While county officials, business owners and residents this week were celebrating the news that more businesses and activities would be allowed to resume, the Douglas Public Health Network continued to work quietly to make sure COVID-19 remained contained.
Douglas Public Health is using a three-pronged approach to keep COVID-19 at bay and allow life to get back to some semblance of normalcy: Continued testing for the virus, contact tracing to find anyone who may have come into contact with someone who is infected, and provisions to ensure there are enough hospital beds, equipment and staff to isolate people infected in case there is an outbreak here.
COVID-19 testing, contact tracing and measures to isolate patients have been in place for more than two months now. But with the county entering Phase 2 of reopening, and the possibility more people will be exposed to the virus, these efforts are considered critical in the fight against the COVID-19 pandemic.
DPHN started its COVID-19 contact tracing program in early March, using four epidemiologists on staff. In early April, six volunteer trainees were brought on board, and the self-named Epi-Strike Team was launched.
That initial group included retired nurses, school nurses who had time because of school closures and a couple of dental hygienists.
Today the team is in hiring mode, and hopes to have as many as 18 members in order to be prepared should COVID-19 begin to spread here.
“We are currently hiring a more permanent staff as we recognize COVID-19 response is a long-term effort, and some members of our team will be returning to their normal jobs as Oregon reopens,” said Laura Turpen, lead epidemiologist for Douglas Public Health.
The details of the terms of employment for these new hires are still being worked out, but they should make between $15-$30 an hour depending on their skills and experience and the type of work they will be performing, DPHN officials said. The money for the Epi-Strike Team will come from local, state and federal public health funds, he said.
In a recent interview on KQEN News Radio, Brian Mahoney, a disease intervention specialist with DPHN, said a medical background isn’t necessary to be effective at contact tracing, but being a good listener is.
“Really what we want is people who can connect with people in the community,” Mahoney said. “You have to be able to connect with people, and you have to be able to get people to tell you things that may be a little embarrassing or uncomfortable to tell so that we can track down where you might’ve gotten the disease.”
Douglas Public Health is far from alone in stepping up its contact tracing capacity. State public health departments nationwide are hiring thousands of these workers, and experts are calling for more than 100,000 contact tracers to be put in use across the country.
We know it worksContact tracing is a public health strategy that has been used successfully to combat infectious disease outbreaks across the globe, from the strategy used in the 1930s to help get syphilis under control in the United States, to the 2014 Ebola epidemic in West Africa.
“It was the technique that helped us end smallpox. You found out who had it, who they got it from, and you took care of it,” said Douglas County Public Health Official Bob Dannenhoffer. “We know that it works with COVID-19. When you find a case, you find all the people they may have gotten it from and who they may have given it too. And by doing that you can really slow the spread of the disease.”
Fundamentally, contact tracing works by tracking down all the contacts of an infected person and then taking appropriate action to stop the spread of the disease. In practice, that action will vary depending on the nature of the disease — for example, you wouldn’t need someone to self-isolate at home and stay away from other people if a disease can only be transmitted sexually.
“What we’re really trying to do is break the chain of transmission,” Mahoney said.
The current coronavirus has been particularly tricky to contain because patients can be contagious a few days before they display symptoms, and some infected people may never show symptoms. Furthermore, the time between the onset of symptoms from one case to another is estimated to be quite short, around four days. All these characteristics have helped the virus spread rapidly — and that means that tracers have to move quickly to reach patients and their contacts in order to cut off new branches of infection.
Because of all of that, many experts maintain that contact tracing is key to safely reopening the economy.
“This is a person-to-person disease. You have to trace people and stop them from spreading the disease, and to do that you have to contact them,” Mahoney said. “There’s no vaccine and no treatment. The only way that we can actually hold the disease in check is to practice social distancing and isolation of sick people and quarantine of those who have been exposed for a long enough period of time so that no one else is exposed.”
A contact tracer’s work typically begins when they are assigned to a case following a COVID-19 test on someone that comes back positive. The contact tracer will then contact the person to ask several questions, including any symptoms they had, and information about people the person has been in close contact with recently. Based on the answers to those questions the contact tracer will help come up with a strategy to isolate the patient, which might include such things as how to get food or medications delivered. That also goes for people who were exposed to someone with the virus and need to be quarantined.
Sometimes the contact tracer helps with those provisions, Turpen said.
“We have delivered meals to people, thermometers and pulse oximeters, medications, clean bedding, groceries, etc.,” she said. “Many people have family or friends that assist with those things while under quarantine, but when they don’t, we step in to help.”
Stepping up effortsThen the contact tracer sets out to track down all the people the patient may have come in close contact with while they were infected. The Center for Disease Control and Prevention defines a close contact as someone who was within 6 feet of an infected person for at least 15 minutes, beginning two days before the infected person began experiencing symptoms.
“We want to make sure people are calm when we talk to them. We understand the there is a shock when we say ‘You’ve been exposed to a communicable disease,’” Mahoney said. “So we have to have some sort of emotional intelligence and be able to de-escalate some things and have a little humility and be very non-judgmental.”
A typical case can take 20 calls or more to trace everyone they had close contact with. Sometimes patients may not know the names of everyone they came in contact with, like when they were at the gym or a market. Still, others might only know the first names of people they had contact with. In situations like that contact tracers will use whatever pieces of information they can get to track down potential contacts.
Just how many contract tracers are needed depends on several variables, including how dense a population is and how prevalent COVID-19 has been in the area, Dannenhoffer said. Having 15 to 20 contact tracers working in Douglas County, with its population of about 110,000 people spread out over a large area, and relatively low number of positive cases, should be plenty, he said.
“We’re feeling pretty quiet here in Douglas County, the rest of the world not so much,” Dannenhoffer said. “If we were having something like 10 new cases a week, that might be different.”
He also said that the work of contact tracers may have been made more difficult with the recent spate of protest rallies and marches, which brought large groups of people together.
“We do really worry that this will cause pockets of outbreak, and those pockets of outbreaks will be hard to stop,” Dannenhoffer said.
But overall, he said he is pleased with the efforts and effectiveness of the Epi-Strike Team, and the way the community has responded to it.
“We’re asking people fairly in-depth questions and people have been very cooperative and forthcoming and they have been really grateful, kind and generous,” Dannenhoffer said.