As Oklahoma enters the first phase to reopen shuttered businesses and send some people back to work on Friday, officials and health experts say the state must ramp up testing, tracing and isolation efforts to lower the risk of coronavirus flare-ups.
Gov. Kevin Stitt last week announced a three-phase plan to reopen the state with the first stage of the plan starting Friday, when restaurant dining rooms, movie theaters, gyms and places of worship can open statewide as long as they adhere to “strict” social distancing and sanitation guidelines.
Infectious disease experts say that reopening even in a tiered approach brings the risk of a resurgence of COVID-19 infections and though the state is seeing a slow but steady downward trend in new cases and hospitalizations, the state must remain diligent.
To get a better grasp on where the virus is spreading and to contain it, widespread testing and a robust workforce of contact tracers are key.
“That’s the key, and then isolate them (infected people) at home so that the rest of the non-infected people don’t have to be sheltered at home,” said Gary Raskob, dean of the College of Public Health at the University of Oklahoma and regents professor of medicine and epidemiology.
Contact tracing is a core tool used by public health staff to control the spread of disease by working with confirmed patients and connecting with everyone they had close contact with while the patient might have been infectious.
The process, which can take several hours or several days, helps infected people and those who were exposed isolate themselves.
There are 150 employees across the state who do contact tracing, many who are nurses juggling multiple duties. Over the next month, the state aims to add 500 tracers in partnership with the National Guard, University of Oklahoma and Oklahoma State University, said Commissioner of Health Gary Cox. The health department is in the process of training another 150 people.
The state has been “strategically building out” its contact tracing capabilities in a phased approach, Cox said. Oklahoma could double its tracing capacity as early as next week, he said. The goal is to have 1,000 ready to deploy as needed.
“Testing and contact tracing go hand-in-hand in our efforts to really slow the spread and minimize spread of COVID, while at the same time, safely opening our economy here in Oklahoma,” Cox said at a news conference Thursday.
The National Association of County and City Health Officials recently issued a position saying there should be 15 contact tracers per 100,000 people in a nonemergency situation and 30 tracers per 100,000 people during a pandemic.
With its current 150 tracers, Oklahoma has under four tracers per 100,000 residents. However, if the state were to reach 1,000, it would have about 25 per 100,000.
Former U.S. government officials released a letter Monday calling for an additional 180,000 contact tracers until a vaccine is available, NPR reported.
Contact tracing is a “substantive undertaking,” Raskob said, and experts say investigators need to be able to contact 10 to 15 people per case. The state might need to get “innovative and think out of the box,” he said.
“I know the health commissioner is working very hard to get the state there very quickly,” Raskob said. “So you know, I think there could be debate about what that is but it’s going to need a lot of people, and I know that they’ve been working every day around the clock very hard to get people there to be ready to train new people to do that.”
The Tulsa Health Department and Oklahoma City-County Health Department, which are independent from the state, have their own tracing capabilities.
In Tulsa, the department expanded from a group of four epidemiologists to a team of 25 people conducting contact tracing after many employees were reassigned to the role, said Leanne Stephens, a spokeswoman for the department.
“We are continually assessing our operations to ensure adequate staffing to meeting the need, and are able to draw on community resources like the Oklahoma Medical Reserve Corps as needed as well,” she said.
Over the last month, the state has notably increased its testing capacity, largely by opening 80 drive-through testing locations. On April 12, it had completed about 22,500 tests, and as of Thursday had done over 60,000 tests.
By the end of May, Cox said, the goal is to have tested over 2 percent of residents — or 90,000 people — in the state, which has a population of less than 4 million people. The department announced on Thursday that it will start to deploy vans to underserved communities for testing.
Stitt reiterated earlier this week that the state has all the tests it needs and encouraged even those who have no symptoms to get tested if they wanted.
“We need more testing,” he said. “It’s great for the surveillance, and even if you are asymptomatic and you just want to get tested, we encourage you do that.”
The Oklahoma State Medical Association has recently come out and said it believes it is too soon to start reopening the state. Early limitations around testing was a hurdle, and increasing capabilities is key to safely reopen the state, said OSMA President Dr. George Monks.
“I think we’re really going to ramp up in the next week or two or at least I’m hopeful that we can,” Monks said in an interview last week.
As the state starts to reopen, leaders should keep an eye on new cases in case there is a spike, said Dr. Douglas Drevets, OU Medicine chief of infectious diseases. That metric relies on the state continuing widespread testing efforts. State and local health departments are also tracking reports of influenza-like illnesses.
“I think we should have a fairly good warning system about what’s happening in our own community,” Drevets said on Wednesday.
It’s important officials watch surrounding states that are also starting to reopen, such as Georgia and Texas, and try to learn from their experiences, he said.
Stitt has said that plans to reopen the state would rely on data and that he would adjust plans to reopen if needed.
“I think phasing is crucial because we cannot let it resurge to the point that it exceeds the ability to contact, trace and isolate, or exceeds the ability of our healthcare system to deal with it,” Raskob said.
Has Oklahoma passed its peak?
“It depends on what peak we’re talking about. We have probably passed the peak of hospitalizations for now,” Drevets said.
“That doesn’t mean we won’t see another resurgence in the future. We have not yet passed the peak of deaths because we’re still seeing and recording deaths in Oklahoma, although our number of deaths per day will also start going down now that hospitalizations have gone down, too.”
