By Nathan Ham
As states become more and more anxious to reopen and try to restart their local economies, it appears the latest and arguably most important strategy to combat COVID-19 is going to be contact tracing.
As the virus has spread to all parts of the world, health organizations have had to develop different strategies to figure out the best way to limit the spread and treat the ill. Early on, North Carolina and many other states focused on trying to get as many tests as possible. That strategy turned out to be futile as the number of tests needed far exceeded the number available. The first change in strategies came when North Carolina Governor Roy Cooper issued a stay-at-home executive order.
“I think one thing that is really important for the public to understand is that our testing guidance really changed in the middle of this because the governor issued a stay-at-home order and we switched away from testing lots and lots of people to telling people to stay home if they were sick. We have tested fewer people over the last few weeks. I think that it is important to keep that in mind when we look at the numbers,” said Jennifer Greene, the Health Director at AppHealthCare, which provides health department services to Watauga, Ashe, and Alleghany counties.
Now that Gov. Cooper has shared his phased-in approach for reopening North Carolina, the strategy change to contact tracing becomes incredibly important.
“Testing guidance has changed again because we are preparing to reopen. We are telling people if you are sick, we want to test you. The reason for that is one of the key pieces to this is identifying the virus, isolating those who are sick, and telling people who are their close contacts to quarantine for 14 days,” Greene said. “In order for us to reopen, we have to have those pieces really strong and in place. Even though it doesn’t look like things have changed a whole lot, we have continued to adapt to get ready for reopening. This is a different type of situation that we’ve never seen before.”
Out of the eight positive COVID-19 patients in Watauga County, none have had to be hospitalized. Greene says that as the state reopens, there is a greater chance of having people become ill with more cases of the coronavirus. However, if the contact tracing works as expected, the individual with COVID-19 and his or her close contacts will be quickly isolated and quarantined.
“We have a team of nurses who have some special training in contact tracing. Initially, when we find out we have a positive case, the nurses will make contact with that person who is positive and they do some data collection with an interview,” Green says. “They ask questions to try to find out where someone has been, what kind of occupation they have, who they live with, and what their ages are to see if they have a higher risk. Trying to understand how someone is interacting with their broader community really helps us identify those close contacts.”
Legal isolation orders issued through AppHealthCare require a person to stay at their reported address for at least seven days since their symptoms began and for at least three days without a fever and no fever-reducing medicine. Household members or people identified as close contacts get issued a quarantine order.
“When we place someone in quarantine or isolation, we are checking on them. A nurse calls and checks on their symptoms and gives them guidance,” Greene said. “We do think most people are cooperative and listen to the guidance they get from their doctors and us. Right now we are issuing isolation orders for people who are sick and quarantine orders for people who are high risk and have been in close contact.”
According to Greene, being within six feet or less of someone with COVID-19 for 10 minutes or longer greatly increases the risk of exposure. With the eight positive cases in Watauga County, Greene estimates that roughly 16 to 20 people were quarantined as close contacts of the eight individuals.
AppHealthCare also takes additional steps to protect emergency personnel in the community. Addresses where someone is quarantined or in isolation with COVID-19 are flagged as a way to try and protect police officers, firefighters, and emergency medical staff so they will know to wear additional personal protective equipment.
The health department encourages anyone who thinks they might have COVID-19 to reach out to a healthcare provider, whether it be their family doctor or through the telehealth options with Watauga Medical Center. Greene says that their focus will be a lot more concentrated on contact tracing than on testing for new cases.
Medical personnel has to think about their own safety as well. “As you manage testing, you have to manage your personal protective equipment too. It takes equipment to be able to effectively protect the healthcare worker who is taking the sample to test,” said Greene.
Reopening North Carolina
The next question to be answered will be where does North Carolina go from here? Gov. Cooper’s stay-at-home order was extended to May 8 when a phased reopening is expected to begin. Tennessee, Georgia, and South Carolina have all started reopening numerous businesses this week.
“I think the governor has made a wise decision to slowly reopen. The phased approach makes good sense to me. However, seeing the other states surrounding us loosening things up could certainly affect North Carolina’s (positive test) numbers as well,” said Greene.
Greene added that she expects the state to release additional demographic information on the positive tests that have been counted throughout the state as North Carolina prepares to reopen.
“The state has been thinking very carefully about the information we have been collecting and I think that we will see them posting more information as soon as this week that has more detail about cases. We are trying very hard to make sure we are not compromising patient privacy either, and that is a hard balance during all of this,” Greene said.
Locally, the AppHealthCare board plays a major role in the information gathered and shared with the state, and the information shared to the general public for their safety. David Triplett is the board chairman and county commissioner Perry Yates is on the board as well as other representatives from Watauga, Ashe, and Alleghany counties. The board will have calls with county and town managers and will share public health guidance that they receive from state epidemiologists.
“We’re trying very hard to connect with each other. It’s affecting our whole community so our goal is to coordinate as much as we can and hear what other people are hearing and listen to feedback,” Greene says.
Contact tracing is what the focus will be on now and while it is something that will be very labor-intensive, it is something that AppHealthCare and other health organizations in the state will take seriously as efforts begin to find some sort of new normalcy for dining out, shopping and recreational activities.
“We have a very important role here. Everybody takes this very seriously. They care about this community very much, as do I. I am a Watauga resident and have worked in this public health agency for nearly 16 years and I care a lot about these people,” said Greene. “We are going to be giving it our best. Our nurses have been taking calls 24/7. Much of our staff hasn’t had a day off in a couple of months now. They are committed and one of our core values here is community and another is service. We have people who are in this that believe in public health and want to do the right thing for their community. I think that is really important right now.”