By Rebecca Sohn, CalMatters
A month ago, everyone in Merced County infected with the coronavirus got a call from county officials, asking questions about whom they’d come in contact with. It’s a tracing process that experts say is critical to stopping the spread of the highly infectious disease.
Now, facing a five-fold increase in infections, Merced County officials have abandoned the effort. They have not attempted to conduct contact tracing for several weeks.
Health experts say the county’s decision threatens public health because investigating and notifying the contacts of infected people is vital.
Merced County is violating an agreement it signed with the state in May, asserting that it would perform the investigations as a condition of reopening its businesses. Newsom administration officials, however, declined to comment on what, if anything, they plan to do to enforce the requirement or whether other California counties have eliminated the investigations.
County supervisors — including the board chair who signed the agreement with the state — said they were unaware until contacted by CalMatters that their health department had stopped contact tracing weeks ago.
CalMatters reached out to 27 California counties with rising infections and hospitalizations or large numbers of cases to ask about their extent of contact tracing. Merced was the only one that confirmed in June that it was no longer conducting it at all, although six did not respond. The other 21 said they were tracing most people or at least some.
Kristyn Sullivan, Merced County’s supervising epidemiologist, said the county is now only doing case investigations — reaching out to infected people to tell them to quarantine but not asking about their close contacts or the places they’ve been recently. She said that interviewing people about their contacts has become ineffective because there are too many cases.
Infectious disease experts, however, disagree, saying that some tracing of contacts is better than none. Without it, people exposed to the virus have no way of knowing so they keep spreading the disease.
Perry Halkitis, dean of the School of Public Health at Rutgers University and the principal investigator for New Jersey’s contract tracing program, said that tracing is “one of the best tools in an arsenal to control the spread of COVID-19.”
In Merced County, a rural area north of Fresno with about 278,000 residents, 2,260 people have tested positive for the virus as of today and 15 have died. Half of the infections are in children or ages 18 to 35. And the numbers are rising.
With more than two out of three of its cases infecting Latino residents, mainly those who work essential, low-income jobs in agriculture and manufacturing, it’s clear who is most at risk from the county’s lack of contact tracing.
No questions asked
Hugo Garcia, 38, who lives in the Merced County town of Winton, tested positive for the coronavirus on June 16, but county officials did not ask him about whom he had come in contact with.
Garcia’s symptoms were mild and he recovered, but his 85-year-old mother Sinforosa, who he said contracted the virus from him, died on Wednesday after being hospitalized for more than three weeks. He had to make the agonizing decision to take her off life support when doctors said she wouldn’t recover. His sister and at least three other family members are sick, too.
No one from the county asked any of them questions, Garcia said.
“They called me two times — once to tell me a sheriff would come to give us the quarantine order and then again to tell me the public health department would send me a notice telling me that my quarantine order was lifted. That’s all we heard from the county,” Garcia said in Spanish. “They only contacted me twice.”
Garcia’s situation is far from unique.
About 60% of all Merced County’s residents are Latino, but they represent nearly 70% of all coronavirus cases in the county, according to recent county data. The disproportionate rate at which Latinos contract COVID-19 could be attributed to close working conditions on farms or in food packing and manufacturing plants, Sullivan said.
Garcia, a Mexican native who has worked at an almond processing plant for 16 years, said he thinks he got sick at work. His employer didn’t take precautions to keep employees safe after he was told to keep showing up to work when people started getting sick, he said.
Garcia worked shoulder-to-shoulder in an area with more than two dozen workers that was shut down after nearly everyone tested positive.
Sullivan, a psychologist who oversees the county’s contact tracing and case investigation program, said even though they aren’t doing tracing interviews, they are alerting workplaces and healthcare facilities about COVID-19 positive individuals that have visited those locations.
Yet Garcia said the public health official he spoke with never asked where he worked, where he went or how he got sick.
“The plant didn’t take the right measures to protect us,” Garcia said. “When the first case broke out, they should’ve closed the plant, but instead, we were told to keep on working as if nothing happened. But then all of us got sick, and the county didn’t do anything to help us.”
Without a trace
Merced County had committed to 42 contact tracers as part of obtaining a phase-one state waiver to reopen some of its businesses in May. Yet its current team of around 13 — seven health investigators and four to six officials notifying workplaces and healthcare facilities — is now less than half the size it was, despite the surging cases, and none do contact tracing.
The county stopped asking infected people about their contacts when cases began to surge, Sullivan said. She couldn’t give an exact day, but said it stopped entirely around the last week of June.
Sullivan said the decision to stop the investigations was partly due to limited staff, but mostly because of the rising number of people being exposed to the virus.
“The spread is too wide for contact tracing to be effective,” she said, adding that it would “have a very, very minimal impact on eventual disease spread.” She also emphasized that testing turnaround times are slow so there would be a long delay between the infection and when officials reach the patient and the people they’d been around.
