By Philip Van Slooten
Capital News Service
ANNAPOLIS, Md. — “Answer the call” and download the COVID Alert app have joined the growing list of pandemic precautions, such as wearing a mask and social distancing, as the Maryland Health Department battles a pandemic surge during this holiday season.
“Of course everyone wants to be with family and loved ones, but we are in the midst of a pandemic and cases are skyrocketing,” Dr. Katherine Feldman, director of the Maryland Department of Health’s contact tracing unit, told Capital News Service on Thursday.
The health department on Tuesday reported over 1,600 more confirmed cases and 32 deaths added to state totals in the past 24 hours. The counties with the highest number of cases continue to be Prince George’s, Montgomery and Baltimore while the spike in Allegany challenges hospital capacity.
Feldman said it was important for Marylanders to enable the MD COVID Alert exposure notification app, answer a contact tracers’ call, wear a mask, socially distance and continue to take other pandemic protective measures to “reduce transmission and have all of us stay safe and healthy.”
MD COVID Alert is a passive system that users enable on their iPhone or download to their Android phone in order to receive notifications when they have come in close proximity to another user who may have tested positive for the virus.
Feldman describes “close proximity” as within the 6-foot social distance threshold for at least one minute of exposure to a potentially infected person.
The app then makes the user “aware they were exposed, so they can take preventative action,” which includes getting tested and self-quarantining to stop the spread of the disease, Feldman said.
The Maryland Department of Health launched the system Nov. 10 and reported over one million Marylanders, around 17% of the state’s population, downloaded the exposure notification app within the first week.
Research results released in September of Washington state’s exposure notification system found COVID-19 infection rates could be reduced by 8% and deaths by 6% when at least 15% of the population enables the app and the system is complemented by traditional contact tracing methods.
Traditional contact tracing involves an investigation process where health department officials question individuals infected during a disease outbreak in order to find out whom they may have come in contact with and “break the chain” of infection, according to the Centers for Disease Control and Prevention.
This process is also used during outbreaks of food-borne illnesses in order to locate the source.
Gov. Larry Hogan, R, stated in a Nov. 17 press conference that while the number of state contact tracers have been “ramped up” to around 1,400 in order to reach as many people as possible who may have been exposed to the disease, there are other challenges to address.
“Our problem is that so many people refuse to give the information. A little more than half, if we contact them, don’t want to participate,” he said. “We have to get the word out for people to participate.”
Hogan said the state was administering around 30,000 tests a day, and many people had downloaded the alert app, but it was still important for infected Marylanders to answer tracers’ calls.
This is for tracers to determine who else may be infected, so they can be notified and encouraged to get tested and to quarantine as well.
“Contact tracing is critical for local public health officials to be able to understand how an epidemic is moving through a community,” said Dr. Wilbur Chen, an infectious disease specialist with the Center for Vaccine Development and Global Health in the University of Maryland’s School of Medicine and an adviser to Hogan’s COVID-19 task force. “We have to have the same approach for finding out who has symptoms and who has been in contact with them, in order to determine the source.”
According to Feldman, local health departments began investigating the first COVID cases in March and April but were quickly overwhelmed. A statewide effort began in June.
Chen explained one of the first hurdles the state program had to overcome in the early days of the pandemic was to hire more tracers, because of how easily COVID-19 can spread through a community.
“COVID is a fast-moving target,” Chen said. “But we need to get those who are infected or exposed quarantined in case they are not symptomatic. All of this has to be done as quickly as possible.”
But an ongoing concern is for Marylanders to answer the phone when called.
“In order for us to stem the spread of the disease, we need to talk to the cases and talk to the contacts (they may have had) and give them guidance,” Feldman said. “So, it is important for them to answer the call.”
But the guidance to get tested and self-quarantine is information Chen said some Marylanders don’t want to hear.
“Some people don’t want to get into trouble,” he said. “So, they may fudge their answers… to avoid going into quarantine.”
Chen said workers may want to avoid trouble with employers, students may not want to be isolated, or others may not feel comfortable talking to someone of a different culture or background.
All of these factors, as well as not having pandemic information effectively translated into other languages, may increase distrust and hinder contact tracing efforts.
Delegate Joseline A. Pena-Melnyk, D-Anne Arundel and Prince George’s, told Capital News Service on Friday that providing accurate translations for potentially life-saving information is critical in the midst of a surge.
“I went to the (MD COVID Alert app) website,” Pena-Melnyk said. “And it’s not easily accessible in Spanish. That’s a concern.”
Currently, there is a “Translate” link at the top of the Maryland Health Department’s MD COVID Alert page, which contains information about the app as well as what steps to take if alerted you’ve been exposed to someone infected.
When clicked, it pulls up a list of many languages to translate the page into, but leading the list is a disclaimer stating the site uses Google Translate, and the provider “does not guarantee and does not accept responsibility for the accuracy” of the service, including any inability to translate associated PDFs or graphics.
“Immigrant communities are hit hard by COVID-19,” Pena-Melnyk said. “COVID has shown health disparities in communities of color not just in our access to health care but in the lack of translated materials. So, if you have an app like this, that is supposed to notify people of who is positive, it is imperative to make it friendly and welcoming to use.”
However, Chen pointed out people who are uncomfortable taking a tracer’s call might respond more urgently to an alert notifying them of what next steps to take if potentially exposed to the virus than to a phone call.
Still, Sen. Clarence K. Lam, D-Howard and Baltimore counties, emphasized a lack of public trust during a pandemic is a serious problem that public officials should do more to address.
“Overcoming public distrust is a huge piece of this,” he said. “When it comes to sustaining public health, we all have our part to do to maintain that. It is up to public officials to reduce mistrust and fear in participating in these really important public health programs.”
Lam said he felt there was a high level of trust at the state and local levels, but representatives must be responsible and model appropriate behaviors such as social distancing and mask use and not hold large public gatherings.
“If their elected officials are not out there setting a good example and modeling appropriate behavior,” Lam said. “If they’re going to events where no one is masked and no one is doing their part, that is going to come back and haunt their community.”
Lam emphasized that everyone has a part to play in stopping the spread of the disease, and downloading the app is an important step but not the only one, especially as the holidays approach.
“Some may believe just because I downloaded the app, I can go to Thanksgiving dinner now, and that’s not the case,” Lam said. “Because the app is only going to alert you when the harm is already done.