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“Disappointed.” What do North Carolina contact tracers say about the job associated with the proliferation of COVID-19 cases | News

 


Raleigh, NC — When Margaret Campbell drives a group of people driving through Chapel Hill, flocking to restaurant tables and taking a walk to a holiday party, she can only think of everyday work.

The Nurse Practitioner leads Orange County’s contact tracing efforts. When someone in one of those restaurants or on their way to one of those parties gets the coronavirus, someone on Campbell’s team sends them a phone call or text message and who they are Know if you were exposed to.

The goal is to delay the spread of COVID-19.

“You work very hard and see the number of cases continue to grow,” Campbell said. “And you see — you run around, and you see the people around you.

“It can be a little disappointing, or sometimes very, very disappointing.”

Cases of COVID-19 are skyrocketing in every corner of North Carolina, from the city center of the Triangle to rural areas like Greene County, just outside Kinston. As the count goes up, more cases will be investigated and more people will be contacted.

Public health officials have sought to familiarize people with contract traces, which have been used for decades for diseases such as mumps and measles. However, the pandemic, unlike recent memories, presents the challenge that thousands of people are positive each day and infectious disease staff are having a hard time catching up.

To help with this, the North Carolina Department of Health and Human Services has launched the Carolina Community Tracing Collaborative, a partnership that continues to employ 1,510 contact tracers. Throughout the state, more than 2,700 people are involved in joint and community health sector efforts, according to DHHS.

Still, some health officials told The News & Observer that if the number of cases continues to grow, North Carolina is experiencing more than 6,000 new infectious diseases each day and needs more help. You will also soon find that contact tracing works only if patients share information openly and quickly.

To assist in this, DHHS announced on December 23 that if a contact tracer has a mobile phone number or email address of a person who is positive or exposed to COVID-19, that person will be advised on quarantine. Announced that it will automatically receive text or emails containing links. How to get resources and more information.

A December 18 memo by state epidemiologist Zack Moore tells the local health sector that in the event of resource shortages, prioritized contacts related to clusters and potential outbreaks. .. Also, if authorities learn about them within four days of a positive sample test, focus on contacts related to the “risk” environment, such as apartment buildings, schools, and food processing facilities. I will propose.

These contacts receive phone and follow-up texts or emails, while other contacts only receive texts or emails.

Amy Ellis, a DHHS spokeswoman, said contact tracers would try to contact people who tested positive within 24 hours of knowing the case and the contacts they reported within 48 hours. She said it would take an average of 1.96 days for case investigators to actually find someone who was positive on the phone.

According to Ellis, case investigators reached 68% of those who tested positive, but DHHS believes the actual number is probably higher due to slower follow-up data entry due to the recent surge. ..

Ellis added that in the first 20 days of November, tracers reached 74% of the contacts provided.

“Contact tracing provides us with important information about where this virus is spreading and who may have been exposed, so we want to keep it and do its job. I think, “said Dr. Mandikoen, Executive Director of DHHS.

In Orange County, new infection rates are rising, but slower than in some nearby counties. Campbell wants her team to be at least partially responsible.

“Every time we call it a contact, it’s a small drop in the bucket, which helps slow the spread of COVID,” Campbell said.

“Giant puzzle”

The scale-up of contact tracing for COVID-19 was different from what the health sector saw in recent memory.

Prior to the pandemic, Campbell said there were six people on the Orange County infectious disease team. Currently, 36 people are investigating cases, including volunteers and those who switch between normal duties in the contact tracing and health departments. Orange County also has access to approximately 55 people through Trace Collaborative, which follows up on contacts.

There is a similar activity in Wake County, said Dea Address Miss, a nurse supervisor responsible for contact tracing efforts. Wake’s group has 25-30 case investigators and 52 contact tracers who follow up on exposed people.

“This is a huge puzzle and a big maze that requires the collaboration of many people,” Smith told N & O.

“You take a deep breath before you start every day and say,’Hey, what started yesterday? What started yesterday?'” Smith said. “It will definitely affect the number of cases we see, so we will try to re-strategy if necessary.”

For example, when students began returning to the classroom, Wake County revamped the questions asked to those who tested positive for the coronavirus.

Previously, investigators didn’t have to ask about the school — they knew people weren’t there. Now, according to Smith, school questions are some of the first questions asked by parents with school-aged children who test positive. After all, the entire classroom may have been exposed to the virus.

The virus can also spread rapidly in churches, workplaces, or other places where people are crowded.

“We need only one person to infect all of them,” Smith said.

Wake County spokeswoman Leah Holdren said many of the incidents in December were related to holiday gatherings and community expansion.

