LOCAL

Delayed contact tracing in Minnesota counties

Test, trace, and isolate. A mantra roll call would identify a count of nearly 5,000 COVID-19 tests performed daily in Minnesota, a dramatic increase from the early days of the pandemic. Contacting tracing? Slowing.

As a result of increased testing, short staffing, logistics, and technology, contacting those testing positive and identifying associated contacts is taking several days. At the beginning of testing roll out, investigations were launched within 24 hours of a positive case report. Other factors leading to delays include incorrect phone numbers attached to test results, and people just not answering calls. A hiring freeze, preventing additional case investigators from coming on board, also contribute to delays. State Health Department employees have been redeployed from other departments to conduct tracing.

The process of contact tracing had to be revamped to a digital platform to both account for the needed efficiency with pandemic level case counts and also allow for remote-based work.  In the past, contact tracing was done manually on paper, on-site at the Minnesota Department of Health. Now, with a digital platform, local health partners can contribute to investigations,but the process takes time to broadly implement. 

Some counties have adequate staffing to take on contact tracing; others do not. This variability in staffing numbers at the county level could lead to a wide statewide variation in how contact tracing is conducted. As a result, the Department of Health is asking the Legislature for $300 million from COVID-19 response funding to assist with contact tracing efforts. Of that sum, $228 million would be allocated to an outside vendor to fill labor gaps.
 
Minnesota Public Radio News

NATIONAL

Tribal Nations in health and economic crisis

The health and economy of Tribal Nations have been disproportionately affected by the COVID-19 pandemic. The shutdown of casinos and tourism has depleted essential revenue necessary for health clinics and social services to operate. Nearly 500 casinos have stopped operation as a result of stay at home orders. 

Over 700,000 people are now unemployed or furloughed with Non-Native Americans comprising nearly 70% of the casino workforce. Unemployment rates on some reservations—before the pandemic—were over 50%.  A critical source of income for many included working odd jobs and selling piecework at festivals, much of it dependent on summertime tourism—all of which have been canceled. Financial losses continue to accumulate as a result of the $8 billion delivery delay from the Treasury Department for federal stimulus.Tribal leaders worry reservations will be the last places in America to financially recover. 

Without adequate funds to run health services, many people—many with chronic medical conditions—are not receiving basic health care. In rural areas with scarce housing, extended families have been forced to shelter together—in tiny homes often without clean running water. According to Indian Health Services, there have been more than 5,467 confirmed cases of COVID-19. Occurring in clusters, concentrated spikes in cases are further challenging resource limited tribal clinics and rural hospitals, which had fragile infrastructure even pre-pandemic. In New Mexico, Native Americans account for 57% of confirmed cases statewide, despite only comprising 11% of the population. The country’s largest Indian reservation, Navajo Nation, has a higher death rate than any state in the country except for four located in the Eastern Seaboard. A Doctors Without Borders team was dispatched in April and expects to remain until June in Navajo Nation.
 
New York Times
CNN
Indian Health Services

INTERNATIONAL

Effects of COVID-19-related service disruption in Sub-Saharan Africa

Health service and supply interruptions as a result of the COVID-19 pandemic could lead to more than 500,000 extra deaths from tuberculosis and other AIDS-related illnesses in sub-Saharan Africa in 2020-2021, reversing longstanding public health campaign gains. For perspective, an estimated 470,000 people died in this region from AIDS - related deaths in 2018. 

This projection estimate was generated by a modeling group convened by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), and based upon a six month disruption of antiretroviral therapy. Over the next five years, there could be an average excess of 40% deaths. In 2018, 25.7 million people were estimated to be living with HIV and 64% of those were taking antiretroviral therapy. According to the WHO, this model is to serve as a wake up call for the continued delivery of global supplies of tests and treatments to susceptible countries. Even short term HIV treatment interruptions can significantly negatively impact health. 

Since 2010, mother to child HIV transmission infections have declined by 43% in sub-Saharan Africa. Disrupted services could lead to a dramatic increase in child infections - as much as 78% each in Malawi and Zimbabwe and 104% in Uganda. Winnie Byanyima, Executive Director of UNAIDS, said, “the COVID-19 pandemic must not be an excuse to divert investment from HIV. There is a risk that the hard - earned gains of the AIDS response will be sacrificed to the fight against COVID-19, but the right to health means that no one disease should be fought at the expense of the other.” 

World Health Organization