Who Sets the Protocols for COVID-19 Testing and Tracing – the State or Localities?

by James A. Bacon

The Northam administration plans to dispatch $650 million of federal helicopter dollars directly to cities and counties to help cover the cost of responding to the COVID-19 epidemic. The state’s priorities for monies received under the federal CARES Act are expanding testing and hiring public health staff to conduct contact tracing, reports the Richmond Times-Dispatch.

“Testing and contact tracing are going to be reserved right off the top,” Secretary of Finance Aubrey Layne said Monday. ‘That’s going to be the number one priority because that’s the key to both the health and economic situation going forward.”

In the abstract, it makes sense to spend the money as Layne suggests: on testing and contact tracing. But questions arise that are not answered in the article. Who decides which protocols to follow with the testing and contact tracing? Will each locality make its own decision? The advantage of letting localities decide is that they are closer to the situation than state bureaucrats in Richmond and better able to apply the resources where they are needed most.

Conversely, should the state set standard protocols? The advantage of standard protocols and coordinated testing is that more meaningful conclusions can be drawn about how the virus is spreading and how best to combat it.

On Friday Governor Ralph Northam announced a pilot program with the City of Richmond to aiming to “increase equitable access to personal protective equipment in underserved communities.” His chief diversity officer, Janice Underwood, explained that the administration wants to ensure that “the most under-resourced communities in Virginia have access to testing, life-saving PPE, and culturally affirming educational materials in preferred languages and formats.”

How will these tests be delivered? Through local hospitals and health clinics? What criteria will be used to test someone? If the purpose of testing is to accurately estimate the prevalence of the virus by geography, income group, and racial/ethnic group in order to inform decision making on economic shutdown measures, a representative but randomized testing protocol is called for. Is that what we’ll get?

Contact tracing is a potentially useful tool as well. People testing positive for the virus are queried about their whereabouts over the previous few days, and people they may have encountered are contacted and informed of their possible exposure. If done properly, contact tracing can serve a double benefit — it can reveal high-risk behavioral patterns that can inform public health authorities about which measures work, and which don’t.

Where are people contracting the disease? The workplace? In family environments? At Wal Marts or the CVS? In large gatherings taking place in violation of the no-more-than-ten-people-together rule? In the great outdoors? Perhaps control measures need to be tightened in some areas and relaxed in others. Also, it might be useful to know if the disease is spread by a relative handful of careless high-risk individuals who infect a large number of people, or by the population at large. Such knowledge would help people adopt appropriate self-isolation practices.

Who decides which goals to pursue — the state or the localities? Who ensures that our multi-million investment in contract tracing yields the maximum public health benefit?

In sum, the $650 million to be spent on combating the virus could be an extremely beneficial investment or a total waste of money…. depending on how it is spent. I would feel far more reassured if Northam would explain his thinking to the public.

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22 responses to “Who Sets the Protocols for COVID-19 Testing and Tracing – the State or Localities?”

  1. LarrytheG Avatar

    I had assumed that the State via VDH would establish protocols.


    This has been a problem. Testing for testing sake – by various different entities does nothing other than tell someone at the time of their test that they were or were not positive.

    When comparing Virginia to other states – where other states were just doing “testing” without any protocol – criticizing Va for low levels of testing really meant not a whole lot.

    Now, if Va scored low on a uniform standard for testing and contact tracing, it would have been a justified criticism and especially so if it came from people on both sides of the political spectrum.

  2. MAdams Avatar

    As far back as March PA was using Virginia Private labs for testing. I don’t think it’s a stretch to believe that the VDH hasn’t managed this whole situation very well.

    1. djrippert Avatar

      VDH has been a disaster throughout this pandemic. Those in the know have said that VDH was known to be inept for years but no major problems ever exposed it. Until now, of course.

      1. LarrytheG Avatar

        Nope. That’s a GOP narrative…. virtually no one outside the GOP believes it.

        Find me a single – non-partisan article that claims VDH is “inept”.

        If that’s true, it should have been in the media , or on the internet, right?

        Here, do this: GOOGLE: ” Is the Virginia Department of Health inept?”. Or swap “inept” for “incompetent”.

        what do you get?

        1. djrippert Avatar

          I know that your understanding of the world is limited to what you can find through internet searches. However, commenters on this blog with extensive knowledge of the matter have left comments questioning VDH’s competence going back years. If you like doing searches why don’t you scroll through older comments and see if you can find them.

          As far as “Republican narrative” … when I say “inept for years” why would you assume that does not count the years of the McDonnell Administration or the years when the GOP controlled the General Assembly?

          Finally, can you explain why HIPAA regulations preclude Virginia from disclosing nursing home COVID19 deaths by nursing home while those same regulations have no bearing on Maryland’s disclosure of that same information?

          Meanwhile, the mindless opacity of our state government is having real world implications here in NoVa …. just ask the Mayor of Alexandria. Perhaps he is in on this Republican plot too?


          1. LarrytheG Avatar

            the “extensive” knowledge only impresses me if it is bi-partisan. If it is not, then go fish. Interent, polls, and other information is allowed but echo chamber is a no go.

            re: McDonnell.. well if you include ALL government then what can I say? Do you think that also about Maryland? What’s the difference between Hogan and McDonnell?

            On the HIPPA – yep.. it’s a flimsy excuse… but I DO NOTICE in other states it also works the same way. Not justified.

  3. djrippert Avatar

    Anything that can be done locally should be done locally, including the setting of protocols for testing. It’s the local hospitals that may get overwhelmed not the backrooms at Bookbinder’s. I don’t think NoVa can survive anymore of the “help” we have been getting from Richmond. Hampton Roads either, although for different reasons.

