County Health Officer talks of recent challenges in contact tracing, with some persons testing positive refusing to cooperate with Health Department staff
Editor’s note: The Sarasota News Leader is providing general reporting on the novel coronavirus to readers for free as a public service.
On July 11, the day before the Sarasota County Commission officially began its four-week summer recess, Commissioner Charles Hines emailed Rich Collins, director of the county’s Emergency Services Department.
“I know the Commission is on break for a little while,” Hines began, “but I’m sure we are all very interested in continuing to receive the latest updates in regards to hospitalizations and ICU beds.”
Hines was referring to the novel coronavirus pandemic, on which both Collins and Chuck Henry, the county’s Health Officer, provided updates to the board members during their regular meeting on July 8.
“Medical professionals and common sense dictates that in areas [where] you [cannot] socially distance, masks are important and can help slow the spread of the virus,” Hines continued. “Our Commission, for various reasons, was not willing to issue a mandatory order. However, I would hope we would be willing to reconsider that position should evidence from other [counties] indicate the mask order, rather than a strong recommendation, is slowing the spread of the virus,” Hines added.
“If that direct correlation between counties that have implemented the mandatory order and the ones that have not is shown,” Hines wrote, “I believe [County Administrator Jonathan] Lewis would have evidence and the power under his emergency powers to consider issuing a mandate or call an emergency meeting for us to consider doing so. I’m open to continue this conversation at any time and thank you all for the hard work that you’re doing.”
Hines concluded that email with the following: “As long as hospital beds remain available and the death rate continues to decline that is good news.”
Subsequently, Sarasota Memorial Hospital (SMH) officials have made it clear through public outreach that its COVID-19 patient count has continued to climb.
On July 13, the hospital reported that its patient census included 98 people who had tested positive for COVID-19. The update added that 19 COVID-19 patients were in its Intensive Care Unit (ICU). In June, the report pointed out, the hospital increased its ICU capacity from 62 beds to 72, noting, as well, that it has “enough ventilators to create more than 100 ICU beds, if needed, to manage a surge.”
The following day, July 14, SMH reported 111 patients who had tested positive for the virus. Of the 54 persons in the ICU, the update added, 26 had COVID-19.
By July 15, the COVID-19 patient count had climbed again, to 118. The number of infected persons in the ICU had not changed, however.
Additionally, on July 15, Kim Savage, the hospital’s public information officer, sent an email to the news media, writing about concerns that David Verinder, CEO of the Sarasota Memorial Health Care System, had addressed that day in a video interview. Among them, she wrote, “SMH continues to monitor all resources to ensure we can meet the needs [for] the community. While SMH has enough PPE [personal protection equipment, such as masks and face shields], [other] equipment and beds, there are growing concerns about proper staffing and the hospital is working hard to combat these challenges.”
Further, Savage noted, Verinder had said that “[w]hile SMH continues to address the COVID-19 pandemic, the hospital is asking the community to take this seriously and take all proper precautions including hand hygiene, social distancing when possible and wearing masks to reduce the spread of the disease.”
During the County Commission’s budget workshops on July 1 and 2, Commissioner Hines raised the issue of masks, but it was clear that he did not have support from the majority of his colleagues for the implementation of an ordinance.
On July 8 — the board’s last regular meeting date before its summer recess — he again brought up the topic as Collins of Emergency Services was providing a COVID-19 update to the commissioners.
After Collins talked about numbers of cases in counties and municipalities where mask ordinances have been implemented, Hines questioned whether enough time had passed since the measures were put into place to determine their effectiveness.
For example, the latest “heat map” county staff had produced, in collaboration with the Florida Department of Health in Sarasota County, showed the zip code areas with the highest totals of new COVID-19 cases over the previous 14 days in Sarasota County were within the city of Sarasota. The City Commission’s face-covering ordinance went into effect at 12:01 a.m. on July 1.
“If all of a sudden those statistics flip on their head,” Hines said, showing direct evidence that masks are leading to a reduction in new coronavirus cases, then that would indicate the need for county action on face coverings.
Addressing the county administrator, Hines added, “That’s what I want you to watch, Mr. Lewis, while we are on break.”
Hines added then that Lewis might need to issue an executive order requiring the use of face coverings or request that the board members conduct an emergency meeting to consider such action.
In a Facebook Live interview posted on July 15, county Health Officer Henry continued to stress the importance of wearing face masks, as he has during commission meetings. “The science is clear,” Henry said during the Facebook Live interview with county Communications Director Donn Patchen: “If we wear face masks, it helps prevent the spread of coronavirus.” When people cannot be certain they can maintain social distancing, they should wear face masks, Henry said, especially indoors.
During the commissioners’ discussion on July 8, Henry pointed out that some people refuse to wear masks, regardless of local government mandates.
Commissioner Nancy Detert said she believed more people would wear masks if they had clearer statistics about the number of COVID-19 patients in the hospitals and the number of deaths attributed to the virus.
Yet another issue that concerns her, Detert indicated, is the fact that young people were told at the outset of the pandemic that “they were immune [to COVID-19].” Yet, she added, “The science keeps changing. … They could die; they could get very sick. That [knowledge] might change their behavior, too.”
