Alaska’s contact tracker – who has been punished since June – is currently in a healthy spot, public health officials said this week.
This is because COVID-19’s daily business counts have begun to skyrocket in recent days, and a growing team of new contacts has recently come on board.
“People are being picked up (now) within 24 hours,” said Dr. Louisa Castrodale, an epidemiologist from the state of Alaska.
Whether the state’s contact capacity will be sufficient to warm up to the pandemic’s ups and downs depends in large part on what Alaskans and government officials are doing to curb the spread of the coronavirus.
Contact detection – the research process of tracking how a virus moves through a population – is key to slowing the spread of COVID-19, public health experts have said.
The ability of contacts to work quickly and effectively can be affected by high infection rates in a community and by how many close contacts a person has. That is reflected in how contact detection capacity has fluctuated during various stages of the pandemic in Anchorage and in Alaska.
For example, in March when many businesses were closed and boundaries for social gatherings were in place, those who tested positive for the virus in Anchorage had only a few close contacts, making outreach more manageable, according to city health officials. .
Daily business numbers began to gradually increase after most pandemic-related restrictions on businesses and meetings were lifted in May. State contact trackers, in addition to capacity, were still able to contact 95% of cases within two hours of the state hearing on a positive test result, said Tari O’Connor, deputy director of the State Division of Public Health, in mid-June. . In Anchorage, contact tracing was available for large penalties: Officials at the time described the state of tracing contacts as if it were past capacity.
Towards the end of June, with people mixing in groups and going out more often, those testing positive for COVID-19 in Anchorage reported having more and more dozens of contacts or being at locations with dozens of people contacting tracers were unable to detect, said the director of the Anchorage Health Department in early July.
The state even asked health care providers in July to instruct patients who test positive to begin reaching out to their own close contacts.
A few weeks ago, contacts began to prioritize matters and stop following up with everyone, O’Connor said, and that is still the case today. The state’s liaison officers want to make sure they don’t fall behind and that they have enough capacity to handle clusters that cost more time and effort, O’Connor said.
“Part of the initial issue was that we were not able to get all the cases on time,” O’Connor said. “And I think we’ve solved that problem.”
It’s hard to say exactly what the delays were – they’re still moving their work into a new electronic system. More groups of tracers are now in the system, she said, “but we are still early to learn how to control these types of metrics in real time.”
In late June, Rhonda Johnson, a recently retired professor of public health, described her as a contact person “as a way to engage productively in responding to the safety of my own home,” she said.
Rhonda Johnson, DrPH, is part of the UAA surgeon who conducts telephone case studies and contact tracing of people who have tested positive for COVID-19. Thursday, August 20, 2020. (Bill Roth / ADN)
They are now spending their days making calls to Alaskans who have tested positive for COVID-19 and their close contacts.
“The purpose of the call is to help answer questions, make sure they have enough information to be safe, and then identify their contacts. And also to understand the source of her infection, ”she explained.
Johnson and her team work closely with the state of Alaska as well as local health departments, she said.
It’s part-time work, always less than 30 hours a week, but Johnson said it can still “feel quite intense.” She juggles with her days and reaches out to dozens of new things and checks in on existing ones.
Most of the time, she said, she finds the work rewarding.
“It’s very interesting every day,” she said. “You know, you never know what the other end of the phone will be.”
Johnson said the vast majority of the people she talks to are both cooperative and interesting.
“Most people are happy to try to think about what’s going on, and what they should do,” she said.
She is often thanked for checking on people, she said, and has learned a lot from the job.
“Now that you’ve made calls in almost every region of the state, you really see the real cost of the pandemic,” she said.
Prior to the addition of the contact service workforce, Alaska had already dispersed a group of people across the state who were contacting new COVID-19 cases.
Public health nurses play a different role in the state’s health system than one such nurse in an intensive care unit who can work with an individual patient and family, said Lorne Carroll, a public health nurse at Homer Public Health Center.
“Our primary customer is the entire population,” Carroll said. “That we have 730,000 customers.”
Statewide, health care providers and labs must report certain conditions to the state Department of Epidemiology, which then shares it with local public health nurses. Those nurses will then begin a source case investigation and contact investigation, he said. That has been going on for years with tuberculosis and botulism.
And Carroll said while almost all public health resources are targeted at COVID-19, there are other life-threatening diseases they still need to manage.
“Obviously, tuberculosis does not stop because there is a pandemic,” Carroll said. “And those services we provide are very unique, so we have to continue those, no matter what.”
Helping with communicable disease at the local level is part of his job – the skills they use for sexually transmitted infections and are transmitted to COVID-19 by disease or edible diseases.
“COVID is very much in our position description,” he said.
“Really, (contact tracing) all starts with a cold call,” Carroll said.
Usually he starts with a lot of questions to start a relationship. Getting COVID-19 can feel sensitive and stressful, he said.
Carroll will typically have a large calendar with him and a headset to keep his hands free, and he will ask the person on the other line to help “basically build up the recent past,” he said.
During the case investigation, contact persons use the date that the person tests positive as their starting point. Then they move backwards – looking for when the person started having symptoms and if they were 10 minutes or longer within 6 feet of someone, he said.
They try to find out who is a high-priority issue – for example, people who may be at high risk for spreading the disease, such as someone who lives in a community setting or works in health care and close contact has with people who are vulnerable to COVID-19. In addition, someone with an increased chance of death or hospitalization can be considered a higher priority, he said.
Those cases also get a follow-up call every day.
The low-priority cases are asked to isolate and receive information on how to talk to their close contacts about quarantine.
The contacts spend more time with the high priority cases, listing out contacts during their infected period.
“And then when we’re done with that phone call, we actually pick up the phone and start calling each of the contacts one by one,” Carroll said.
The conversations are confidential. They do not share the name of the person who tested positive, which he says helps reduce the stigma of COVID-19.
“That’s a certain skill as a set of communication strategies that feels new to some people, but for public health nurses, we’ve been dealing with tuberculosis and other communicable diseases for decades,” Carroll said.
Alaskans can help contacts by keeping a log of everyone they are in close contact with, and by keeping this list short, public health officials have said.
Johnson, the retired professor of public health, added that timing matters when identifying close contacts.
In general, anyone who came into close contact with the infected person in the two days before someone tested positive could infect that individual.
For everyone, the person came into contact earlier with that – up to about two weeks – they were more likely to be the potential source of the person’s infection, Johnson explained.
Their advice for someone who has tested positive is to isolate them for at least 10 days after a positive lab test, even if they are asymptomatic.
“If you are symptomatic, the isolation period is longer,” she said.
If you are a close contact of someone who has tested positive, Johnson said her advice is to normally make yourself quarantine at home and limit contact with others.
“Monitor yourself for symptoms,” she said.
