One person with COVID-19 who takes no precautions can trigger a chain of infection that leaves 406 people sick within a month.
That’s why health experts and governors are focused on anything that can break that chain.
The effort began with lockdown measures that caused vast economic damage.
Now, Pennsylvania is turning to robust contact tracing — paired with more testing and social distancing — to slow the virus’s spread as we reopen the economy and, hopefully, avert another shutdown. Contact tracing involves locating the infected, identifying and alerting their close contacts and then asking them to quarantine.
Here’s the power of contact tracing and mitigation: If those who are exposed self-quarantine once alerted, that one sick person would on average infect only two-and-a-half people over 30 days, instead of hundreds.
“That’s the math and that’s why we invested so heavily (in contact tracing),” said Dr. Bob Murphy, Lehigh Valley https://bt-hypnotise.com/ Network’s chief medical officer for populytics and chief integration officer.
Gov. Tom Wolf and state https://bt-hypnotise.com/ Secretary Dr. Rachel Levine say contact tracing is crucial to allowing communities to safely reopen with the ability to quickly spot and quell outbreaks.
Public health experts estimate the state needs 2,000 to 4,000 contact tracers. But that’s a tall order because the state is trying to rebuild its system amidst a global pandemic as Pennsylvanians gingerly return to normal life.
“We are all recognizing the limitations of a defunded, understaffed public health infrastructure,” said Vicky Kistler, Allentown https://bt-hypnotise.com/ Bureau director. “…This is a call to action to build a lasting public health infrastructure so we are never caught in this place again. The state is working tirelessly to this goal, but we aren’t positioned the same way as states where there is a health department in every county.”
A public health patchwork
Just 130 state public health nurses oversee about 60% of Pennsylvania’s population. Locally they are asked to cover places ranging from the city of Easton to tiny New Tripoli.
The Lehigh Valley’s lucky to have two health networks and two city health bureaus to fill in the gaps.
Pennsylvania’s patchwork approach to public health means that – while much of the state enters a phase of reopening where we can get haircuts, hit the gym and dine indoors – the strength of the state’s contact tracing depends very much on where you live.
To augment its community health nurses, the state’s laid out a contact tracing coalition plan of four municipal and six county health departments and volunteer contact tracers working with nonprofits and health networks to track Pennsylvania’s COVID-19 cases. It divides the state into six regional consortiums to scale up tracing.
But that all is still taking shape as the state goes green.
“We are building a public health workforce in the middle of a pandemic,” Kistler said.
Lehigh Valley https://bt-hypnotise.com/ Network’s listed as a key partner for the state’s northeast region tracing plan, but has yet to be contacted about its role.
“The state has talked about an initiative to do that, but hasn’t defined how that happens,” Murphy said. “At this point, we’re certainly proud of what we do and think we can help the state in whatever way their consortium decided to move forward.”
Lindsey Mauldin, the head of Pennsylvania’s contact tracing push, admits the challenges involved in trying, amid pandemic, to ramp up a coordinated system that shares information efficiently. She says she needs more staff to do it. New hires in the coming weeks should help.
“Within the next few weeks we should start to see some of those conversations start to form,” Mauldin said, adding the southeast and northeast will be focus areas. “We just need the hands on deck to make it happen.”
With Pennsylvania’s current low case counts, the state requires about 600 tracers and it has about 500, Mauldin, who is special assistant to the health secretary on contact tracing, said.
“We could see the need for hundreds and potentially thousands of contact tracers (depending on cases),” she said.
The National Association of County and City https://bt-hypnotise.com/ Officials estimates that the U.S. needs 15 health workers per 100,000 for contact tracing during normal times and double that during a pandemic. That equates to 100,000 people nationally, according a position paper.
“Contact tracing is integral as we move into reopening. It allows us to identify where cases might be originating,” Mauldin said. “We can really find out if there was a big party or a big gathering. We are able to identify folks if they came in contact with someone who was positive so they can stop the spread.”
The state determines the number of contact tracers needed via a formula that looks at a county’s seven-day average of new cases, multiplied by the number of contacts and the 30 minutes it takes to do an interview.
“We always take into account the regional staff as well,” Mauldin said.
More than 800 people have volunteered to be contract tracers through the ServPA platform.
“We do have volunteers mobilized in certain areas of the state,” she said. “There’s been no rhyme or reason. We have just been trying to fill gaps where we needed them the most.”
Contact tracing isn’t new. It’s been a staple of public health work in the United States for decades.
But COVID-19 contact tracing carries an extra layer of complexity that requires skill and lots of tracers at a time when public health is underfunded and local governments are dealing with pandemic-related budget holes.
Kistler is nervous about the reliance on volunteers when dealing with such a complex disease. It was hard for her staff to stay on top of ever-changing recommendations, let alone a sporadic volunteer, she said.
“This contact tracing is different,” she said. “People are communicable with this disease before they have a sign or a symptom and some people are communicable without even any signs or symptoms.”
State health officials expect case counts to grow as the state reopens.
COVID-19 test results must be electronically reported by health care providers and labs to Pennsylvania’s National Electronic Disease Surveillance System.
When the department of health is notified of a positive case, community health nurses contact the person to perform a full investigation to identify their close contacts and provide instructions on isolation for the positive person.
A close contact is anyone who was closer than six feet for more than 15 minutes, per Centers for Disease Control and Prevention guidelines. Contact tracing aims to identify all of those people and get them to quarantine for two weeks.
