Stopping a pandemic in its tracks begins with a single positive case.
From there, teams of healthcare professionals work around the clock in an effort to stop it from spreading any further.
Contact tracing is the process of identifying people who have been exposed to an infectious disease, in this case COVID-19, and mapping the spread of that disease.
According to Haley Evans, district epidemiologist for the Central Virginia Health District — which includes Lynchburg and the counties of Amherst, Appomattox, Bedford and Campbell — the goal of contact tracing is simple: To help mitigate, if not stop, the spread of the coronavirus and other infectious diseases.
“If we can identify them and place them in quarantine then they are not exposing people going forward. So we are slowing, if not stopping, the spread of the virus,” Evans said.
The process is broken down into two phases: case investigation and contact tracing.
Ta’Kindra Westbrook, epidemiologist with the Thomas Jefferson Health District — which includes Nelson County — said case investigation is the first step in tracking the spread of the virus, but that doesn’t begin until an individual has tested positive for COVID-19.
From there, case investigators will ask the patient questions.
These questions focus on establishing travel and interactions with the goal of determining each possible exposure that could have occurred while the patient was symptomatic.
“[Case investigation] starts with talking with the person, the interview of the person. We want to know the onset of their symptoms, the duration of their symptoms, their movements … and then we find out who their contacts are,” Westbrook said.
While talking with the patient, case investigators will attempt to establish what exactly those interactions were and how long they lasted. They’ll also ask questions to find out how closely the patient and the contacts were standing while they were interacting with one another in addition to if any other safety precautions were taken.
With the information in hand, the actual contact tracing process begins by getting in touch with those people and places identified by the case investigators.
Once that’s done, contact tracers, which Westbrook said could be the same people who perform the initial case investigation depending on the size of the department, will follow up with those leads.
Most contact tracing begins in the home, seeing how many people live together, if distancing is being performed in the house or if commonly used areas are being regularly cleaned.
They ask the individuals if they have traveled anywhere or interacted with other people — like coworkers, friends or other family members.
Evans said because of Health Insurance Portability and Accountability Act (HIPAA) regulations, contact tracers are not allowed to identify the person who tests positive for COVID-19, only that they had recently been exposed to somebody who had tested positive for the virus.
“People have gotten upset with us for not revealing the name of the person, but we just can’t do that,” Evans said.
Kathryn Goodman, chief public information officer of the Thomas Jefferson Health District, said once a positive case is established, contact tracers with TJHD will perform anywhere from one to 20 follow-up interviews depending on the number of contacts identified in the initial case investigation.
In addition to Nelson County, the Thomas Jefferson Health District serves Charlottesville as well as Albemarle, Fluvanna, Greene and Lousia counties.
Evans estimated as of Friday more than 516 individuals have been interviewed in the Central Virginia Health District since contact investigations started. In the Central Virginia Health District, 160 people have tested positive for COVID-19. There are 12 cases in Nelson County.
According to Evans, the Centers for Disease Control and Prevention said the average person has 36 contacts, which can add up quickly. Regardless of how many contacts a person may have, however, contact tracers must follow up with each person, go through a similar line of questioning, assess that person’s risk and recommend appropriate actions for that person to take.
“It can be quite labor intensive if you take a case and then add 36 more people that have to be taken through the process,” she said.
Timeliness plays a crucial role in the contact tracing process as well.
“We want to reach out to folks as soon as possible because obviously, if what we assess is their risk is high, we don’t want them out in the community,” Westbrook said. “Our one priority is to minimize spread. Time is a critical factor in this for sure.”
Evans said the hours needed to track down the necessary contacts can often be long and arduous.
“We’ve been working seven days a week since I think February, we work 24 hours if needed. We’re working late and starting early to make these calls and talk to these contacts.”
Evans said one of the reasons the state can now consider reopening is because of the public health interventions that are helping to flatten the curve.
During the interview process investigators also establish which symptoms the person is experiencing, the duration of those symptoms, establish the individual’s risk and recommend appropriate measures for the individual to take.
Westbrook, who has been with the district for about 21 months, said these measures could be anything from recommending testing, contacting a healthcare provider or just keeping a watchful eye to see if symptoms worsen or even appear, as many people can be asymptomatic.
Evans said her department will recommend 14 days of self isolation or self quarantine from the date of possible exposure, which in many cases may not be the same day the person was contacted. She said 14 days is standard across health districts.
For people who test positive for COVID-19, remembering every single social interaction can be difficult. So contact tracers often go to great lengths in interviews.
“We try to jog their memory as much as possible so they remember that information,” Westbrook said.
Evans said any and all information is important to the contact tracing process.
According to Carl Mack, peer support specialist for the Central Virginia Health District, the people he has had to contact for the most part have been cooperative and forthcoming with the necessary information.
“A lot of people were very responsible after they knew and they were doing things proactively to kind of contain themselves and remove themselves,” Mack said.
Nick Cropper covers Nelson County. Reach him at (434) 385-5522.
While not being an epidemiologist, Mack was recruited to assist with investigative efforts because of his ability to speak Spanish. He said whenever a COVID-19 patient or possible contact comes up that speaks only Spanish, he is the one to perform the investigation.
He said he goes through a list of standard questions in the process, the same questions that establish a person’s interactions and travels.
From what she’s seen, Westbrook said COVID-19 patients sometimes take the initiative to call the people within their own circles and let them know.
Contact tracing isn’t unique to the coronavirus. Evans said contact tracing is performed with any infectious disease: tuberculosis, sexually transmitted infections and measles, to name a few.
“If someone finds themselves involved in this whole process they should expect a phone call from us …,” Westbrook said. “It shouldn’t be anything they should be frightful of, or fear, or have any hesitations to talk to a case investigator. We are here to help and mitigate the spread of this virus.”
Nick Cropper covers Nelson County. Reach him at (434) 385-5522.