Two sentences in a recent situational update distributed by the Cayuga County Health Department summarized the challenges they and other rural health agencies face as they work to contain the spread of COVID-19.
In the news release Friday, the department wrote that they are "continuing to see a rise in the number of positive cases and contacts throughout the community and are working diligently to enroll these individuals into isolation and quarantine with the staff that we have available. If you are symptomatic, stay home until you receive your test results."
The COVID-19 case spike in Cayuga County has presented challenges for the health department, which has a staff of about 40 employees. In the first 16 days of November, there have been 195 cases. It's likely that by the end of this week the county will have its most cases in a month since the beginning of the pandemic. The high is 228 in October.
The high case numbers take a toll. When someone tests positives for COVID-19, they are placed in mandatory isolation. Part of that process involves the health department monitoring these individuals, ensuring that they are abiding by the isolation order and can advise them if there are any changes in their symptoms.
Through contact tracing investigations, people who may have been exposed to the virus are identified. These individuals are placed in mandatory quarantine. The health department will maintain contact with the quarantined people and can provide guidance if they develop symptoms of the virus.
With a small staff and large numbers of cases and contacts — there are more than 100 active cases and over 600 people in quarantine, according to the county's latest update — the health department is struggling to keep up with the outbreak.
"What we reported on Friday are all the cases that we were able to finish contacting," said Kathleen Cuddy, the county's public health director. "We did finish contacting the remaining ones on Saturday. Without question, we are not able to contact the people in quarantine often on the same day that we're speaking with the people in isolation. We're doing what we can, but there is some delay. We know it's not unique to us.
"Oftentimes, people may hear that they are potentially exposed to someone who is positive and may need to go into quarantine. We appreciate their awareness and concern and we encourage people if they think they've been exposed to someone to act as if they have been. We will connect at some point, but it may take us a couple of days."
The primary reason for the delay is staffing, Cuddy said, but they are getting more help. The department has recently hired new employees who are assisting with the COVID-19 response. They also have new employees who are starting this week.
One decision could help the county as it works to properly isolate positive cases and quarantine contacts. Beginning this week, the health department will use CommCare, a digital platform to track COVID-19 information, including contact tracing.
When the state Department of Health began using CommCare, it was optional for counties. Cuddy said Cayuga County used the program on a limited basis when there were cases among different counties. But they relied on their own system, which included spreadsheets maintained by department staff, instead of fully adopting CommCare.
As the fall approached, the state made the counties an offer: If they used CommCare, they would provide grants for additional staff. Cayuga County decided to use CommCare in exchange for the funding, which would allow them to increase their staffing levels.
The health department is working to transfer its historical data to CommCare. One advantage of the platform, Cuddy said, is that it will provide real-time information on the situation in the county and the state Department of Health will have access to the data.
The county could also receive some help from virtual contact tracers to ensure that people who are connected to positive cases are placed into quarantine.
"I think it will provide us with some benefits," Cuddy said.