Kansas counties remain unable to conduct contact tracing for all individuals who contract COVID-19 — and the federal government is acknowledging that reality.


Under revised guidance from the Centers for Disease Control and Prevention released last week, local public health workers are being urged to triage which cases are traced.


That means focusing on tracing associates of individuals who tested positive in the last six days, those who live or work in nursing homes or prisons and those who are at a higher risk of having severe complications from the novel coronavirus.


"As the burden of COVID-19 worsens in an area, and the capacity to investigate new cases in a timely manner becomes more difficult or is not feasible, health departments should prioritize which cases to investigate and which contacts to trace," the guidance read.


Some counties, most notably Sedgwick County, have already announced changes to their contact tracing protocols in line with the CDC recommendations.


As COVID-19 surges in the state, widespread contact tracing, once hoped to be a major asset in helping slow the virus’ transmission, has become a tough ask for many local health departments.


"Unfortunately the health departments just cannot do it all," said Charlie Hunt, a former chief epidemiologist at the Kansas Department of Health and Environment.


Hunt’s tenure as the state’s top disease control expert included the swine flu H1N1 outbreak in 2009. He said most of the emphasis then, however, was on a more broad-based survey of where cases were and didn’t rely as heavily on contact tracing.


That makes the current strategy unique for most health departments, who have been forced to attempt to hire and train staff members to carry out the practice on the fly.


"Certainly the public health workforce didn’t have the capacity to do that," said Hunt, who is now a senior analyst at the Kansas Health Institute. "There have been a lot of staff added to do that kind of work but they need to be trained ... It is just an incredible burden to try and build up a workforce in such a short period of time and have them be proficient and effective and so forth."


And contact tracing wasn’t exactly straightforward before the recent surge in COVID-19 cases, owing in part to a law passed earlier this year that gives residents wide latitude in opting out of contact tracing efforts.


The statute, signed into law by Gov. Laura Kelly earlier this year as part of a bipartisan COVID-19 deal, makes participation in contact tracing voluntary, limits the use of a cellphone app or other mechanism to track potential spread and makes contact tracers swear an oath that they will abide by the law.


Public health officials across the state have argued that participation in contact tracing has dropped due to the measure, despite the fact that the practice has always been voluntary and a staple of preventing disease spread for years.


In Shawnee County, for instance, health officer Gianfranco Pezzino has said that 10% of people reached for contact tracing don’t participate.


Dennis Kriesel, executive director of the Kansas Association of Local Health Departments, said some residents will outright lie to local health department staff about whom they have been near.


Some local departments reported to Kriesel, moreover, that even church leaders hadn’t been forthcoming about whether parishioners had been exposed.


Officials hope the new CDC guidelines will potentially free up staff to more effectively trace contacts.


And because health departments have been so devoted to keeping up with contact tracing, Kriesel said prioritizing the cases involved would help staff more effectively tackle other duties, including preparing for a potential vaccine rollout in the coming weeks.


"(The guidance) has been something that a lot of the health administrators have been asking for for months now, that the levels are too high and it has just gotten so bad at this point," Kriesel said.


Many local health departments have been forced to send cases they can’t handle to the KDHE for several weeks now.


But Kreisel said the state isn’t in a position to be of much help either.


"KDHE can’t keep up anymore and sends the cases back (to the counties)," he said.


The state is in the process of hiring more staff but even the expanded operations won’t be enough to cope if the state is seeing 1,500 new cases per day or more, Kriesel noted.


This is no surprise, officials say.


"This is hitting everyone in the state, so keeping up with contract tracing is very difficult," said Karen Hammersmith, one of two interim directors of the Reno County Health Department.


Counties have continued to urge residents to effectively trace contacts on their own, alerting friends, family members and other known associates of their infection.


That can be a tough sell in some instances, Hammersmith said, with residents hesitant of bringing a positive test to the attention of their employer, for instance.


It is easier to get an individual to loop in their loved ones, she said.


"It’s not something they are required to do, but particularly if they are close friends or family, they usually get no pushback by notifying them," Hammersmith said.


Hunt noted that the new CDC guidance would provide some relief but noted officers will still need to hunt for key information that will be necessary to determine whether a case needs to be given top priority.


That means staff will still need to be working the phones.


"While I think the prioritization criteria will help somewhat, it may not alone reduce the burden enough because much of that information is not going to be known until the cases are investigated," Hunt said. "So it may not work for a large number of cases."