or be invasive, but to help the larger community.
“Some people are fearful of this, but it’s so important,” she said. “If people don’t participate, then it hinders our abilities.”