One Oregon county has widespread COVID-19 testing. Others aren’t so lucky.

‘They don’t have a rainy-day fund or bucket of money that’s just waiting for a big crisis.’

 

TRACE team members during the pilot phase of the project this April in Corvallis, Oregon.
Karl Maasdam/OSU

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On a cloudy Sunday morning in early May, Oralia Mendez walked up to a house in Corvallis, Oregon, introduced herself to the man at the door, and asked him if he would be willing to swab his nose for the virus that causes COVID-19. 

The visit was part of an Oregon State University project meant to help the Benton County Health Department deduce the prevalence of COVID-19 and mitigate its spread. Called TRACE, short for Team-based Rapid Assessment of Community Epidemics, the project sent teams of volunteer OSU students and health workers, including Mendez, to collect swabs at randomly selected Corvallis homes. “We want to help fight this virus,” said Mendez, who, along with her student teammate, Shoshanna McCleary, successfully collected several samples that morning.

TRACE is one of several projects nationwide that are trying to paint a clearer picture of the coronavirus’ quiet circulation within a community. But because many local health departments lack the resources to run this type of study, they must rely on funding from universities and other organizations. In Oregon, that means places like Benton County are able to rigorously track the virus, while other counties can only tackle immediate needs, like responding to current COVID-19 hotspots.

Volunteers from Oregon State University are going door-to-door to ask Corvallis residents for nasal swabs to test for Covid-19.
Karl Maasdam/OSU

With tests for the coronavirus still in short supply, many areas have largely restricted testing to people with symptoms. This is vital for identifying local outbreaks and figuring out who needs to be isolated and treated. However, such testing doesn’t reveal the full propagation of the virus throughout a community, as it leaves public health officials blind to the number of patients experiencing mild or no symptoms. Projects like TRACE aim to collect data from people with and without symptoms in order to reveal the virus’ true spread.

“Everybody is talking about the lack of funding. It’s an ongoing financial struggle.”

But carrying out such community-wide surveillance is expensive. The TRACE project — which involved collecting thousands of swabs across Corvallis — was funded by OSU and a $750,000 grant from the David and Lucile Packard Foundation. In nearby Lincoln County, the public health department received $50,000 from the state government this year for its entire communicable disease program, including the county’s COVID-19 response. “Everybody is talking about the lack of funding,” said Susan Trachsel, Lincoln County’s executive assistant and public information officer. “It’s an ongoing financial struggle.” 

Even recent federal aid hasn’t addressed this need: In northern Oregon, the Washington County Public Health Department received $1.4 million through the Coronavirus Aid, Relief and Economic Security Act, but none of that money was allocated for a community-wide study to screen for coronavirus. Instead, it will fund efforts like education, tracking and contract-tracing programs. “It’s unusual to get (federal or state) money for studies,” said John Auerbach, CEO of Trust for America’s Health, a research and advocacy organization. Large health departments with thousands of employees may be able to do a widespread monitoring study, “but that’s not your typical health department.”

Instead, many projects are financed and run by wealthy organizations or universities. For example, the Bill and Melinda Gates Foundation gifted $3.7 million to a screening program in Seattle. The University of Utah is also set to begin testing 100,000 randomly selected residents across four counties, and the University of California, Berkeley has launched a new study to capture the spread of the virus in the Bay Area.

A TRACE team member talks with a neighborhood resident during the pilot phase of the project in April.
Karl Maasdam/OSU

Underfunding for public health is not a new problem. According to a 2020 report by Trust for America’s Health, approximately 56,000 public health jobs — roughly a quarter of the total — were eliminated nationwide over the past decade, chiefly because of cost concerns. “(The 2008 recession) hit health departments incredibly hard, and they haven’t recovered,” said Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials.“They have to pick and choose what they focus on — usually triage what are the most pressing issues.”

That’s the case for the Benton County Health Department, which lacks the time, staff or resources to run the TRACE project on its own. “Our department was and is not capable of independently developing and carrying out a study of this size and complexity,” Charlie Fautin, Benton County’s interim health department co-director, wrote in an email. Still, Fautin recognizes that TRACE is critical for uncovering the number of mild or asymptomatic infections. Early data suggests that two out of every 1,000 people in Corvallis have the virus — information that will help the health department make informed decisions about future policies regarding COVID-19 restrictions, especially as Benton County reopens.

Researchers hope to eventually expand TRACE to other Oregon counties. In an ideal world, all local health departments could run COVID-19 screenings like this, said Auerbach. But for the time being, these projects may be limited to counties that receive extra help. “(Local health departments) don’t have a rainy-day fund or bucket of money that’s just waiting for a big crisis,” said Casalotti. “It’s a challenging position, because everything is so tight.”  

Helen Santoro is an editorial fellow at High Country News. Email her at [email protected] or submit a letter to the editor.

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