When someone tests positive for COVID-19 a team of nurses springs into action to alert family members, friends and co-workers who may have been in close contact with that person.
Based on Centers for Disease Control and Prevention (CDC) guidance, a close contact is someone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before illness onset until the time the patient is isolated. So contact tracing will start with those who meet this definition, according to Brandi Combs, regional director for the state Department of Health’s District 5 in Southwest Oklahoma.
“If they have had close contact with a positive case, we want to test them. Anyone interested in being tested can get tested at their county health department. They need to call ahead for instructions,” Combs advised.
Close contacts go into quarantine for 14 days, as symptoms can appear anywhere from two to 14 days after exposure. If they test positive, the health department will contact them and a case investigation will occur.
If they test negative, they will continue to quarantine until 14 days from known exposure and get retested if symptoms consistent with COVID-19 develop.
If the test is negative and no symptoms develop after 14 days ,they can come out of quarantine and continue social distancing.
District 5 Nurse Manager Janene Atchley said public health nurses – both registered nurses and licensed practical nurses – are the ones who do the investigations. Qualified people who partner with them in the community or National Guard members who have had appropriate training aid the nurses in this endeavor.
It’s also nurses who do the actual COVID-19 testing because they know to take precautions with their personal protective equipment and follow the correct procedure for collecting specimens. The procedure currently used is a nasal swab, and those are sent off to the public health lab at Oklahoma State Department of Health headquarters in Oklahoma City. Patient care assistants help the nurses with lab processing, labeling and packaging.
District 5 covers 10 counties, one of them being hard-hit Greer County. One District 5 county has two sites. Another county, Washita, does not have a health department.
Atchley estimates that 25-27 nurses in District 5 trace the close contacts of people who test positive for COVID-19.
“That’s across our whole area. We do share that load, because if one county gets inundated with more cases, then in that one-nurse county that’s a very small rural area, other nurses step up and help with that. And it works both ways,” Atchley said.
The people who do the tracing get special training for the job, she noted.
“We do have a reporting system that is through the Acute Disease Service. Any reportable disease (as identified by the CDC) goes to the state health department, and then it comes out in a reporting system, which is assigned to the county health department to investigate,” Atchley explained.
That goes for any reportable disease, be it tuberculosis, salmonella, E. coli or anything else.
Right now COVID-19 is of special concern, so the nurses have special training in communicable disease investigations.
“We have protocols and guidelines that we use to manage or follow up on each case and contacts,” Atchley said.
The time it takes to trace the close contacts will vary depending on the occupation of the person who tested positive, how many people are in the family, how transient family members are and if they live in a highly populated household or some kind of facility.
The nurses identify who the close contacts are and then call them to let them know. Often they find that the close contacts have been expecting their call. If the contact was living in the same household as the person who tested positive, he or she is well aware of what symptoms that individual was presenting.
“Oftentimes they’re contacting us for testing already. I’ve not encountered anyone being super-surprised or upset because most people are in close proximity of the positive cases and most of the time they’re aware,” Atchley said.
“We ask them if they have symptoms. We do a lot of education with the contact. We give them instructions for isolation and what that entails and just general guidance for sanitation and prevention of spread of illness. We do encourage them to be tested,” she said.
“A lot of people do have symptoms. We ask them what is the date of their onset of symptoms. That’s a very important point to know, is what the symptom onset date was for a case or a contact. There’s a lot of discussion that happens over the phone,” she said.
The nurses educate these close contacts on what to look for. They let them know where they can go for testing. They encourage them to monitor their own symptoms and notify their physician if they are unable to manage their symptoms at home.
“So we just give them a very wide, broad array of resources,” Atchley said.
“We talk to people throughout their isolation period so that we can tell when to release them from isolation. We just don’t call them and we’re done. We do keep following up on these active positive cases until they’re released, to make sure that they are better. Most people do recover, but everybody’s release date may not be the same. It depends on their symptom onset.”
She reports that District 5 has adequate testing ability and plenty of testing supplies, and the Comanche County Health Department offers COVID-19 testing.
“We do want people to know that testing is available with the county health department. For anyone who’s interested, all they need to do is just give us a call if they feel like they need to be tested. There’s not a limitation on that. We have supplies. That is not an issue,” she said.
Asked what message she would like to convey to the public, she had this to say:
“We want people to continue to use their precautions with hand hygiene and social distancing and covering your cough. All of those things are just as important now and will be in the near future with things opening up. It’s very important that we still utilize that guidance and take heed to that.”
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May 03, 2020 at 01:00PM
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