Door County Public Health Officer Susan Powers and Dr. James Heise, the Door County Medical Center’s chief medical officer, conducted a live Facebook conversation on Monday, Sept. 28, 2020.

The rapid spread and surge in cases of COVID-19 is straining Door County’s resources for contact tracing and contributing to a slow in testing, leading to some changes in those practices, health officials said Thursday.

The dramatic increase in cases over the past few weeks led Door County Public Health to change the way it does contact tracing this week, Public Health officer Susan Powers said.

And a significant rise in the positivity rate of COVID-19 tests—coupled with a shortage of tests—has contributed to longer wait times for test results, Door County Medical Center chief medical officer Dr. James Heise said.

Door County also has seen its first hospitalizations due to COVID-19 in months, amid concerns about hospital capacity across northeastern Wisconsin, Heise said.

The news comes as Wisconsin has seen its highest spike in COVID-19 deaths since May. The state set a record with 27 deaths reported Wednesday, with 21 more on Thursday and five on Friday. The state Department of Health Services reported 2,745 new cases on Friday, with a seven-day average of 2,439 new cases reported over the past week.

Door County has reported 104 new cases this week, including 13 Friday. There are 113 active cases in the county as of Friday, up nine from Thursday. Three people in Door County have died of COVID-19 since the beginning of the pandemic.

Public Health changes strategies as contact tracers reach limits statewide

Door County Public Health announced in a press release issued Monday that staff would no longer call people who are close contacts of a positive COVID-19 case.

Powers emphasized Thursday that the change is not the same as ending contact tracing altogether.

Public Health staff still will conduct the same “interview” with positive cases, Powers said, to identify close contacts. But in an effort to maximize the efficiency of its staff and contact other positive cases more quickly, Public Health now is asking positive cases to reach out to their close contacts directly and ask them to quarantine.

Public Health staff members previously were making 10 to 20 calls to close contacts per positive case, Powers said.

A close contact is defined as someone who spent at least 15 minutes cumulatively within six feet of a contagious positive case over a 24-hour period, regardless of whether either person was wearing a mask or whether there was a plexiglass barrier between them, Powers has said. Close contacts also can be people in the same household or who stayed overnight in the same household, or people who had close physical contact such as a hug.

“We are all-in on COVID—we have not given up in any fashion,” Powers said. “We are just restrategizing because we needed to get to people sooner.”

The changes at Door County Public Health reflect a statewide trend of contact tracers – and contact tracing staffing levels – not being able to keep up with the rapid spread of COVID-19.

Local health departments in Manitowoc, Marathon and La Crosse counties, as well as the Eau Claire city-county health department, all have said they are changing contact tracing practices or are unable to keep up with their usual practices.

The state Department of Health Services on Sept. 15 issued a memo to local and tribal health departments with guidance on how to prioritize contact tracing given limited resources.

“In the face of surging disease or limited staffing, local and tribal health departments are encouraged to adopt flexible strategies to meet the goals of contact tracing and monitoring as best they can,” the memo reads.

Powers said Public Health changed its practices after first trying to send some cases to a state-run contact tracing team.

“They were as far behind as we were, so that was really a dead end,” Powers said.

Door County Public Health simply does not have enough staff to continue calling close contacts directly, Powers said. Its contact tracing staff includes four key Public Health staff members and four part-time contact tracers who started last month, each working 24 to 32 hours per week, she said.

Public Health is hoping to hire an additional “handful” of contact tracers, Powers said, with the exact number determined by how many hours each person can work.

Powers said she doesn’t have an exact number in mind of how many staff members it would take in order for Public Health to continue calling close contacts.

“It would take much more—I think it would take the disease incidence to go down, frankly, no matter contact tracers we had,” she said.

But she said she’s happy with how the new process has gone this week, noting that Public Health is much closer to being caught up with new positive cases, whereas previously staff members had not been able to contact positive cases for up to four days after their test results.

Part of her thinking in making the change, Powers said, was guided by the uncooperative responses Public Health staff had gotten when asking close contacts of positive cases to quarantine.

“What we were running into unfortunately is a lot of skepticism on the part of people that we were reaching out to—not wanting to talk to us, and having the feeling that we were trying to push them into doing something,” Powers said.

“We had the feeling that people might respond better to their own friends and family than they would to a call from us,” she said.

Public Health staff now also are more available to answer questions from and provide guidance to schools and businesses, Powers said.

Shortage of tests, high positivity rate lead to slower test results

The surge in positive cases also contributed to a “perfect storm” that resulted in slower test result times of up to three to five days in recent weeks, Heise said.

The spike came at the same time as the Medical Center’s testing equipment was undergoing routine maintenance, he said. When those machines came back online, the heightened demand for testing and higher positivity rate meant the Medical Center had to send some tests to a lab run by Madison-based Exact Sciences Laboratories, where results take longer than those for tests the Medical Center processes in-house.

The higher positivity rate among COVID-19 tests means the Medical Center cannot process tests nearly as quickly, Heise said.

