State Sen. Missy Irvin and other legislators at a quickly called, sparsely attended, and nearly 4-hour-long joint committee hearing today told Arkansas Department of Health leaders that they didn’t understand why the state is paying millions of dollars on COVID-19 contact tracing when long delays in result turnaround times make the tracing pointless.
The state has approved $38 million for contracts with General Dynamics and the Arkansas Foundation for Medical Care for 700 contact tracers, and so far 305 have been hired, in addition to the 200 or so already working with the Arkansas Department of Health.
Irvin (R-Mountain View) said that federal CARES Act dollars to the state are “dwindling” and that contacting people two weeks after they may have tested positive is too late to slow the spread of infection by identifying contacts and warning them to quarantine. “We have to accept that [the delays] are a reality and we have to recalibrate, in my opinion,” Irvin said. “I don’t understand spending $40 million or $60 million on contact tracing if you can’t get a test result back within 24 hours. I want to really focus on testing, how testing is being prioritized.”
Delays in getting testing results from national laboratories like Quest because of the increased numbers of people getting tested and lack of chemicals has been a hot topic, particularly because it hampers contact tracing, and criticism of the federal government’s indifference to the problem has been both bipartisan (Governor Hutchinson and the state’s congressional delegation have asked the government to employ the Defense Production Act) and widespread. The department of health can do nothing about that, and legislators acknowledged that.
However, the health department, which can get results within 48 hours from its own lab, says it will reach people with positive results in three to five days. Persons testing negative will get a letter, and people have complained about waiting for weeks to be told they are negative.
Stephanie Williams, the deputy director for the health department, said the department is attempting to increase its testing capacity with additional platforms, including point-of-care Abbott ID tests and antigen tests, and expects contact tracing to speed up as more people are brought on board. She said the health department thought it was to receive seven Abbott tests, but did not. (She did not address the fact that the CDC recommends that those getting negative results from Abbott ID be tested with another platform because of Abbott’s false negative percentages.) She told legislators that case investigations and contact tracing require trained personnel and is not as simple as they perhaps believe.
Williams said the department was about a month behind in getting its contact tracing where it wants it to be because of the appropriation process, and that to speed up the contract had decided to expedite things by hiring General Dynamics rather than use a traditional competitive process. Now, she said, “it’s starting to make a difference” and would be crucial in the fall when school is back in session.
Irvin, who is married to a physician, also questioned the health department directive requiring testing of people scheduled for elective surgery as both using up a limited resource and because, she said, doctors are having to pay out of pocket for repeat fast-response antigen tests for themselves to keep their patients safe.
The health department is also considering doing away with the need for testing for elective surgeries, and will in fact address that in a meeting Friday morning, Dr. Jennifer Dillaha, state epidemiologist, said.
With one or two exceptions, legislators, including Reps. Michelle Gray (R-Melbourne) and Mary Bentley (R-Perryville), and Sens. Kim Hammer (R-Bentonville) and Alan Clark (R-Lonsdale), were aggressively critical of the department, challenging its testing strategy and lag time in reporting results. Clark accused the agency of being guilty of “incompetence and overreach at the same time,” saying he wanted more information from contact tracers on the source of outbreaks and how many people were infected at, for instance, restaurants, and the handling of testing at prisons. (That data is released weekly by the department.) A couple of legislators, including Hammer, suggested the department was more interested in contact tracing than testing and was not using its resources properly. (Williams responded that the two go hand in hand.) Some of the attacks ranged into different subjects, such as health department directives on masking, manner of testing and how quarantining keeps people away from work.
Gray, for example, questioned the health department’s authority to cite businesses that do not demand that their customers wear a mask, saying it was unfair to take them to task for their customers’ behavior. When Williams explained the directive addressed business practices specifically — and that the department has fined no one, but asked businesses to abide by the directive to inform customers they must mask — Gray looked across to Hammer and called out, “Do you hear that Hammer? That’s a huge overstep.”
Gray also complained about the manner in which local health units are handling testing — by providing self-testing kits — and said it was “embarrassing for me. Hospitals and clinics are doing testing for their patients in full PPE and our own health department won’t come out and do the swabs themselves.” She also questioned the efficacy of the kits, since the swabs are shorter than the nasopharyngeal swabs that medical personnel use. The health department representatives informed Gray of the steps taken by the health unit staff — they provide the test on a tray and information on how to collect the sample and then stand at a distance while the person takes the test so that they do not have to wear full PPE — and assured Gray that the new system of swabbing was recommended by the Centers for Disease Control and found to be effective.
Bentley claimed that masks trap carbon dioxide and that making people wear them all day was harming their health. Dillaha responded by saying yes, masks can be uncomfortable, but they have proven to be highly effective in preventing the spread of disease, and that there are no studies suggesting that they harm the wearers’ health.
Hammer weighed in on getting guidance from the health department on when Arkansas could get back to business. “I’m not minimizing deaths,” he said, “but a lot of people have died of other things. At what point will [the department say] let’s resume normalcy.” He also said there was “debate” whether deaths being declared as caused by COVID-19 actually were, and asked if the health department could declare the pandemic over. Dillaha explained that a pandemic is a worldwide outbreak of disease and the state can’t declare it over. She added that because it is a new disease, such things as when or if there will be herd immunity or when the disease reaches a steady state in the population, can’t be predicted.
There were questions about how the department will handle quarantine during the school year, but Irvin reminded the committee that there will be a joint hearing with education and public health committees on Monday when that topic will be addressed.