‘They’re the ones who have the information.’ Miami-Dade waits on Florida for contact tracing

As the number of new COVID-19 cases surges statewide and in Miami-Dade, local officials have struggled to identify the precise places where the disease has been spreading — key information that public health officials need to help contain outbreaks of the disease.

But two months into Miami-Dade’s efforts to safely reopen businesses and other public spaces, county officials and the Florida Department of Health are still working out the details of how many workers will be needed to carry out the labor-intensive and time-consuming task of contact tracing — identifying those who have come into contact with someone who recently tested positive for COVID-19.

On Tuesday, Gov. Ron DeSantis said Florida has received federal grants for the state health department to hire workers to perform contact tracing.

“I’ve already green lighted $138 million for the Department of Health to support not just contact tracing but other personnel,” DeSantis said at a press conference in Miami. “All the counties have gotten huge amounts of money from the CARES Act. The contact tracing is something that can be done.”

The CARES Act is the coronavirus relief bill passed by Congress in March and intended to address economic fallout from the COVID-19 pandemic.

Asked who would hire contact tracing workers, the governor turned to Miami-Dade Mayor Carlos Gimenez, seated next to DeSantis, and said: “He announced that he was going to do it. ... He gave us a heads up that they were going to be investing in some of it.”

Gimenez did not respond. But afterward, he said the county does not have any workers on its payroll who perform contact tracing, and that he would wait for the state to execute a plan.

“It’s the purview of the Department of Health,” Gimenez said. “They’re the ones who have the information.”

During the news conference, DeSantis downplayed the importance of the work: “Contact tracing is not going to be enough.”

Later, though, he added that he has approved “a robust plan” from the health department for contact tracing. He didn’t provide details on how many people have been hired to do the work or even how many cases have been investigated through contact tracing.

“It’s a lot of people. It’s a lot of stuff,” DeSantis said. “But I think it’s also important to just point out that when you have a lot of these asymptomatic 20-year-olds, there’s not a lot of contact tracing that’s being effective with them because they haven’t been as cooperative with doing it. So there’s limits.”

Does Florida have enough workers?

In the past three weeks, as Florida’s case count has soared and more patients with COVID-19 have filled hospital beds, the state health department has reported that many of the new cases are occurring among younger people and particularly among those who visit bars or attend private house parties.

But the state’s daily reports on COVID-19 show that more than 84,300 cases or nearly 40% of Florida’s 213,794 persons diagnosed with the disease to date have yet to be contacted. The state report said about 30% or more than 63,480 Floridians who tested positive reported having contact with a known case, and only 1.2% of all cases or about 2,700 acquired the disease while traveling.

Florida’s health department did not provide any additional details on the agency’s statewide contact tracing efforts on Tuesday but two months ago, on May 6, Alberto Moscoso, communications director for the health department, put the number of contact tracers at 1,000 or more.

“More than 1,000 individuals, including students, epidemiologists and other staff from across the department, are currently involved in contact tracing every positive case of COVID-19 in Florida,” he told the Miami Herald.

The agency has not provided responses to the Herald’s repeated requests for details of the program, such as the number of people interviewed, the percentage of new cases linked to a known case and the percentage of cases linked to persons in quarantine.

Contact tracers are considered by public health experts to be essential to stamping out infectious disease outbreaks — reaching out to those who test positive, tracking down their contacts and connecting them to services. They also monitor persons under quarantine.

In order to effectively trace COVID-19 cases, Miami-Dade would need 10,695 contact tracers or about 387 tracers for every 100,000 residents, according to the Mullan Institute at George Washington University, which publishes a contact tracing workforce estimator. The calculation is based on Miami-Dade averaging 1,625 new cases a day. In the past two weeks, the county has averaged 1,725 new cases a day, according to the state’s latest county level report.

For all of Florida, the health department would need 48,439 contact tracers to conduct interviews, notify persons and follow up with known cases, according to the George Washington University estimator.

The state’s health department confirmed 7,347 new cases of COVID-19 on Tuesday, raising the statewide total to 213,794 since the pandemic began. Of those, 2,066 cases were reported in Miami-Dade, bringing the county’s total to 51,058 known cases since the start — even as Gimenez announced this week that he would roll back reopening, including restaurant indoor dining, because of the spike in coronavirus cases.

Local officials need more data

Local government leaders say they need more detailed information to inform policy decisions on what parts of the community to shut down and when to mandate face coverings in public places. Miami Mayor Francis Suarez said he has asked the health department where people are saying they may have been exposed to the virus — information that would be provided through contact tracing.

On Tuesday, Suarez said he has been asking for more specific contact tracing data from the health department on twice weekly phone calls. He has another call scheduled for Wednesday, when he plans to again ask where — specifically — the virus might be spreading.

“We are pushing the department of health to give us the data that we need to make better decisions,” Suarez told the Miami Herald. “We’re not quite where we need to be in terms of information in order to make decisions.”

Joseph Corradino, mayor of Pinecrest and first vice president of the local League of Cities, said the lack of specifics leaves municipal leaders doing “a little bit of guesswork” on where outbreaks may be occurring and how to respond.

“We can’t treat it with precision,” he said. “We can’t treat it surgically.”

Working with the state

Contact tracing was supposed to be a central element of Miami-Dade’s reopening plan under Gimenez, who told county commissioners on May 19 that Miami-Dade would more than triple the 200 or so contact tracers Florida’s health department said it had working in the Miami area.

“Right now the state has a total of 1,000 contract tracers statewide,” Gimenez said at the time. “We’re going to have 800 to 1,000 right here in Miami-Dade.”

A May 4 presentation about how to stem the pandemic in the county prepared by the McKinsey & Company consulting firm under a $568,000 county contract envisioned a flood of contact tracing data guiding Miami-Dade’s response and a regional exchange of information to track the spread of COVID-19 across county lines.

Among the to-do items listed in the presentation: “Tracking daily figures on % of population, # cases traced” and “Daily review of new contact tracing results affecting neighboring counties.”

Eight weeks later, the Gimenez administration said it still had not reached an agreement with the DeSantis administration to expand contact tracing in Miami-Dade. Florida’s Health Department says confidentiality rules reserve diagnosis information to the state, meaning county governments can’t launch separate contact tracing operations.

“We’ve been trying to work with the state for a couple of months on contact tracing,” Gimenez said at a July 2 press conference at a staging ground for county crews heading out with masks and hand sanitizers in the COVID “hot spot” of Allapattah in Miami. “That’s entirely in their purview, entirely under their control. ... We’ve also extended our hand to help in any way possible with contact tracing.”

On Tuesday, Gimenez said he would wait to see what the state does with its contact tracing efforts in Miami-Dade. He said the health department has an arrangement with CareerSource, a statewide workforce policy group, to train and hire workers to do contact tracing.

But he did not say the county would take the lead on the effort.

“The state put $138 million into contact tracing,” he said after the press conference. “I don’t know why Miami-Dade needs to put additional money into it. If we have to, we will. I’m going to let that process ride out.”

Miami Herald staff writers Ben Conarck and Mary Ellen Klas contributed to this report.