One worrisome cluster of COVID-19 cases was traced to an employee at Baystate Medical Center in Springfield who traveled outside Massachusetts to a hot spot area and to hospital staff who were lax wearing masks in a break room. Another was discovered among lifeguards in Falmouth.
These recent clusters have fueled concerns among public health specialists about the ability of the state government to quickly spot and contain outbreaks of the virus before they get out of control. With virus counts rising again in some states and countries that had lowered their cases, these local health leaders say it is critical Massachusetts improve its disease-tracking methods before the fall, when more businesses reopen and more people head back to work and school.
Particularly troubling, they say, is the state’s inability to quickly flag clusters in specific industries, such as in gyms or restaurants. This is the kind of unglamorous, behind-the scenes work that is crucial to tracking systems. And it could determine how the state responds to another outbreak — with a pinpoint containment that is less disruptive or a broad shutdown that affects much of society because the government doesn’t have a grip on how infections are spreading.
“If you don’t know which industries are hot spots, and if you can’t tell the difference between an outbreak and community spread, you are [operating] really blind,” said Shan Soe-Lin, managing director of Pharos Global Health Advisors, a Boston nonprofit focused on global health matters.
The crux of the concern is that the decade-old computer system connecting local health departments with the state’s central disease-tracking database wasn’t designed to handle infections on a pandemic scale. What’s more, an executive order and state law addressing data about COVID-19 cases provide vague or conflicting instructions for how essential information to track infections is collected.
“When the state makes a requirement for information to be collected, they need to think about who collects it and how to enforce it,’ said Samuel Wong, director of public health in Framingham.
Conditions in Framingham illustrate the rising concern about tracking coronavirus outbreaks, especially those potentially linked to the workplace. Currently, the median age of people in Framingham infected with COVID-19 is 29 — about 30 years younger than what it was earlier in the pandemic, Wong said.
“That’s telling us that, as we reopen, more working-age people are starting to come back to work, and we are seeing more cases affecting that age group,” he said.
Wong and other local health department directors are frustrated that information about a person’s occupation is not routinely collected when they are tested for COVID-19.
The new law requires the state Department of Public Health to publicly report that information. But it’s unclear who is supposed to collect that data — the providers conducting the tests or the local health departments that notify residents who have tested positive. So it’s perhaps not surprising that in the latest state data, occupational information is missing from more than 80 percent of recent tests.
“If there is no enforcement and no teeth, you will not see substantial compliance,” Wong said.
The state law also doesn’t require information on the type of industry in which a tested person works.
Readily available information about both the occupation and industry of infected individuals in a suspected cluster would allow health officials to avoid “a sledge hammer” approach when addressing outbreaks, said Robert Hecht, an epidemiology professor at Yale University’s School of Public Health.
Instead of closing everything down, he said, they could be tightly focused on only those places and industries where infections are festering.
The Baker administration declined an interview on the state’s process for monitoring coronavirus outbreaks and instead e-mailed a statement.
“The identification and investigation of clusters is a collaboration among local public health officials and the Department of Public Health,” the administration said. “As a potential cluster is identified, the department remains in close contact with local health officials to provide any additional support that might be needed, such as additional transmission prevention guidance or testing.”
The state department also declined to respond in detail to written questions about its ability to track clusters, saying in an e-mailed statement that occupational industries are being added to the tracking system.
DPH “is working with partners and stakeholders to improve data collection for the short term, while simultaneously developing long-term solutions,” the department said.
Exactly what factors are driving recent clusters in Massachusetts is unclear. Governor Charlie Baker has blamed individuals flouting such health guidelines as social distancing, and not the slow resumption of normal economic activity.
“The public health data is going to drive our decision-making, but so far, most of the data we see about where the clusters have come from have had a lot more to do with people just sort of letting down their guard more than anything else,” he said last week.
Public health experts say they’re not sure about that because the state is not widely tracking infections by occupation or industry.
“We don’t have the kind of monitoring and widespread testing, even with the improvements the administration has made, we don’t have some of the data to really assess that,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association.
And there are warning signs workplaces may be a source of the next outbreaks.
The Massachusetts attorney general’s office has received more than 1,700 complaints about coronavirus-related concerns at work sites since the shutdown was eased in mid-May. Hotels, restaurants, and sales-related businesses are among the most commonly cited industries, and the top complaints involve lack of social distancing and insufficient protective gear. There were more than 460 complaints involving retaliation or requiring employees to work despite having COVID-19 symptoms.
“It is alarming,” said Jodi Sugerman-Brozan, executive director of the Massachusetts Coalition for Occupational Safety and Health.
“We talk about these clusters as if it was one bad actor with no mask in a restaurant,” Sugerman-Brozan said. “But what about all these workers who were not bad actors but had to work to pay their bills.”
Information about contagious diseases is supposed to flow smoothly and quickly between state and local authorities.
Health care providers collect basic details, including patient names and contact information, and send it to the state health department for entry into the disease-tracking computer system, known as MAVEN. The state then alerts local health departments when a resident has been diagnosed with a contagious disease.
Local officials, in turn, are supposed to track down others in the community who may have been exposed, in order to isolate them.
Under an April 8 executive order by the Baker administration, health care providers were directed to “make every reasonable effort to collect complete demographic information, including full name, date of birth, sex, race and ethnicity, address, and telephone number,” when ordering a COVID-19 test for a patient.
The executive order also said the state health department would issue further guidance on how its directive should be implemented. Nearly four months later, health specialists say, they have yet to see that guidance.
Now, when local health departments receive a notice from the state about a positive COVID-19 case in their community, it’s often missing critical details — such as the patient’s complete contact information or race, said Sigalle Reiss, president of the Massachusetts Health Officers Association and Norwood’s health director.
“The focus of the local health board is contact tracing and quarantine, not demographic data,” Reiss said. “Our focus is disease prevention, because isolation and quarantine are more important.”
Municipal health departments have been filling in missing information as they contact infected residents, she said. One stumbling point has been collecting information on a person’s occupation because the state’s software system doesn’t provide choices that accurately reflect most of them, she said.
Other states have struggled with similar problems, said Letitia Davis, a Massachusetts epidemiologist who specializes in tracking workplace illnesses and injuries. Davis has recently been helping health departments in other states address data-collection issues, particularly related to occupation and employment information.
“The challenge is, you’ve got to train the people collecting the data to ask the right questions” and enter it into the computer correctly, Davis said. “It gives us the information we need to guide prevention efforts.”