Editor's note: This is Part 2 of a three-part series talking with local public health officials about contact tracing, Region 1 mitigation enforcement, staffing, messaging and public health concerns as it relates to the current surge in COVID-19 cases in DeKalb County. Read Part 1, on contact tracing and asymptomatic community spread, at www.daily-chronicle.com.
Daily Chronicle editor Kelsey Rettke and sports editor/reporter Eddie Carifio spoke with Lisa Gonzalez, public health administrator and Greg Maurice, director of health protection, for the following on contact tracing data, what it tell us and what it doesn't amid public demand for data to justify mitigations on local businesses.
It's been nearly a month since DeKalb County bars and restaurants were forced to close, again, for indoor dining amid record COVID-19 cases and a resurgence that's now spread across the nation. And as local and state public health officials grapple with enforcement, facing seven months of pandemic fatigue, politically-charged pushback and local business owners desperate to save their livelihoods, many are demanding proof in the pudding: does the data support mitigations which target bars and restaurants first?
State public health officials, along with Gov. JB Pritzker, say yes, and affirmations from local public health officials, in turn, hold the line for justifying mitigations, each citing specific scientific studies – whether its a statewide cases study of 18,000 cases across Illinois from the Centers for Disease Control's Morbidity and Mortality Weekly Report, or CDC national data.
None of that is local DeKalb County data, however, and while that doesn't mean community spread isn't happening because friends or family are gathering out to eat or sitting at a bar for a 2020 post-work happy hour, public demand for proof has only grown since mitigations began.
"There are over 400 local businesses that are impacted by mitigation," said Lisa Gonzalez, public health administrator for the DeKalb County Health Department. "We have a small portion maybe making decisions that are not in support of mitigation strategy."
In the past 12 days, there have been 479 cases recorded in the county, accounting for 18.7% of all local cases identified in the county since the pandemic began seven months ago. Mitigations in DeKalb County are extended through at least Nov. 14.
Getting that data people are starving for as mitigations continue could take time, Gonzalez said.
"When the state mitigations were about to happen at the very beginning of this month, we also were asking, 'Tell us the data that supports this,'" Gonzalez said. "You've heard the state health director and the governor talk about this: Essentially what they're looking at is some national data."
Gonzalez then cited a July 2020 MMWR report that shows adults who are confirmed positive for COVID-19 are about twice as likely to have reported dining in a restaurant than those who tested negative.
It's the same report cited by state officials shortly after Oct. 3, when a prohibition on indoor dining and stipulations on large gatherings first began in the geographical health area known as Region 1 (which includes DeKalb County, Winnebago County and the Sauk Valley area).
According to in-state contact tracing data in that MMWR report provided by Pritzker's office which surveyed 17,939 cases of the virus, restaurants and bars account for 2,300 of those cases, second only to "other," a category that includes vacations, family gatherings, weddings and college parties.
The next highest cause was workplaces other than office settings, with 2,016 cases reported. Schools reported 1,460 cases, colleges 657 and long-term care facilities 423. The report includes locations identified by those who tested positive when asked by contact tracers where they visited or worked within the previous 14 days. In the state, 69 of 97 counties reported location information.
The documents from Pritzker also list 13 separate studies that the office said support their decision to close indoor dining at restaurants and bars.
Where's the local data for DeKalb County?
"Locally, what I can tell you is that, and you've heard me say this, I kind of sound like a broken record, but the community spread is very widespread," Gonzalez said. "According to IDPH, regional data, and it doesn't matter the region, when they look at the top locations that cases have frequented, those are, in no order, workplaces, schools, restaurants and bars and other gatherings."
The caveats of contact tracing help rule certain locations out, she said.
"With schools and workplaces, contact tracing is pretty easy because we know where the students are, we know their desk assignments, who's working when and where," Gonzalez said. "When it comes to restaurants and bars, it's more complicated, especially with bars because people are typically standing up, they're close to one another, passing by one another, so that's the rationale that we've been given from the state level."
Digital contact tracing streamlined?
It also comes down to record-keeping, and – as Pritkzer said Wednesday in his daily COVID-19 news conference – not all health departments keep record in the same way.
In an effort to streamline the contact tracing data across Illinois for the state's 97 public health departments, IDPH has implemented a new digital database called Salesforce, a digital patient management platform which allows individual departments to input tracing data.
"We have 97 local public health departments in IL, some are more technically proficient," Pritzker said Wednesday. "It's taken us some time to get those health departments working on same system."
Using Salesforce also is a stipulation of the $2.8 million grant the DeKalb County Health Department received from IDPH in July to help with pandemic response efforts, which also helped them hire 10 contact tracers to conduct case investigations, some additional staff to help with restaurant and bar inspections, track complaints and conduct enforcement.
Historically, their process has been paper and pen, Gonzalez said. So it will take time to aggregate that data onto a digital system.
"At the beginning of the pandemic, our case investigation and contact tracing were primarily done via paper," Gonzalez said. "We've been doing case investigation for a very long time in public health – everything from chlamydia and gonorrhea to tuberculosis. Any communicable disease, you name it."
In July, the state rolled out Salesforce, which helps automate that process.
"Right now, we're doing a combination of paper and Salesforce," she said. "Once we get everybody using it regularly and frequently, we think that it will give us really good data come out if it."
What does it look like now?
If you were to look at contact tracing data in the DeKalb County's Salesforce database, it may not reflect the truth, Gonzalez said.
"For example, we know that staff have worked really hard, in fact seven days a week, to do contact tracing, every single positive case that comes into our system," Gonzalez said. "But because we've been using this hybrid model, the reports coming out of this system, they don't reflect that at all. In fact, our numbers don't look that hot because quite frankly we're using this hybrid system."
Gonzalez said she hopes "within a few months" that numbers for contact tracing data in Salesforce will more accurately reflect the real data contact tracers are seeing locally. She said the data will break down cases by industry.
In his press conference Wednesday, Pritzker said the IDPH will begin posting outbreak and exposure data early next week – exposure data being mostly a product of contact tracing, and outbreak data which will show places where two or more COVID-19 cases proven directly connected to each other occurred, whether in a school, public place, or, even a restaurant.
Does Gonzalez think it will be easier to enforce mitigations, justify the efforts to business owners or public outcry over loss of livelihood whenever that data is ready to be handed over?
"Yes, I think that's probably the case," Gonzalez said. "Obviously with more data, you have more justification for your decision making. However, the state's data is still data. It may not be 100% comprehensive, but it is a sample of what we're looking at, so I would assume that our data would likely look very similar."
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