As of July 15, the median age in Sarasota County for persons who had tested positive for COVID-19 was 39. The lowest median age since July 1 was 36, the Florida Department of Health reported; the highest median age was 50.
‘Overwhelming the hospitals’
Commissioners also talked with Henry about the fact that, from the beginning of the pandemic, they were told to focus on the need to prevent the hospitals from becoming overwhelmed with COVID-19 patients.
Henry explained that as enabling the hospitals in the community to continue to function, to provide care for everyone who needs it, regardless of what a person’s medical issue might be.
Lewis added later that, as he understood it, the goal was to keep the medical complexes from having “to go into their surge plans,” which — as Henry and Collins have pointed out — make it possible for them to handle extra patient capacity.
“If Sarasota Memorial Hospital says, ‘When you hit this number, we’ve got serious concerns,’” Chair Michael Moran responded, “then we need to have serious conversations” regarding steps the board can take to control the situation.
“What keeps you up at night?” Commissioner Christian Ziegler asked Henry.
“Worrying about our overall health care system,” Henry replied.
Commissioners also debated the issue of hospital capacity in regard to persons admitted because of problems stemming from a COVID-19 infection and those who were found to test positive for the virus after they became patients.
“Hospitals typically will test every admission,” Henry told the board members, because the medical staff needs to know the status of each person in their care.
A person who has COVID-19 has to be put in isolation, Henry added, and staff has to use full PPE to care for the person. Therefore, caring for anyone with COVID-19, he pointed out, “dramatically increases staffing and spacing requirements.”
The contact tracing issues
During his July 8 remarks, Henry also responded to a number of questions from Ziegler about contact tracing.
As Ziegler has pointed out in the past, a member of his family who was asymptomatic decided to get a COVID-19 test. Before the person learned the result, the person spent time with Ziegler and Ziegler’s wife and three children. As a result, Ziegler said, the Health Department notified them of the need to quarantine themselves for 14 days.
Henry explained that his staff had had more challenges in recent days, with new daily positive case counts climbing higher than 100 and, in on one occasion, above 200. (On July 3, the Florida Department of Health in Tallahassee recorded 243 new COVID-19 patients in Sarasota County. However, on July 11, the figure was 465 — the highest daily total thus far for the county. On July 15, the figure was 281, the state reported.)
On July 8, Henry told the commissioners that the state had provided more money to his department to hire extra staff for contract tracing, which had helped.
Then Henry talked about other concerns related to the tracing.
“The one thing that we’re beginning to see,” he said, is that individuals who may have attended an event and later learned that they were with someone who tested positive did not isolate themselves until they could get tested, too. “Time after time,” he added, “we interview people who got tested but continued to work and continued to socialize [until they learned their results].” That creates even more work for staff handling the contact tracing, Henry stressed.
Quarantining for 14 days after exposure to the virus, he said, is “every bit as important as staying home if you’re sick.”
Then Henry explained that as staff members interview persons who have been in contact with someone who later tested positive, the staff members may learn of even more potentially infected people who need to be reached.
Yet another challenge staff has had to contend with, Henry said, has been lack of cooperation from some persons identified as having tested positive. For example, he added, individuals have told staff members, “‘I don’t want to talk to you. I’m not going to tell you where I work. I’m not going to tell you who my friends are. I don’t need the government in my business.’”
For another example, he continued, when staff calls the phone number a person who has tested positive listed with the testing site, no one will answer. In those situations, he said, staff will try other means of contacting the person, such as undertaking some investigative work to determine the individual’s address. “There is a lot of backtracking that goes on.”
In response to another commission question, Henry acknowledged that he has not had the time to keep up-to-date with the scientific journals he normally would read. However, he said, “I have not seen science that definitely says that immunity is there” if a person had the virus and recovered from it.
County employee illness
One other issue that has arisen since the commissioners went on their break has been a rise in the number of Sarasota County Fire Department personnel who have tested positive for COVID-19.
On July 14, Sara Nealeigh, media relations officer for the Emergency Services Department, announced that three employees had tested positive for the virus. The Fire Department, she added, was working with the Florida Department of Health and performing “additional cleaning and thorough decontamination.”
Previously, on July 2, Nealeigh reported two firefighters had received positive test results that day. “One is an employee who came in contact with [an] employee who tested positive June 25,” she wrote in an email to the news media.
On July 3, yet another employee tested positive, she noted in an email that day.
In her July 14 report, Nealeigh added, “Going forward, Sarasota County will update confirmed COVID-19 positive county employee cases each Thursday after 3 p.m. This will include Emergency Services, [Sarasota County Area Transit] and other front-facing, customer service-related positions.”
The subsequent announcement, on July 16, noted that one Public Utilities Department employee also had tested positive for the virus this week.
During the July 8 discussion with Henry and Emergency Services Director Collins, Commissioner Ziegler had pointed out, “Naturally, as the virus goes through the community … you’re going to have more people who get COVID, which is unfortunate.”