Maine has again been forced to scale back its efforts to trace the contacts of every person infected with the coronavirus, shifting more of that responsibility onto some lower-risk individuals as the illness keeps surging to record levels and overwhelming the state’s ability to do all that work on its own.
Until now, the state’s disease detectives have reached out to all people confirmed to have COVID-19 to determine how they may have caught the disease and to get a list of their closest contacts so that the detectives could advise those people to quarantine.
But the state will now only offer that intensive outreach to people in some of the highest-risk groups for catching and spreading the infection, according to Nirav Shah, director of the Maine Center for Disease Control and Prevention.
Those groups include children, people older than 65, hospitalized patients, racial and ethnic minorities, people with disabilities, health care workers, school workers, and residents and employees at congregate living facilities such as nursing homes and homeless shelters.
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People outside those groups will no longer receive the gamut of the state’s contact tracing services, but will instead be contacted by call center workers at Maine’s health department who will ask them to reach out to their recent contacts themselves and tell them to quarantine. Those call center workers will also offer other resources and information to infected people who don’t fall into the priority groups.
It was an “extremely difficult” decision to make that change, Shah said during a news conference on Monday.
While it’s meant to ensure that vulnerable places such as hospitals, nursing homes and schools can keep benefiting from robust contact tracing, he acknowledged the risk that some individuals who fall outside those groups may not reach out to all of their contacts themselves. He also noted that some people might not be identified as high-risk if they’re not asked or they don’t answer some questions when they are tested.
Those are risks “that we had to balance against making sure that we really focus on individuals who are at the highest medical risk,” Shah said. He estimated that between 40 and 60 percent of people infected with the coronavirus on any day fall into one of the high-risk categories that warrants a full state investigation.
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Shah announced the change on Monday, when the state broke another record with 425 new daily coronavirus infections, the first time that number climbed above 400. He first hinted that the changes were coming at the end of last week.
The ongoing surge has swamped the state’s disease investigators, who must sort through many different lab results each day to determine which cases are new, before they can even begin the rest of their investigation and contact tracing. There were still more than 4,000 of those lab results waiting to be sorted as of Monday afternoon, according to Shah.
Maine CDC has made a few other recent changes in its investigation and contact tracing of new coronavirus infections as staff have been overwhelmed by the surge, including boosting the number of employees doing that work to more than 140. The Maine Department of Education has also deployed a team of mostly retired school nurses to notify those considered close contacts of students and school staff members who test positive for the coronavirus.
Maine Health and Human Services Commissioner Jeanne Lambrew said the state anticipates adding another 30 case investigators and 50 contact tracers in the coming weeks.
But the state has made other moves over the past month to scale back the extent of its contact tracing as infections have risen. On Nov. 19, the CDC announced it would no longer try to determine the origins of suspected cases of COVID-19 until they have been confirmed with a laboratory test. A few days later, it stopped directing contact tracers to remain in touch with coronavirus-infected individuals throughout the course of their illness.
A number of other states, confronting surging case levels, have made similar changes to their contact tracing strategies. Maine health officials consulted with counterparts in New Hampshire, New Jersey and Kentucky before rolling out the change, Shah said.
“This is a challenge that the entire country is facing,” he said.