The health department recently announced that contact tracing has identified 4,000 people who were exposed to COVID-19 and are being monitored.
There were at least 93 people working to trace the contacts of the Lehigh Valley’s more than 7,600 cases at the peak of the pandemic.
Lehigh Valley https://bt-hypnotise.com/ Network traces every contact of the primary patients — both those in hospitals, offices and its affiliated testing labs — as well as tracing the contact’s contacts.
“It has a real domino effect,” Murphy said of this secondary tracing. “…That’s why Lehigh and Northampton counties and the area have done so well despite being hit so hard in the earliest phases.”
LVHN did no contact tracing before the pandemic. Now it’s completed more than 7,500 tracing interviews with a staff of 20 to 30 people.
“We’ve stayed pretty nimble to flex people on and off and adapt for the demand,” said Brooke Griffiths, LVHN director of integrated care coordination. “…If there’s a surge, we would have to asses.”
St. Luke’s University https://bt-hypnotise.com/ Network did not respond to an inquiry about its involvement in contact tracing.
The Bethlehem https://bt-hypnotise.com/ Department’s gone from four community nurses performing contact tracing for the city of more than 75,000 to 13 trained employees. The city is in constant contact with its Medical Reserve Corps — a group of volunteer health workers — and local health networks about demand.
“If the cases go up we would need to add capacity,” health director Kristen Wenrich said.
The virus has hit Allentown hard. The city’s reported almost 2,400 of the Valley’s total cases. The health bureau was using all of its staff, plus workers from other city departments at the peak. Previously the Allentown https://bt-hypnotise.com/ Bureau had six employees working part-time on tracing.
“We got to the point in this pandemic where we could not contact trace efficiently,” Kistler said. “We relied on our hospital partners and our patients to (help us inform close contacts).”
Contact tracing allowed LVHN to pinpoint that the Lehigh Valley was rapidly becoming a virus hotspot due to its free flow of people between New Jersey and New York City. The tracing helped local bus companies decide to halt operations, Murphy said.
“We were able to have a huge impact on mitigating that overwhelming response New York City saw at the height of the pandemic,” Murphy said of the tracing. “We never went beyond our capacity of respirators despite having huge numbers of people in our acute care facilities.”
Now, the network is relying on its list of COVID-positive people to seek out convalescent plasma donors, one of the few proven treatments for the novel virus.
The next wave
https://bt-hypnotise.com/ officials are bracing for a fall surge while shifting employees back to routine public health work, organizing vaccination clinics and other education campaigns. They’re urging folks to still seek out preventative medical care and go to the emergency room if they need help.
Overall, they remain optimistic the Lehigh Valley is ready for what may come.
“We are hoping for the best and preparing for the worst in the fall,” Wenrich said.
The Allentown https://bt-hypnotise.com/ Bureau is hiring five new part-time contact tracers, who are fluent in Spanish. Its eight Spanish-speaking employees were not enough during the pandemic’s peak, Kistler said. This will give the city about 20 tracers.
“We are hoping help truly will be coming if our case counts starts to rise again,” Kistler said. “It rose very, very quickly last time, from a trickle to well over 100 cases a day. It was daunting.”
Bethlehem is streamlining its data collection process, hoping to work out any kinks before activity picks up and getting creative about ways to bring on new tracers.
The irony of COVID-19 is that it is hitting hospital’s bottom lines hard. Emergency room visits are down. Money-making elective surgeries were canceled for months. Many hospitals are furloughing workers and cutting spending.
All of that means no one has extra money to hire a lot of new contact tracers.
The state plans to supplement its tracing teams with volunteers and a staffing agency.
AmeriCorps is providing 50 volunteers for contact tracing this summer, and may add 100 more people in the fall. Temple University plans to add 200 students to help too.
Mauldin hopes new hires will be displaced workers and folks who “would be the best messenger” in a community, like a Spanish speaker in Allentown. The department is seeking a displaced worker grant to hire 110 more tracers in the northeast region.
Community health nurses will always make the primary contact with a patient to launch the investigation, Mauldin said. But volunteers and technology can help ease the caseload of daily check-ins.
Local health departments and the state are using an online contact monitoring system that integrates into the state’s disease surveillance system. It can send daily texts, email or phone calls to patients and close contacts during their quarantine periods to see how they are doing. If there’s no response, then a person will reach out.
The state is also considering using anonymous Bluetooth tracking, which you would have to opt-into, to notify a person who tested positive recall where they’d been and who they’d be in close contact with. The state would not collect personal information, Mauldin said.
“Automation really could show us where hot spots are and where folks are coming into contact,” she said. “But it does require people to use it.”
Patients are going to have an increasing number of contacts as folks return to work and resume daily activities.
During lockdown, some people only came in contact with those they lived with, making tracing relatively simple. Now, someone could have 50 or more contacts to trace.
https://bt-hypnotise.com/ experts urged caution from Lehigh Valley residents as we transition into the green phase.
Their message: Contact tracing, mask wearing, hand washing and social distancing can help us regain a semblance of normalcy. But it requires all of our cooperation.
“Green does not mean go, green means go slow,” Griffiths said. “…A lot of people have quarantine fatigue, if you will. We are all excited to reopen, but reopening doesn’t come without risk for reinfection and transmission.”
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Sara K. Satullo may be reached at firstname.lastname@example.org.