Campbell of Orange County said social gatherings, weddings and funerals are particularly difficult to investigate and track.

“It depends entirely on the person you are interviewing that you give you complete information, and also just have the information itself,” she said.

For example, according to Campbell, college students infected with the virus during the party may have been flying from house to house in groups. And while someone in the group may know someone in the host or party, the infected person may not know the name of the host, let alone a complete list of people who were there.

According to Campbell, it can also be difficult to investigate cases that occur in events with people across state boundaries. This is because at least one other health sector, often further coordination is needed.

The increase in the number of cases also makes it more difficult for public health authorities to identify hotspots.

“As the number of cases increases, so does everything, but the number of us is still the same,” Campbell said.

Partial information

When a case investigator sends a phone call, text message, or email to a person who tests positive, it is long about where the person may have been infected with the virus and who may have been infected. I want to have a conversation.

It doesn’t always happen.

“We struggle with the quality of the information that people who test positive for COVID provide us with, and there are many who provide us with partial information,” Campbell said. Told.

PiaMacDonald, an infectious disease epidemiologist at RTI International, said health authorities in North Carolina and across the country may be working harder to convince contacts to talk to tracers.

“People aren’t sensitive to making calls, don’t trust the person making the call, and don’t provide enough information to the person making the call,” McDonald’s said. The current model of is significantly different in scale of the problem, but similar to past efforts.

Mr Smith of Wake County said case investigators there did not reach about 10% of people who tested positive for COVID-19. About 2% of people who test positive say they don’t want to join a contact tracer, and 3% start the process without answering all the questions completely.

“Some people can provide contact information without any problems, especially if family members or people in the same household are already positive,” Smith said. “But I found that many people don’t want to disclose other people’s information.”

People who believe they have been infected with COVID-19 at work may not want to name their colleagues where they work, Smith said. Investigators often remind them that their information is kept secret. Their contacts are simply called and reportedly exposed to someone who tested positive.

The number of contacts people identify usually ranges from 2 to 16, but could increase further depending on the willingness of the person disclosing the information, Smith added.

From August 1st to December 1st, a total of 10,072 people in Wake County were COVID-19 positive. During the same period, according to county officials, 1,147 of the 15,269 identified contacts were positive, which means that more than 7 of the 100 known contacts were infected with COVID-19. ..

“With 100% contact from our contacts, we could have had more contacts with more information,” Smith said.

Staff level

In early November, Joyblock, director of Green County Health, was in need of help.

Her county in eastern North Carolina faced a total of three major COVID-19 outbreaks, twice in state prisons and once in nursing homes. Each person who tested positive had to be interviewed to see where they could have been infected with the virus and who they could have been infected with.

To complete the task, Brock had herself two full-time contact tracers and her main infectious disease nurse. She turned to Carolina Community Tracing Collaborative for help.

A collaboration between DHHS, North Carolina Community Care, and the NC Area Health Education Center began in April to support the local health sector. The initial recruitment included 250 tracers, but has since grown to 1,510. According to DHHS, 625 of these tracers are bilingual.

In December, approximately 345 contact tracers were added in collaboration, according to data reported by DHHS.

In both Orange County and Wake County, resources were growing the thinnest when the university tried to open last summer.

Throughout the fall, Wake County chase was catching up with almost new incidents, largely due to the large number of people employed, according to Smith. The county also has five people from the Community Collaborative who assist in tracking.

As the number of cases has increased over the past month, Wake has demanded more resources from its collaborators. According to Holdren, five more tracers have been assigned, and at least two have been assigned prematurely after the holidays.

Campbell is now more confident in staffing than in July and August, when the incidents surged at UNC Chapel Hill. However, she said Orange County has never been tracked on this scale, making it difficult to predict future needs.

There is also work stress. A series of calls to people who are sick or exposed to the virus. From time to time, they are also hurt by the economic devastation associated with COVID-19.

Teams working remotely meet weekly to answer questions and try to support each other.

“If there is a day when they need to take a personal day, or if they can’t take an incident on that day, that’s what happens,” Campbell said.

Greene County’s Brock encourages contact tracers to take two 15-minute breaks during the 9-hour shift. Brock hired his first full-time tracer in June and a second in September.

Green County also trained two health educators to perform contact tracing in the event of an unexpected surge. So far, Brock said they weren’t needed.

But if that pace doesn’t break by January, she may need more help.

“I can’t expect my health educator to do full-time contact tracing,” Brock said. “If I think it’s overwhelming and I need to hire a third one, we’ll do that.”


(C) 2020 The News & Observer (Raleigh, NC)

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