Clark County Public Health to ramp up tracing and monitoring of COVID-19 cases


The ramp-up is part of Gov. Jay Inslee’s plan to reopen the state

CLARK COUNTY — As of Monday evening, Clark County has seen 393 confirmed cases of COVID-19, with 24 deaths blamed on the viral pandemic. That number includes 18 new positive diagnoses since Friday, and one additional death of a woman in her 80s.

This graph demonstrates the epidemiological curve of the COVID-19 outbreak in Clark County. Image courtesy Clark County Public Health
This graph demonstrates the epidemiological curve of the COVID-19 outbreak in Clark County. Image courtesy Clark County Public Health

The news comes amid growing pressure on Gov. Jay Inslee to accelerate his four-phased plan to reopen the state. Battle Ground City Councilors last week unanimously voted to send a letter to Inslee’s office, urging him to let local government have more control over when and which kind of businesses can reopen.

On Tuesday, Inslee unveiled a key element of his plan to reopen the state, which will include 1,307 contact tracers, made up of 530 state and local public health professionals, 351 members of the Washington National Guard, and 390 Department of Licensing employees.

“We think of this as a smart weapon against this virus,” Inslee said during a Tuesday press conference announcing details of the plan. “It’s smart because it’s targeted for the folks that are positive and, if it’s successful, it will allow us to open our economy.”

Inslee described the tracing program as a “corral we want to put around this virus,” and noted it would include contacting confirmed COVID-19 cases within 24 hours. They would then follow up with close contacts within 48 hours.

“We need people to isolate themselves as soon as they get symptoms, including their entire household, even before we get testing back,” said Inslee. “This is going to take a lot of commitment by individuals in Washington.”

Inslee noted that tracers would not be disclosing to close contacts of confirmed cases who it was that may have exposed them. They will also not be asking about immigration status, financial situation, or marital status.

Lieutenant Steve Hobbs of the Washington National Guard said they would be following the lead of the state Department of Health, which would be providing information on who to contact.

Hobbs said they would only be reaching out to people who have agreed to be contacted, and that the individual would have the right to end the call at any time.

“This is a unique mission for us, but it’s not unique for us to help the people of Washington state,” said Hobbs.

Inslee said he anticipates that they will largely be ramped up for contact tracing by the end of this week.

Last week, Clark County Public Health unveiled a proposal to spend just over $8 million, much of which would go towards hiring 18 case investigators, another 18 contact tracers, and support staff. 

Most of that cost, the county hopes, would be covered by the nearly $27 million Clark County expects to receive from the CARES Act. Already, $1 million has come in from the state and federal sources for coronavirus response.

Until now, Public Health has taken an emergency approach to contact tracing. For most confirmed cases, patients are given a one-page document with recommendations for self-quarantine, which they are asked to share with any close contacts.

In cases where the COVID-19 patient may be high risk, or has been around people in a higher risk category, such as an adult care home staff member or patient, tracing has been more intense.

“In those cases, we not only interview the cases, but we also identify who their close contacts are and we engage with the close contacts,” said Dr. Alan Melnick, the county’s Public Health officer at the most recent Board of Health meeting.

Clark County Public Health Officer Dr. Alan Melnick is shown here at an interview with Clark County Today in February. Photo by Chris Brown
Clark County Public Health Officer Dr. Alan Melnick is shown here at an interview with Clark County Today in February. Photo by Chris Brown

But that doesn’t rise to the level of “active monitoring,” which would mean daily check-ins with confirmed cases and their close contacts.

“That’s what we’re working on here with the CARES Act funding,” Melnick says. “As the stay-at-home order is modified, we really need enough staff to do that active monitoring of folks in quarantine.”

Active monitoring includes daily check-ins with people who have tested positive for the coronavirus, as well as those they have been in close contact with. 

Melnick has said that, while the governor’s “Stay Home, Stay Healthy” order does provide the authority to require involuntary isolation, Clark County Public Health will only be asking people to self-isolate.

“Voluntary compliance works; and we’ve seen it work during the measles outbreak,” the department said in response to a question on their Facebook page.

In order to provide options for people who need a place to stay, the proposal includes $608,000 for the Department of Community Services, which would staff the Motel 6 in east Vancouver, where people can stay if they can’t isolate themselves at home. It is also being used for members of the area’s homeless population who test positive for the infection.

Public Health stresses the proposal is just that, a worksheet that is still being finalized.

“We might ramp up or ramp down depending on what we’re seeing,” Melnick told the Board of Public Health. “We hope to have folks in place, starting pretty quickly, but ramped up by the end of the month.”

During the 2018 measles outbreak, the county had as many as 250 people working to do contact tracing, says Melnick. But most of those came from the state public health department.

“This time, you know, everybody around us is having the same problem,” says Melnick. “So we don’t have that.”

It’s unclear how quickly the county could begin the hiring process. Members of the Clark County Council could approve the spending as early as their Council Time meeting on Wednesday.

Public Health says it would take approximately three weeks to train case investigators, and around three days to get tracers up to speed.

