The Barton County Health Department on Tuesday started handing off all of its positive COVID-19 cases to the Kansas Department of Health and Environment for investigation, a controversial move made by the County Commission last month to offer relief to beleaguered local health officials.

Health Director Karen Winkelman told the commission, meeting as the Board of Health Wednesday morning, they are in a waiting mode to see if this works. But, for the time being, things are going well.

“It’s like there is a light now,” Winkelman said, adding they have access to the positive case list and noticed 47 more positives where forwarded to the KDHE. “So takes a load off.”

The Health Board plans on meeting on the first Wednesday of each month for the next few months to keep up to date on COVID and on whether this new system remains in the county’s best interest. There had been much concern about relinquishing local control and if the state is up to the challenge.

In January, the KDHE saw many smaller health departments struggling and offered three options to help alleviate workloads. These included allowing departments to stick with doing all investigations in-house, turning over half to the state, and turning them all over to the state.

Barton picked the 100% option. But, “we can opt in or out at any given time,” the health director said.

The plan went into effect this week.

Contact tracing

The county ceased contact tracing on Jan. 12. This week, on Tuesday, the KDHE dropped it as well.

“The responsibility is going to be on the person themselves, or on the parent of a minor, to alert people they’ve been in contact with COVID,” she said. 

Because of this, it becomes nearly impossible to determine if a cluster (five or more related cases in one facility) exists, she said. The state is encouraging counties to continue tracking this, but “we are really almost unable to do that.”

Contact tracing differs from the investigation, she said. The investigation includes asking questions about the onset of symptoms, vaccine status, and overall health while providing general information, but tracing involves tracking down those who were in contact with a positive case.

Winkelman said 61 counties out of 105 in the state have opted to turn all positive cases over to the KDHE. In addition, 26 are turning over half. Eighteen counties have chosen to continue doing their own investigations.

There were counties of all sizes in each category, she said. “It was really all for various reasons. They know their community, they know their county.”

Stepping up efforts

The agency said it has 100 full-time people to manage investigations, and plans to add another 200 by the end of February. 

The KDHE reported 55,000 cases across the state in January, District 1 Commissioner Kirby Krier said. “There’s no way that the can handled 55,000 cases.”

“During this really high surge, they are prioritizing those under 18 and those above 65,” Winkelman said. Those in between will receive a text message alerting them they tested positive.

“So it’s going to be really important from the people reporting the positives that we have all that demographic information,” she said. “If you need a letter of isolation recommendation for your job or for any situation, (the state) will provide that.”

If more than seven days lapses after a reported positive, they will not investigate because that critical period has passed, she said. And, cases involving a COVID death will not be investigated.

She said the county has only done this for a short time, so it is difficult to determine if this will work in the long-term. 

“Our President of the United States, Joe Biden, said there’s no solution,” Krier said. “He has no solution and he said basically, which in one way I can agree with, right back to the local level.”

“You have asked me before about national issues,” Winkelman said. But, “it goes back to local. I think each county knows their county. You know, what is needed in their county.”

“I think the best form of government is the local government because we’re closer to the people and the needs,” District 5 Commissioner Jennifer Schartz said. “It falls to us. I think we need to accept that responsibility and lead our constituency in the best way that we can.

“I realize that during this pandemic, things have shifted numerous times and I expect it to continue doing that,” Schartz said. But, she finds it interesting that now that the state is taking over, there are fewer requirements “because they knew it couldn’t be done.”

She applauded Winkelman and her staff for hanging in there until a solution was found.

The issue of pay

There was a lot of talk about staffing at the Health Department. Winkelman is down one nurse and that position has remained unfilled for over a year, and she just lost a certified nurses aid.

“I think it’s imperative that we make some sort of decision on how many additional nursing positions are needed over at the Health Department,” District 4 Commissioner Jim Daily said. He suggested tapping federal COVID relief grant funding. 

There was hesitation about what would happen when the relief money runs dry. 

Daily wanted to hire two additional nurses. But, after hearing from Winkelman he suggested one. However, a motion to this effect failed. 

The Health Board cannot take binding action. Any item would have to come before the county commission for final approval.

And, “I think we need to maybe move the salary up a little bit so we can attract some folks,” he said. “We need to look at that party seriously.”

For nurses, the pay is in the $25-per-hour range, and for CNAs, it is $14, Winkelman said. But, salary isn’t always a factor in people leaving.

“I will say that there are other entities paying higher to retain nurses because of nurses leaving the field,” she said. But, people leaving the health-care field is a national problem.

Winkelman said they are starting interviews to fill two new clerical positions. They also have openings for a part-time dietitian and a full-time financial officer.

The board thought it better to delay action on additional staffing until Winkelman has a better idea if the relationship with KDHE is successful.

It was also discussed that COVID funding could help with hazard pay.