Dr. Bob England

Dr. Bob England Interim director of the Pima County Health Department

 Mamta Popat / Arizona Daily Star

Few are under more pressure now than the directors of the state and county health departments. Below Dr. Bob England, director of the Pima County Health Department, answers a few of the pressing questions people have been asking regarding the COVID-19 virus:  

Many believe we should be doing everything possible to contact trace the cases we know about, and that we cannot accept that this can't be done. Why can’t we hire people, or shift some jobs around so people can do contact tracing? It requires making phone calls, correct? Seems there are plenty of people who can do this.

We in fact have recruited students and volunteers with epidemiology backgrounds to help us do this work. Most of the work is done by phone but it does require some know how. We have scripts to work from but, sometimes it requires some finesse to make sure you are getting all the important information. Someone with some experience and understanding about . . . how . . . to ask questions is just as important as what questions to ask. (You probably know that better than me!)

That will keep us going for a while. But at some point, this will be as prevalent as the flu, then more than the flu. We will be receiving hundreds of reports per day. So as this continues, even volunteer and student resources can start to run thin. And more importantly, when it is widespread, individual contact tracing becomes not just less important but misleading – we’re all at risk for exposure all the time. So then the messages become more universal, and actually notifying individuals of individual exposures can run counter to that messaging. Our biggest focus will be doing this work in high-risk settings. Cases in long-term care settings, nursing homes, among healthcare workers, etc., are ones where contact tracing and isolation and quarantine are critical.

Is it accurate to say that we look like a low priority state and county because we haven’t done much testing?

We are not the only state where testing is limited and we know that as limited as it is, we are primarily testing the people who are becoming most ill. These are the people hitting our ED’s and hospitals. Without the ability to test more widely, we can’t understand the extent of or the true severity of the infection. So yes, the lack of available testing understates the true incidence of infection, but that is true in many other places, too.

Is there anything else going on right now related to the test kits? How about supply chain issues in general?

There is a lot going on in this arena. We are flipping every rock we can to find the supplies we need. Re: test kits, we have two labs at the U of A making transport media and test kits for us. We’re hoping that these are certified as usable soon. We have tried ordering on the market to no avail so far, but we’re still trying. We begged and got a couple of hundred test kits from a local lab so that we could continue to support testing around clusters of cases for outbreak control purposes. Regarding other supplies, we have received some from the CDC’s Strategic National Stockpile, but that was a small fraction of the requests we’ve already gotten. It’s already been distributed, along with a small stash we had before this began. We are ordering directly from vendors, and are searching for new vendors constantly. Anything we can do to find the supplies our healthcare partners need to protect themselves and perform sample collection, we are doing. We’re even looking at people who make homemade masks, not for critical healthcare needs perhaps, but they may offset other needs to free up other masks, or otherwise help extend their use. We’re even working with local distilleries to make alcohol we can use to create hand sanitizer, and so forth.

How much of what we’re ordering is being diverted to other locations that appear to need them more? Can you give some specific examples?

Most of what we’re ordering has an extended time frame for delivery — weeks to months, so we’re sure that the delay is due to other customers also being in the queue. The only order we had outright canceled out from under us was for 15,000 test kits (swabs, tubes and transport media). We were only informed our order was canceled on the day the first third of it was due to arrive.

What was in place under the Obama Administration that President Trump dismantled, in terms of pandemic preparedness, that is being felt now in Pima County?

I’m not trying to dodge this question, but I don’t really know. I’ve heard the same news that everyone else has about the preparedness team for the White House having been disbanded, but I don’t know what effect that would have had for us here. We are entirely dependent on Federal funding for all our Public Health Emergency Preparedness. The funds for public health emergency response have seen some reductions over the years, but has largely remained intact. Meanwhile, we’re using our Public Health Fund balance for all the items mentioned above and other costs, and hoping to be reimbursed for most of it.

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Contact reporter Patty Machelor at 806-7754 or pmachelor@tucson.com