The City of St. Louis reported 25 new cases of COVID-19 on May 18.
For Franda Thomas and her team of 10 disease investigators at the city’s health department, that number means a lot of phone calls, emails and digging.
“I’m not going to say 25 new cases isn’t overwhelming,” said Thomas, communicable disease bureau chief at the City of St. Louis Department of Health. “That’s 25 people, 25 phone calls and many pieces of a disease investigation. But we are trained and seasoned disease investigators, and that’s what we do.”
As part of their investigation for each new COVID-19 case, Thomas’ team performs contact tracing. It’s one of the most important tools that public health officials have in reducing the spread of the virus. If someone tests positive, Thomas’ team will try to find everyone who may have come in contact with that person and ask them to quarantine for 14 days or get tested. Her team can also monitor these people through new software, which allows the individuals to voluntarily submit information about their symptoms.
During a May 19 aldermanic committee meeting, Alderman Jesse Todd (D-Ward 18) posed a scenario to Thomas. Let’s say Todd was at a neighborhood meeting — with less than 10 people gathered, of course — he wasn’t wearing a mask, and one of the people at that meeting later tested positive for COVID-19.
“Would I need to quarantine for 14 days?” Todd asked Thomas.
She told him, “Yes.” However if Todd had been wearing a mask and had kept six feet apart from others, his risk of transmission would have been much lower and he would likely not have to quarantine, Thomas said.
People who have been exposed can now get tested, so they don’t have to quarantine for 14 days, she said, even if they don’t have symptoms. Similarly during St. Louis County Executive Dr. Sam Page’s briefing on Wednesday, May 20, he said that the county’s contact tracers were having people who were exposed to COVID-19 get tested instead of having to quarantine for 14 days.
“The more people can get tested, the more they can move on with their lives,” Page said.
However, depending on which testing location you call, you may get a different answer. TheSt. Louis American called Affinia Health’s testing call line and (using Todd’s scenario) asked if a person could get tested if he/she were at a meeting with someone who tested positive for COVID-19. TheAmerican was told, “No” — the person had to be symptomatic and testing was still prioritized for essential workers and those who are high risk. Even if the exposed individuals were tested, they still needed to quarantine for 14 days, according to the Affinia call line.
However, people answering the call lines for both CareSTL Health and Betty Jean Kerr People’s Health Centers said that they would test the exposed individual, but the person would need to quarantine until the test results are in.
A spokeswoman for Affinia said in response to Todd’s scenario, “We follow CDC guidelines for testing, which does include testing of asymptomatic individuals in prioritized, high-risk categories.”
Each disease investigation is different, Thomas said. Some people who test positive have come in contact with dozens of people, she said, and require an extensive amount of work and hours. However, others in nursing homes and other situations are more clear-cut.
Alderwoman Cara Spencer, chair of the aldermanic Health and Human Services Committee, expressed concern that the city did not have enough people conducting these investigations during the May 19 aldermanic meeting. National experts recommend 30 tracers per 100,000 population. Based on the high-risk factors facing the city’s population, she said the city should have 90 tracers, but it has only 10. Now that stay-at-home orders have lifted, the investigations are going to be more time-consuming, she said, and people are coming in contact with more and more people.
St. Louis County has a lower rate of infection, she said. However, there are 80 to 90 people currently doing contact tracing for the health department, according to a county spokesperson, though not all are working full-time. The county also is hiring an average of 10 new public health staff members each week. Vigorous testing and contact tracing must be part of the city’s strategy, as well, in lifting the stay-at-home order, Spencer said.
“If that doesn’t happen,” Spencer said, “the steps in reopening could be reversed and the city closed down due to more positive tests, more people sick and, most unfortunately, more deaths.”
Thomas said that her team could use more help, but she is not sure if she needs 90 people — at least not as of May 20, she joked. A spokesman for the city health department said they are discussing how to bring on additional volunteers to conduct contact tracing.
During the May 19 meeting, Alderwoman Sharon Tyus asked Thomas if her team receives pushback from people when they ask them to disclose the names of people they have been in contact with. Thomas replied that they did.
“There have been times when people say, ‘I really don’t want to give you a list. I know this person cannot afford to be out under quarantine — they’ll lose their job.’ Or ‘I don’t know how this will go over with my employer.’”
Some people also don’t trust the government, she said, and don’t want to talk to them. In those cases, they can try to investigate their “footprint” and go to their employer directly.
Tyus said even if investigators don’t disclose the name of the employee, it is likely that the employer would know who the employee is. Thomas said they were aware of that.
Thomas said her team also has been able to put people in touch with social services to make it possible for them to quarantine. The Integrated Health Network has been a helpful partner in connecting people who don’t have primary health care providers with Federally Qualified Health Centers, such as CareSTL Health and People’s. They have also been working with places that provide home meals to make sure those quarantined at home still have access to food.
Thomas said, “We exhaust all options to decrease exposure and give the resources they need.”