Although Health Policy News does not normally include first person perspectives or features on Public Consulting Group project work, we believe that the unprecedented circumstances of the COVID-19 pandemic warrant an exception. As such, I wanted to share a quick note about my work on PCG’s recently-initiated contact tracing projects, assisting several states in building out and operationalizing contact tracing programs.
As I write this, I am on my 31st consecutive day of work helping a state stand up a contact tracing program. States across the country are experiencing spikes in their number of COVID-19 cases, and unfortunately, also recording record high one-day new positive infection rates ( Approximately 61,498 new cases of COVID-19 were reported in the United States on July 28, 2020[1].)
Source: The COVID Tracking Project, pulled on July 30, 2020.
Access the most up-to-date versions of this and other data here.
Contact Tracing is the process of identifying individuals with COVID-19, followed by individuals who have come into contact with that person, in attempt to curtail transmission. In all instance’s, intervention is key, and contact tracing provides the intervention to educate and identify those who may have been exposed to COVID-19. Early results show that contact tracing and case investigations are the best tool public health departments have at their disposal to stop the spread of COVID-19—and until an effective vaccine is widely available both in volume and pricing, it’s effectively their only tool.[2]
Case investigations (the process of identifying and contacting individuals with the virus) require a unique skill set: knowledge of the distinct and varied symptoms of COVID-19 combined with the ability to have difficult, yet immensely important, discussions with those who have tested positive—as well as those with potential exposure.
Below, I’ve compiled a few of the lessons learned and key takeaways from the project team’s experience that we’d like to share with readers.
Confidentiality
Although the federal government has reduced restrictions on sharing some electronic medical records during this pandemic, all tracers must understand first and foremost the importance of patient confidentiality. In our experience training and hiring tracers (who must be residents of the state in which they work), we’ve found that—given the extent of outreach the job requires—there is a high likelihood that tracers will recognize people from their county or community among those identified during the investigation or tracing processes. To maintain the credibility of these efforts and ensure COVID-19 spread is slowed, it’s vital that people who share their contacts or whereabouts with tracers know this information will be kept private and confidential.
Ensure tracers have access to key support services
Another key point to impress upon tracers during on-boarding is that contact tracing calls differ from typical customer service calls in several important ways. Tracers may have to inform someone that they tested positive, were exposed to the virus, or may even encounter an individual in crisis. To ensure tracers are equipped to handle these sensitive situations, states should include a guide to mental health resources (such as support groups, counseling or trauma support hotlines, and free mental health services) among the reference materials they provide contact tracing staff.
Additionally, many individuals who are instructed by tracers to quarantine often respond that they cannot because they have a variety of obligations, all valid and real concerns: childcare, elder care, work, or other responsibilities they believe prevent them from staying isolated at home for 14 days. To increase the likelihood that these individuals will quarantine, it is crucial for contact tracers to impress the importance of doing so while also offering support and resource referrals—for example: information on health and social support programs; testing site locations; food support services; unemployment services; housing support services; and in some instances, emergency childcare.
Testing negative does not mean you are exempt from quarantine
There is a common misconception that testing negative for COVID-19 means you’re allowed to skip the 14-day post-exposure quarantine period and can go about your life as usual. Unfortunately, the testing in use today has a high rate of false positives, meaning that relying solely on a positive or negative test for accuracy is not advisable.
A number of factors contribute to this false positive rate including the test collection method and timing (a test done immediately after exposure may return a negative result due to the individual not having enough virus in their system). Because of this, current medical advice is the same for individuals who test negative following exposure as it is for those who have not been tested post-exposure: quarantine.
Conclusion
I am immensely proud of my colleagues and the states with whom we’re partnering to implement these vital disease-prevention programs. I feel honored to collaborate with dedicated state employees working on these efforts seven days a week; medical professionals coming out of retirement to join PCG’s contact tracer trainings; and folks across the country, who share personal stories about working as a contact tracer to protect their communities, children, parents, loved ones and friends.
Wear a mask, practice social distancing, answer the call if a tracer reaches out to you, get tested, and isolate (the CDC updated its guidelines on 7/21—click here to view) or quarantine (i.e., don’t leave your house unless it’s an emergency—view CDC guidelines here) if instructed to do so.
Stay safe, everyone. Let’s continue to protect ourselves and our communities.
If you have any questions, or would like to learn more, about our efforts to help states implement their contact tracing programs, please reach out to our Health leadership team by contacting Sean Huse (SHuse@pcgus.com).
Footnotes
[1] https://www.statista.com/statistics/1102816/coronavirus-covid19-cases-number-us-americans-by-day/
[2] Effectiveness of isolation, testing, contact tracing, and physical distancing on reducing transmission of SARS-CoV-2 in different settings: a mathematical modelling study, CMMID COVID-19 working group at https://linkinghub.elsevier.com/retrieve/pii/S1473309920304576