Testing capacity ramping up

Another key element of the governor’s plan to begin reopening the state is a dramatic increase in the availability of testing for COVID-19.

To this point, it has been difficult to determine precisely how many tests have been conducted in Clark County. As of May 10, the state public health department lists 6,286 total tests in the county, although Melnick says that number is still likely an underestimate of the actual amount.

“We’re asking again for providers … to provide all results,” said Melnick last week.

Last month, Inslee said he would like to see the state’s testing capacity increase from around 4,000 per day, to something closer to 30,000 or 40,000 before entering Phase 2 of the reopening plan.

Inslee mentioned on Tuesday that 30,000 tests had been provided by Molecular Labs of Vancouver, which should also be able to provide more bandwidth for analyzing test results.

This graph shows the total number of tests performed each day in Washington state as of May 10, 2020. Image courtesy Washington Public Health Department
This graph shows the total number of tests performed each day in Washington state as of May 10, 2020. Image courtesy Washington Public Health Department

In a sign that capacity is increasing locally, Clark County Public Health is now urging anyone experiencing symptoms consistent with COVID-19 to seek testing.

“Early testing is critical to slowing the spread of COVID-19 in Clark County,” the department said in a release on Monday.

Symptoms listed by the CDC for COVID-19 have been expanded. The two most important ones remain a dry cough and shortness of breath, but the list also includes:

  • Fever
  • Chills
  • Repeated shaking with chills
  • Muscle pain
  • Headache
  • Sore throat
  • New loss of taste or smell

Providers have been increasingly testing a larger number of people. The Vancouver Clinic has worked with Public Health to do broad testing in any adult care facility where there had been a confirmed case, along with drive-through testing of first responders and healthcare professionals experiencing symptoms.

This graph shows the rate of hospitalizations for COVID-19 in Washington state as of May 10, 2020. Image courtesy Washington Public Health Department
This graph shows the rate of hospitalizations for COVID-19 in Washington state as of May 10, 2020. Image courtesy Washington Public Health Department

Both Legacy and PeaceHealth Southwest have said that anyone who is experiencing symptoms similar to COVID-19 should now be able to receive a test. Many providers now have access to point-of-care rapid testing, which can provide results in as little as 15 minutes.

“It’s important that people get tested as soon as they begin experiencing COVID-19 symptoms,” said Melnick. “Early testing and identification of cases enables Public Health to isolate those who are sick and quarantine their close contacts. Doing this as early as possible will help us to slow the spread of COVID-19 in our community.”

The county is also providing a list of facilities people can contact if they want to receive a test.

  • Legacy GoHealth. Hazel Dell, (360) 787-4151. Cascade Park, (360) 787-4135.
  • Providence Family Medicine, Battle Ground. (360) 687-6650.
  • Rose Family Clinic, Vancouver. (360) 977-1563.
  • The Vancouver Clinic. Various locations. Call (360) 882-2778 to schedule an appointment.

The state insurance commissioner has required that insurers waive co-pays and deductibles for COVID-19 testing.

There has also been an increase in antibody testing being done in Clark County, though that is at the discretion of healthcare providers. A number of tests approved under an Emergency Use Act from the Food and Drug Administration were determined to have a high number of faulty results, leading the agency to step back and require tests to go through an approval process before they can be sold.

Melnick says, at this point, the high error rate of such tests, which can be confused by the presence of antigens to other coronavirus-caused diseases, such as many strains of the common cold, makes the data somewhat unreliable.

Further, the science behind whether having antigens for COVID-19 makes you immune to being reinfected is still being reviewed.

“So if somebody came to me as a physician and asked me to do a serology test, and I did it,” said Melnick, “I could not give them reliable information on whether it’s safe for them to go back to work, without, for example, using protective equipment, or whether it’s safe for them to be in crowds or anything like that.”

Which is why the state is focused on early testing, and isolation of known and potential cases as a key to keeping the number of infections down even as people return to public life.

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About The Author

Chris Brown comes to Clark County Today with 15 years of local news experience as a reporter, editor, and anchor at KXL News Radio and KOIN-6 TV in Portland. In 2016, he won an Oregon Association of Broadcaster's award for Best Investigative Reporting for a series on America's Violent Youth. He has also been awarded by the Associated Press for Best Breaking News coverage as editor of Portland's Morning News following the 2015 school shooting at Umpqua Community College in Roseburg, Oregon. The second oldest of eight home-schooled children, Brown graduated from high school two years early. After several odd jobs, he earned an internship at KXL Radio, eventually working his way into a full-time job. Brown has lived in Clark County his entire life, and is very excited at the opportunity to now focus full-time on the significant stories happening in his own back yard, rather than across “the river.’’ After a few years in Vancouver, he recently moved back to Battle Ground with his wife and two young daughters. When he's not working to report what's happening in Clark County, Brown enjoys spending time with his family, playing music, taking pictures, or working in the yard. He also actually does enjoy long walks on the beach, and sunsets.

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