Updated March 25, 7:20 p.m.
Oklahoma’s boost to its COVID-19 contact tracing efforts led to no insights and was marred by technology problems and a failure to collect the proper data, a new legislative report finds.
Oklahoma spent more than $6.7 million to centralize its COVID-19 contact tracing last summer at the Shepherd Center in Oklahoma City. The state used temporary workers from Express Services Inc. to staff the call center, which had its own coronavirus outbreaks among employees at times.
Oklahoma Watch reported in December the project was abandoned as cases spiked and contact tracers got behind in their outreach efforts. The Oklahoma State Department of Health has since moved to decentralize its contact tracing back to its county health departments.
Contact tracing is one of the core responses to any infectious disease outbreak. When done quickly, it can tell public health officials where outbreaks are happening and how people became infected. It can also provide insights into possible mitigation efforts like limiting public gatherings or cutting capacity at higher-risk indoor places like gyms, bars and restaurants.
The state health department’s contact tracing “had no measurable impact on the pandemic” and data on transmissions was not timely or accessible to the public or local governments, the draft report concluded.
“The lack of data is a missed opportunity for the state, its citizens and small businesses to make more informed decisions regarding policy and assessing risks within local communities and their economies,” the report said.
The health department’s COVID-19 alert map for counties was confusing to the public and didn’t align with maps produced using the same data by the federal government’s White House Coronavirus Task Force and other entities, like one for schools by the Oklahoma State School Board Association. The state’s alert map also changed its “triggers” for additional mitigation measures several times in the late summer and fall as the virus continued to spread.
“These two color-coded state resources further illustrate the clear divide in the state’s response and messaging to its stakeholders on the situational reality of COVID-19,” the report said.
Meanwhile, Oklahoma’s infectious disease tracking system, known as PHIDDO, was at the end of its product cycle before the pandemic began and hindered the state’s response, according to the legislative report. The system even had trouble communicating with a short-term replacement to handle the large caseloads from the COVID-19 pandemic and regularly crashed when performing routine functions like adding new users.
Independently run health departments in Oklahoma and Tulsa counties reported delays of more than two weeks in getting case reports from the system.
“Often, these health departments received data from PHIDDO too late to have any measurable impact on limiting the spread of the virus,” the report said.
The health department acknowledged some of the shortcomings in its case investigation and contact tracing response. But it said other states with stronger mitigation efforts didn’t fare much better as the virus reached a third peak in late 2020 and early 2021. Contact tracing is less useful for diseases like COVID-19, where asymptomatic spread can occur before an infected person knows they have the virus.
“Public health had a momentous task in 2020 — testing and tracing COVID-19,” the department said in its response to the legislative report. “Resources were an issue at every step of the response. Our technology was inadequate to meet the needs of such a high demand on a system.
“In attempting to track and record the spread of COVID-19 in our own state, because of the communal spread of the disease, data transparency became a critical focus. With this need for data was a conflicting need for privacy.”
During a Thursday afternoon hearing on the report, State Health Commissioner Doctor Lance Frye told lawmakers contact tracing is only as good as the information public health workers can get.
“We had many instances we could refer to where people just refused to either give us information about who they had been in contact with or where they had been, and also refused to quarantine if we asked them to quarantine,” Frye said.
LOFT Oversight Committee member Sen. Kim David (R-Porter) agreed with Frye, citing conversations with her neighbors.
“It was a legitimate concern always with how [contact] tracing was being done and whether CDC guidelines were too prohibitive upon people’s lifestyle, especially in rural areas,” David said.
The health department said in its response to the report more robust efforts to contact trace in other countries, like China or Singapore, relied on centralized national governments that prioritized the common good over individual privacy. It said those strategies don’t work in countries and states with more democratic societies that prioritize individual liberty.
“Here in the United States, and in Oklahoma, many people do not completely trust the technology that might make digital contact tracing effective,” the department said. “Privacy and individual freedoms seem to rub against the protections offered by quarantining and isolating.”
LOFT committee member Rep. Meloyde Blancett (D-Tulsa) told Frye on Thursday she’s under the impression contact tracing was not seen as a critical part of the state’s pandemic response.
“To what degree do you believe or should we believe that contact tracing is a core competency that an effective state health department must have to fulfill its mission of maintaining the health and safety of Oklahoma citizens?” Blancett said.
“It is important, it should be and is one of our core competencies. I think the difficulty in this is the sheer number of cases. With the current systems in place in the United States, nobody was prepared,” Frye said.
LOFT committee Co-Chair Sen. Roger Thompson (R-Okemah) defended Frye, saying the state health department was at a disadvantage because of PHIDDO’s shortcomings.
“That’s something I’ve been trying to work on for a long time, is to make sure that we update our IT. And so, I think with the system that you had in place, you did a remarkable job, and we do appreciate that,” Thompson said.
The state health department said it is already working on a plan to replace its outdated infectious disease tracking system with new lab-reporting software and a system offered by the Centers for Disease Control and Prevention. It did not provide an estimate on when those projects would be finished.
LOFT staff also made several recommendations for the legislature and the state health department on Thursday.
LOFT staff said lawmakers need to find discretionary funds to help with public health efforts, bolster public trust by passing legislation to set up guidelines for sharing personal information in contact tracing and testing programs, and require school- and district-level data in public platforms like the state’s COVID-19 dashboard.
For the state health department, LOFT staff recommended adhering to CDC guidelines for case investigation and contact tracing, include those metrics in daily reporting, adopt best practices for handling public data from other states, adhere to National Governors Association recommendations on disease outbreak data collection and reporting, and include the State Department of Education in developing risk thresholds.