    As for Aubrey “Money Train” Layne – is he still predicting a $2B shortfall in state government “revenues” (aka confiscations of personal property through taxation) over the next two years?

    The dishonesty and incompetence of our state government (under both parties) is staggering. Time to rewrite the state constitution for the seventh time and gut the powers of our state government.

    1. LarrytheG Avatar

      re: ” gut the powers of our state government.”

      hmm… who exactly would you get to do that?

      You’re starting to join some of those other “voices” on BR, congrats.

  4. WeirdScience Avatar

    The Governor’s “approach is grounded in science and data” per his website. And speaking in solidarity with Larry, Nancy & Peter, the science is clear! If the data shows your locaility didn’t vote correctly, your locality doesn’t understand the science well enough to make its own decisions. Its science, man!

  5. LarrytheG Avatar

    Well not just ONE GOv or one scientist… but … when a majority of Governors believe the majority of science … then you got either consensus or conspiracy depending on your own perspective.

    so own it.

  6. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    I understood the Governor’s announcement differently. The state has received about $1.3 billion in federal money that federal law requires be allocated to localities to be spent for COVID-19 related expenses. The problem for the state has been how to distribute this money, which can be spent only for limited costs. His recent announcement of the distribution of $650 million is for half that amount, apparently on a per capita basis, with the rest to be distributed later after further discussions on the most equitable distribution method.

    The state government is getting $1.8 billion to cover its costs in dealing with COVID-19. It is that pot of money for which the Governor has made testing and contact tracing the top priority. Since it will be the state’s share of the federal money that is being used, I assume that the state will set the protocols for the testing and tracing.

    By the way, the administration has given agencies until next Monday, May 18, to submit to DPB their requests for some of these funds to reimburse them for expenses they have incurred, or expect to incur, as a result of the pandemic. After the administration gets a good idea of how much agencies have spent out of their regular GF appropriations to respond to the pandemic, it will know how much balancing it will have to do in order to sufficiently fund testing and contract tracing.

  7. LarrytheG Avatar

    On testing, protocols and contact tracing.

    Think in terms of NoVa, Md, and DC – and how that might work.

    and then think about how it would work for someone who lives in one part of Virginia and travels to another and either contracts COVID19 or infects others.

    the actual testing itself is just a part of it. It’s needs to be uniform and standardized as much as possible or the money may well be wasted.

  8. I just did an online course for contact tracing, and one of the tenets is that it be tailored to the community it is serving. This surprised me at first, but as I considered needs for interpreters, medium of communication may range from in-person to phone to electronic, this made some sense. But I think that the SOP for contact tracing is pretty well set by public health. At least that wheel does not need inventing. Staffing agencies are advertising for tracers city by city in Hampton Roads, but not clear who the employer is.

    Re: disclosure of nursing home data, my family in Cleveland checks daily report on specific facility where positive tests, confirmed cases, and deaths are reported and differentiated as staff or patient/resident. I’m baffled that these numbers would be hidden. These facilities all benefit from Medicare/Medicaid, and that’s where the accountability begins.

  9. Peter Galuszka Avatar
    Peter Galuszka

    What are “federal helicopter dollars?” Was this term in “Boomergeddon?”

    1. MAdams Avatar

      COVID-19 Stimulus monies, and described by Milton Friedman in 1969.

    2. Nancy_Naive Avatar

      Friedman’s description of money thrown by Democrats at a problem. This is in direct opposition of money thrown by Republicans at their friends.

      1. MAdams Avatar

        What’s your point? Peter asked what Federal Helicopter money was, therefore I provided it.

        Actually, Friedman used it as an exercise to show the consequences of changing the value of money. He never intended it as monetary policy, that was completed by Ben Bernanke in the 90’s. I however am not sure what being Republican has to do with it, outside of you view everything through a partisan lens.

  10. LarrytheG Avatar

    Well, also.. the Dems were theoretically not as concerned about whether the money came from debt or from the military budget whereas the GOP wanted it to come from cutting taxes by starving the beast but of course not the military beast.

    Bacon’s fundamental premise has been that SOME DAY, one we had “too much” debt that the budget would get eaten alive by interest and our adversaries would “own” us.

    That’s was before they “discovered” that social conservatism and the Culture War attracted a more committed base!

    Now, it’s all about libtards and nitlibs and their “wrong” values… of course.

    1. Reader alert: This comment bears no remote connection to reality.

      1. LarrytheG Avatar

        How many posts have been in BR about settlement patterns lately?

        How about posts related to the culture war or critical of government, higher ed, public education, even science?

        I rest my case.


        How about an article on some non-culture war stuff – like how the virus is affecting settlement patterns now and into the future, WITHOUT talking about “leftist” urban policies and all that rot?

    2. MAdams Avatar

      The Federal Government doesn’t have a revenue problem, it has a spending problem. While that bloated beast has more than it needs tied up the defense spending portion of that budget, there are plenty of other areas that need audited.

      Waste, fraud and abuse occurs in ever sector, bureaucrats are not elected and it takes acts of Congress to remove them.

      This isn’t a partisan issue, both parties are only out to enrich themselves.

      If you want to reign in the sway of Lobbyist and the like, the 17th Amendment needs to go and Congress would revert to part time employment forcing them to still hold jobs.

      Oh and while you’re at it, cut the amount of flag officers there are and the pet projects and budget items will decrease on a grand scale.

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