Circling the Pandemic: How Contact Tracing Works – County…

These days, people arent exactly clamoring to answer her calls, Joli Carr admitted with a wry smile.

Where she was once the friendly face greeting new mothers and their infants at home, the Campbell County Public Health (CCPH) Senior Nurse has since been relegated to phone duty in the age of COVID-19. In fact, she and her team of 10, including fellow nurses, two supervisors and CCPH Executive Director Jane Glaser, are putting in long days and weekends trying to mitigate the spread.

Their job? To call anyone who has had contact or may have been impacted by an individual who tested positive for COVID-19, and monitor them for symptoms during their mandatory quarantine.

Campbell County Public Health (CCPH) Senior Nurse Joli Carr has been relegated to full-time contact tracing as she and fellow staff attempt to stop the spread of the coronavirus.

Needless to say, not everyone is happy to hear from them, especially when they are told they need to self-quarantine at home for 10 or more days, immediately, which in summers nicer weather and already six months into the pandemic many come with some resentment.

Sitting behind her desk in a corner office at public health, Carr tapped a few keys on her keyboard to pull up the contact tracing form. Per the Center for Disease Control and Prevention (CDC) guidelines, shes wearing a mask, protective eye coverings and a face shield pulled down over both layers of personal protective equipment (PPE). She looks as if shes about to enter a bio-hazard-contaminated zone or about to perform a complex surgery.

In recent weeks, the CDC has tightened down on PPE for health care workers like Carr, she said, and her garb is pretty much protocol when interacting with the public in this capacity.

Though any public health nurse puts in his or her share of contact tracing throughout their career, the pandemic has put them in overdrive, Carr said. Up until now, this is by far the most intense work shes ever done in her 20-year career, including during the SARS outbreak in 2003, as well as CCPHs routine follow-up for anyone testing positive for a sexually transmitted disease (STD).

And if she might have been rusty before, theres no worry about that now as her days now revolve pretty much solely around contact tracing.

Its definitely not a Monday through Friday job, she said, noting that the virus isnt polite enough to take the weekend or holidays off.

There are three rings of contacts, Carr explained, beginning with the person who has tested positive for the virus, also called the index patient. During this interview, they put together an extensive list of anyone that the patient may have come in contact with during the past 72 hours. They ask about that persons travel and activities and the places or events where theyd been.

This naturally impacts members of their household, who are then asked to quarantine for 14 days, as well as anyone with whom the index patient has been in close proximity (6-feet or less) for more than 10 minutes. This might be a trainer or gym instructor, a clerk at Verizon who spent more time updating a new phone, anyone attending a backyard BBQ or a hair stylist or tattoo artist among others.

This excludes shopping trips to Walmart, Albertsons or Smiths, or any other large stores or public events or venues where contact was minimal and likely under 10 minutes.

In some cases, the list might just be relegated to a couple of co-workers or family members. In other cases, it might include contacting anywhere from 30-40 people, all of whom CCPH staff will continue to keep tabs on and call to monitor symptoms and make sure they have someone to care for them or bring in groceries and household necessities, depending on the persons particular situation.

The lab-confirmed positive patient is then asked to quarantine for 10 days upon showing symptoms at which point they receive a letter from CCPH explaining they are bound by law not to leave the house until they been isolated for 10 days or have been symptom-free for 72 hours, which ever happens first.

Those people in the patients first two rings as mentioned above are contacted and asked to quarantine for 14 days, at which point, they might be referred to a healthcare provider for testing or continue to be monitored by CCPH for symptoms.

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This is where some of Carrs calls tend to get a little testy, particularly when it comes to asking someone who feels healthy (whether its the patient who has tested positive or simply someone who appears in one of the two rings of contact to that individual) to stay home when they may or may not have two weeks of vacation time to spare.

Some people tell her they simply cant afford to take off two weeks of work. For the most part, however, people are pretty good at taking the news, she said, but shes definitely experienced a little push back from others.

Legally, they are bound to follow public health orders issued by CCPH per state statue, which are enforceable by law. Here, in Campbell County, Carr isnt aware of anyone who has been cited for defying their public health orders but knew of at least five incidents in Laramie County where people have been cited with fines between $100 and $1,000.

A lot of people, however, find the process unfair, Carr said, particularly now that the weather is nice and the Governors public health restrictions continue to ease.

Some people ask if they can just go camping or get out of town away from people, Carr said, but they cant. Even if they dont run into anyone, theres still stops at the store for supplies or gas. Its still putting others at risk.

People in the third ring, meanwhile, are contacts of contacts such as family members or those who may have contracted the virus from an infected patient. Those in the third ring are not asked to quarantine but rather receive follow-up calls from Carr with regard to symptoms.

The point of contact tracing, after all, Carr noted, is to mitigate the spread of the virus within the community. The fact that there have been more than 20 community acquired cases in the past week alone, she said, is proof that the virus is endemic in the community and will continue to spread.

Its never simple, CCPH Executive Director Glaser said. Its a 24/7 job. It can be a daunting task, but we do it and we do it efficiently.

Contact tracing, after all, Glaser noted, is at the very essence of public health. Increased testing, meanwhile, is making the job more comprehensive.

With mandatory testing prior to surgeries at Campbell County Memorial Hospital, it appears increasingly more people are not showing symptoms but are still carrying the virus, which is even harder to swallow when people are feeling healthy.

Up until this week, most of the cases and contacts have remained within the community. Only last week, that trend reversed with more of the contacts having either visited somewhere else or come from elsewhere to Gillette.

As restrictions are eased and more and more people are getting out, Carr worries about what this means for the likelihood of more people becoming infected. In the past two weeks, they saw more than 20 cases, which tends to ebb and flow based on how quickly labs can process those results, which this past week, meant a two-to-three-day delay getting results back when the state lab ran short of supplies.

Shes encouraged by the number of people wearing masks but noted that theres just as many who are tired of all of the restrictions and justifiably want to enjoy the rest of their summer. Carr gets that but cautions about letting down our guard.

Wear a face mask, she said. Thus far, its too early to study the data to see where and how many people are catching the virus though one pattern is clear. People are passing it on to others, mainly through talking. Masks, Carr said, though not perfect, do in fact keep spittle from spraying on that person or others during a conversation, which is a huge preventive measure that one can take.

I know they are a pain in the neck to wear, she said from behind her own light blue hospital issued mask, but it pays to be cautious.

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Circling the Pandemic: How Contact Tracing Works - County 17