To ease public confusion over constantly shifting COVID-19 guidelines and lessen the pressure on the pandemic-beleaguered Health Department, the Barton County Commission met as the Board of Health Thursday morning and approved changes to COVID protocols. These allow the county to turn isolation orders and case investigations over to the state and adopt the current state and federal recommendations.

Thursday’s one-hour meeting in the commission chamber was a follow-up to a three-hour health board study session Wednesday morning where Health Director Karen Winkelman made her case for the updates. She sought guidance from the board as her Health Department struggles to allay residents’ concerns over evolving rules, as well as relieve burnout amongst the weary staff.

“I think that any time we have the opportunity to educate the public on what’s happening, the changes that are happening, we need to take that to avoid confusion and to show that we are all on the same page,” Winkelman said. She utilized a slide presentation to highlight the timeline for the pandemic, and all the extra work it has placed on the Health Department.

Despite this, “we’ve had a lot of long-lasting partnerships that have happened,” she said, noting other county departments and entities pitched in to help. “The community came together to make this happen.”

However, it was a skeptical board that signed off on giving investigation duties to the Kansas Department of Health and Environment, which is already bogged down. They questioned the state’s ability to handle the workload and hesitated over losing local control.

“I think the state is going to have a problem with this,” said District 1 Commissioner Kirby Krier.

The changes are effective Feb. 1. Should Barton County officials see this failing, the county can opt out at any time.

Investigative changes

The KDHE, seeing many smaller health departments on the verge of failure due to the pandemic, offered three options to help alleviate workloads, Winkelman said. These ranged from allowing departments to stick with doing all investigations and contact tracing in-house, to turning this all over to the state agency, which is hiring more staff to handle the case volume.

Also, contact tracing has been, or soon will be, eliminated from the investigative process at the state and local levels. The investigation includes asking questions about the onset of symptoms, vaccine status, and overall health.

It was Winkelman’s recommendation that Barton County go with what the KDHE called option three, allowing KDHE to handle the investigations.

“It’s overwhelming,” Winkelman said of the flood of cases. So far in January, there have been over 200 positive cases.

“That’s no surprise. It’s the same across the state,” she said. Kansas recorded 22,240 cases between this Monday and Wednesday.

“I think this commission is fully aware of the pressure your department is under,” said District 5 Commissioner Jennifer Schartz. In addition to COVID, the department still has family planning, immunizations and other services to provide.

“You’ve risen to the occasion,” Schartz said. “But, if the state is willing to take on some of the workload, we should accept.”

The KDHE will automatically collect COVID data from counties. Counties will still have access to this information via a secure online database and can pick specific cases to investigate locally.

And, Winkelman stressed, her office is still willing to field calls from residents who have questions.

COVID is one of about 50 infectious diseases (along with small pox and measles) that are mandated by state statute to be reported to the state. The KDHE already does the investigations for the other illnesses.

The staff at a new agency call center will make the calls to conduct interviews. And, the state will generate and send out isolation orders.

“This is huge,” Winkelman said. Her staff spends hours on the phone, and since some people are fearful of giving their personal information, the Health Department callers are abused verbally.

The commission was assured that regardless of who makes the call, the individual is under no legal obligation to answer the questions.

Commission Chairman Shawn Hutchinson, District 3, tossed out a possible option four – where the county handles only investigating positive cases with no contact tracing or quarantines. 

Roughly 90% of the department’s time spent was spent on investigations, and the rest on contact tracing, Winkelman said, so this probably wouldn’t save much time. And, people were becoming much more reluctant to answer.

Doubting the state’s ability

But, “if the state can’t keep up, we are putting our citizens at risk,” said District 1 Commissioner Kirby Krier, who was leery of the plan. “We’ve just thrown our citizens under the bus.

“This commission has always been supportive of the Health Department,” he said. It has consistently backed staff and pay increases.

He said the county has around $400,000 in federal/state COVID grant money. That could be used to hire additional Health Department personnel to handle the work.

But, hiring anyone is not a sure thing, Winkelman said. They have a long-vacant opening for a nurse.

Besides, she said, her staff can’t keep up with the case load either. So, they might as well let the state have a crack at it.

Schartz said she understood Krier’s trepidation.

“As the Board of Health, our primary concern is the health of our citizens,” she said. “Second is to keep the Health Department functioning” so it can serve the public.

“Karen has asked for an intervention because her staff is on the edge,” Schartz said. “We need to be very respectful of that.”

In the end, the board unanimously approved the change, with the caveat they receive regular reports on how the plan is working.

“We’re going to get through this,” Krier said. “COVID is going to be here for a long time.”

“It is worth giving it a try,” District 2 Commissioner Barb Esfeld said.

Isolation changes

As for changes to the lengths of isolations, Winkelman’s recommendation is for the county to switch to the new Kansas Department of Health and Environment guidelines, which mimic those recommended by the Centers for Disease Control. There is still a 10-day isolation, but in many instances a person can go out in public wearing a tight-fitting mask after five days.

Generally speaking, quarantines would be for 10 days.

It’s important, she said, to provide “consistent, concise and clear information.”

But, there are so many factors, she said. Such things as vaccination and booster status, as well as a patient’s history with COVID and their profession can influence how long they have to quarantine.

There is also a set of guidelines for health-care workers due to staff shortages. In certain circumstances, they may return to work after five days, as long as they wear masks.

There are other factors, such as how critical staffing is to a facility and the severity of the person’s symptoms.

Isolations orders are for those with confirmed positive cases requiring them to stay home, and are enforceable by law. Quarantines are recommendations that cover the incubation period and are for people who may have been exposed to COVID and are waiting to see if symptoms develop.

By adopting KDHE’s option three, the county automatically fell in line with these recommendations.