When the positivity rate is low—less than 5 percent—the Medical Center can use a technique called “pooling,” in which it processes tests in batches of six to eight at a time, Heise said. If the entire batch comes back negative, he said, testing staff can move on to the next batch.

If the batch comes back positive, they can process the tests in smaller and smaller batches to determine which individual test or tests are positive, Heise said. When the positivity rate is more than 5 percent, he said, that technique is no longer effective.

The 14-day average positivity rate in Door County was around 2 to 3 percent throughout the pandemic until late August or early September, Heise said. Now, he said, it is about 18 to 19 percent.

Before the positivity rate rose above 5 percent, Heise said, the Medical Center was able to process “well into the mid-hundreds” of tests per day. Now, that number is 40 to 50 per day, he said.

The Medical Center also does not have as many tests as it would like, Heise said, reflecting a national shortage.

Most testing vendors, including the one the Medical Center uses, are apportioning tests based on hospital size, he said. Among the relatively few vendors who do not apportion tests, there has been a run on the market, Heise said.

“It’s our version of toilet paper,” he said.

The Medical Center has two types of tests that both fall under the category of PCR tests, which pick up genetic material of the virus that causes COVID-19, Heise said.

One type of tests is used for hospital patients prior to admitting them to the hospital, Heise said, and can provide results in an hour. The other type, used for members of the public, usually can provide results in 24 hours.

For the one-hour tests, Heise said, the Medical Center might get 30 tests per week from its vendor.

“They basically say, ‘OK, so you’re asking for 10,000, here’s 30,’” Heise said. “That’s really what they do.”

The Medical Center’s goal is to process as many tests as possible in-house in order to keep results times down to 24 to 36 hours, Heise said.

The Medical Center hopes to achieve that by the end of October, he said, in part through the addition of a new type of testing, called antigen testing, that can be used primarily for people who already have symptoms.

The slowdowns in testing have been frustrating, Heise said.

“Really our ability to deal with the pandemic has a lot to do with how fast we can test and act on those results,” he said. “So when we have those slowdowns, it’s very frustrating.”

The Medical Center is operating a drive-through testing center at a building adjacent to its Sturgeon Bay hospital, Heise said.

Testing there is available to people who have symptoms or have been told they are a close contact of a positive case, he said.

Tests are not available to people (other than close contacts) who do not have symptoms, in an effort to prioritize the Medical Center’s limited testing resources, Heise said. But those symptoms do not have to be severe, he said.

“If someone says, ‘I woke up this morning and I have a sore throat,’ and you’re worried, you can get tested,” Heise said.

To get tested, Heise said, people should call the Medical Center’s hotline at (920) 746-3700. A staff member at the hotline will then tell them when they can come for their test, he said.

County sees first hospitalizations in months as Green Bay hospitals near capacity

The Medical Center also has seen its first hospitalizations due to COVID-19 in two to three months, with four people hospitalized this week, Heise said. Three of those people were still in the hospital as of Thursday, he said.

Prior to the four recent cases, Heise said, the Medical Center had seen about 10 people hospitalized in total due to COVID-19.

“That really does represent a significant uptick,” he said of the cases this week.

As of Friday, 110 patients are hospitalized with COVID-19 in Northeast Wisconsin, 41 of whom are in ICUs, according to the state Department of Health Services. Less than a quarter—23 percent—of hospital beds now are available in the region. The state reported 663 people hospitalized statewide Friday, down from a peak of 683 on Wednesday but a 40 percent increase over the past 10 days.

The Medical Center has transferred a few COVID-19 patients over the past few months to Green Bay hospitals, Heise said. Those patients, he said, are not considered hospitalizations at the Medical Center.

“If a patient could be better served with a higher level of care, additional specialists that we don’t have here … then they really should be there,” he said. “It’s our responsibility to make sure they get the best care they can get.”

The four patients hospitalized this week did not need to be transferred, Heise said. But he said he is concerned that with hospitals in Green Bay nearing capacity due to the surge COVID-19 cases around the region and the state, the Medical Center may be limited in its ability to transfer patients there for COVID-19 or other serious conditions.

For example, if a patient comes to the Medical Center’s emergency room with a heart attack and all the Green Bay hospitals are full, care for the heart attack would be delayed because the Medical Center does not have a cardiac catheterization lab that can put a stent in the patient’s heart, Heise said.

Heise said he is concerned about hospital capacity.

“I think that’s everyone’s concern right now,” he said. “If things keep going in the direction they’re going, all health care systems in the region (could be) at capacity.”

“I’m actually more concerned now than I was when this whole thing started—it’s literally at our doorstep,” he added. “I’ve got a lot of resolve that we’re going to do just fine, but I’m hoping that it doesn’t continue in the direction that it’s going.”

Heise said the Medical Center is not close to deciding to shut down any other services in order to ensure it has enough staff to treat COVID-19 patients. He noted that when the Medical Center temporarily closed its primary care operations this spring, it had a negative effect on patients.

“That’s a decision we would make only if we had to do it,” Heise said.

Solomon Lindenberg contributed reporting.