There are no plans to return to contact tracing anytime soon, she said. In the past few weeks, 50 to 150 new cases have been reported in the county a day. She said contact tracing wouldn’t resume until they had fewer than 10 new cases a day.
Many infectious disease experts strongly disagree with the county’s approach.
“Every little bit of contact tracing you do will help,” said Dr. Jeffrey Martin, an epidemiologist at the University of California, San Francisco.
Martin said waiting until case numbers fall below 10 cases a day “doesn’t make any sense.” He said that tracing, for instance, 20 cases a day would make a difference and would be far better than tracing no one.
“There’s always some benefit of informing people they’ve been exposed to a disease,” Halkitis of Rutgers added.
Dr. Anthony Fauci, the federal government’s top infectious disease expert, has stressed the importance of contact tracing but said “it’s not going well” despite an influx of federal money.
“To just say you’re going to go out and identify, contact trace and isolate, that doesn’t mean anything until you do it,” Fauci said. “Not checking the box that you did it, but actually do it.”
Merced County’s caseload is not unusually heavy for the state: Its per capita rate of infections is below the state average.
But unlike Merced, other counties, including nearby ones such as Stanislaus, Mariposa and Fresno, are still trying hard to trace contacts of infected people.
“Contact tracing really becomes an instrument that can help us parse, where are the transmissions happening? Why are they happening?” said Dr. Rais Vohra, Fresno County’s interim health officer. “We have a lot more to learn, but we’re trying to implement the best science that we know that we can bring to bear to the situation.”
A promise to the state
On May 18, Merced County applied for a county variance that allowed it to move more quickly through the state’s stages of reopening businesses.
Dr. Salvador Sandoval, Merced’s public health officer, signed the attestation, saying “we have 42 trained contact tracers and (the state) criterion is met.” The state requires 15 tracers per 100,000 county residents.
“The entire internal staff team of 30 is trained to conduct contact tracing, which means our case count could quadruple (20-28 cases per day) and be able to be handled by the internal staff team,” Sandoval wrote in the agreement. “A case surge of more than four times the currently reported amount would trigger a need to scale back on the phased reopening.”
This month, the county had to close some businesses, such as indoor restaurants, malls, gyms, non-critical offices, houses of worship and hair salons because its infections and hospitalizations have risen so steeply. It is one of 29 counties on the state’s watch list that were ordered to shut down.
Sandoval declined multiple requests for interviews.
Sullivan said that she heard other counties were not doing any tracing but did not identify any. She also said state officials were not concerned because they know that “contact tracing isn’t something we can feasibly keep up with right now.”
State officials declined to say what, if anything, they are doing to ensure that Merced County conducts contract tracing.
“We continue to work with counties across California, including Merced, to provide the resources they need to build upon their existing contact tracing efforts, which includes case investigation,” said Ali Bay, a spokesperson for the California Department of Public Health, in an email.
Bay said that Merced had done some contact tracing recently, but did not provide any details.
Merced County Board of Supervisors Chairman Rodrigo Espinoza signed the county’s attestation on behalf of the board saying that it would trace contacts of infected people.
Espinoza said he didn’t know that the county hasn’t been meeting the state requirements and that the county has not done any tracing for almost a month. He said he is unsure what exactly the county’s public health department is doing in relation to the coronavirus.
The board on Tuesday passed a resolution to hire 21 new case investigators through a federal grant. Sullivan said the department will hire up to 10 investigators for now. They will do the same “minimal” tracing, just alerting patients’ workplaces and healthcare facilities.
Daron McDaniel, supervisor for Merced County’s third district, also said he wasn’t informed that the county wasn’t doing tracing.
“It would be nice if Dr. Sullivan would share that with the Board of Supervisors so that we were aware of it,” McDaniel said.
“That’s what hurts me the most.”
The county is able to reach almost everyone who tests positive to tell them to quarantine, and if not, they send a law enforcement official to deliver a quarantine order to a person’s home, Sullivan said.
But with such a large number of cases among Latinos, some of whom are undocumented immigrants, advocates said that sending police or deputies to tell them to quarantine is unnecessarily frightening because they fear they will be deported.
“There is a lack of trust between the immigrant communities and enforcement agencies,” said Leydy Rangel, a spokesperson for the United Farm Workers Foundation, the largest immigration legal services provider in rural California.
Rangel said that it is especially inappropriate to send law enforcement to an immigrant’s or any Latino’s home without notice, but even informing them that the sheriff is coming could frighten them.
“If we truly care about the health and wellbeing of our community, we’re not going to send someone who poses a risk to them, who scares them,” Rangel said. It would be far better for the county to send a public health official, she said.
In Hugo Garcia’s family, in addition to his mother who died, his sister, her husband and their three kids are all sick with COVID-19.
“I don’t know who to blame more – the county or the (almond) plant,” he said. “I’m more upset about my mom. That’s what hurts me the most.”
Nadia Lopez of the Fresno Bee and Rachel Becker of CalMatters contributed to this report.
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