Last week, Jennifer Smith, a state epidemiologist turned whistleblower, confirmed that she was aware of just 10 contact tracers following up on Covid-19 cases for the Department of Health. She had made that statement before, but this time put it in writing as part of a statement distributed by her attorney, Carl Varady. Carl is a very, very good attorney.

The ridiculously small number of contact tracers was quite different from what the public was being told for months. We heard officials continually telling us how the number of contact tracers was being rapidly ramped up, as it needed to be.

KHON, May 8, 2020.

…the health department says it’s already training more people for contact tracing and will have the capacity to trace up to 920 people per day before any surge occurs.

“Nine hundred twenty people a day. That’s as many as we can possibly imagine can happen, given the limits of our health system,” said Dr. Bruce Anderson, DOH director.

Bruce Anderson, quoted in a Star-Advertiser story on May 19, 2020 on the importance of contact tracing:

As Anderson explained Monday, “It’s not going to disappear. We’re going to have COVID-19 with us for many, many years to come, possibly our lifetimes. Our ability to manage the disease is going to be based on our ability to respond quickly and appropriately to new cases and contacts, and we expect that will continue.”

Elsewhere in the story, it was estimated that Hawaii needed 300-500 contact tracers.

Big Island Now, May 21, 2020.

A contact-tracing program — developed via a partnership between the Hawai‘i Department of Health and the University of Hawai‘i — will supplement the state with between 100 and 300 new contact-tracers as necessary, DOH Director Bruce Anderson said.

KHON-TV, June 19, 2020.

The health department is ramping up its contact tracing capability to prepare for more surges and it’s getting help from the University of Hawaii.

“We’re training 64 people per week in that program and we’re just about to finish week two. So we’re on track to train about 370 people by mid July 2020,” said Aimee Grace, UH Health Science Policy director.

Hawaii Public Radio, July 8, 2020.

In a sober tone, the normally upbeat Caldwell revealed that he was informed by the state Department of Health that if the daily rate of new infections remains at the level seen on Tuesday, it could prohibit the ability of the state’s contact tracers to effectively track down others potentially exposed.

That kind of tracing is widely viewed as essential to containing the pandemic. The health department already has 30 contact tracers on staff, with hundreds more being trained.

“Hundreds more being trained.” Really?

Hawaii Public Radio, July 16, 2020.

Park told the senators that the department is hiring and training more contact tracers but the focus shouldn’t be on contact tracing or testing, but rather on whether the community is abiding by the measures to reduce the spread of the virus.

You get the idea. Everyone acknowledged that contact tracing is critical. And we were repeatedly assured that the number of trained contact tracers was rapidly growing.

Then along came Jennifer Smith with a reality check.

From her statement September 10.

Contrary to other public statements I have read and heard, I was aware of a total of only 10 epidemiologist investigators at the Department on Oahu tracking the spread of COVID-19. The members of our team worked six to seven days a week 10 to 12 hours per day, often with no pay for overtime, trying to defend Hawai‘i from the pandemic while the numbers of infected people continued to mushroom. Our workload reached 300% of intended capacity, working with outmoded computers, overwhelmed phones staffed by people without complete training, and a data system that was never validated. Even working from home on weekends, we could not keep up.

In a meeting with Dr. Park on July 31st, I told her that our team was overwhelmed and could not keep up with the escalating numbers of infected people because our time and resources were already stretched to capacity. Her only response was to demand that we had to do more. A management culture of “bullying, shame and blame” fosters a culture of fear, not the solid science that is essential to insure Hawai‘i’s public health. Employees should not have to choose between protecting their careers, through unquestioning loyalty to ineffective leadership, versus asking for the tools to do the kind and quality of science necessary stop the pandemic. Our job is saving lives, not saving face. I was forced to leave the Department on September 4th when the faction protecting Dr. Park, at what I believe is the cost of public health, prevailed.

Contrary to public statements made by others, the only thing I have ever threatened was the toxic management culture at the Department and that has directly impeded my and other epidemiologist investigators’ work.

On top of the toxic administrative culture, the Department of Health was relying on obsolete technology, including a pair of fax machines, to communicate Covid-19 data through the system.

Okay, the terrible part of this story is that I’m afraid this is a template for critiques of most state departments. Too few people staffing key offices with little or no training, obsolete technology, and abusive management. When state departments are doing their jobs, or are not doing them as well as we should expect, we can’t blame the front-line workers. I’m willing to bet that in many other cases, those front line staff are facing the same toxic mix.

Officials like Bruce Anderson and Sara Park are smart and experienced people. Even they are caught in an under-resourced and overly political system.

We’ll eventually get past the Covid-19 pandemic. But will we find a way to get past a dysfunctional bureaucracy?