The Wilkes County Health Department is in all-hands-on-deck mode for contact tracing in the wake of the COVID-19 outbreak at the Tyson Foods Inc. chicken processing complex in Wilkesboro.
This process of supporting COVID-19 patients and notifying contacts of exposure to stop transmission chains is essential to slowing the spread of the virus, said Wilkes Health Department Director Rachel Willard.
“I have the hardest working team (of contact tracers) in the state and they by far are the reason this county is staying safe. They are the true heroes in my book,” said Willard.
“And we’re still running a full capacity clinic during this response” at the department’s Wilkes Community Health Center, a Federally Qualified Health Center.
Gov. Roy Cooper said increased contact tracing, more COVID-19 testing and progress on certain trends are needed to lift statewide COVID-19-related restrictions.
Local contact tracing team
Kristain Miller, part of the health department’s COVID-19 contact tracing team, discussed this work Friday. Miller is a physician assistant who normally sees patients at the Wilkes Community Health Center. She also has a master’s degree in public health, but this is her first contact tracing.
The team consists of the clinical services program manager, two communicable disease nurses, two providers, two health department nurses and 10 Wilkes County public school nurses. They rotate through the team each day.
People don’t know they tested positive for COVID-19 until a contact tracer calls unless they learned this from their healthcare provider. “Very seldom do we not reach someone—probably not over 4-5% of the time.”
Miller said that if a contact tracer calls a COVID-19 patient three times on three days without reaching the person, the next step is sending a certified letter instructing the person to call the contact tracer.
“Most people are very compliant…. and it can be hard to think after being told” you have COVID-19, said Miller. “Some may feel they’re in trouble, but they’re not. Some respond with denial.”
Contact tracers tell COVID-19 patients that they must self-isolate for a certain period, explain this and ask if the health department needs to help them with food or other basic needs while they self-isolate.
Asymptomatic or symptomatic
Whether COVID-19 patients are asymptomatic (don’t display symptoms) impacts how long they must self-isolate. It also affects what others must do if they had “close contact” with them. Close contact is being less than six feet away from a person with COVID-19 for more than 10 minutes.
Asymptomatic patients are told to self-isolate for 10 days from the date of specimen collection. Patients with visible symptoms are told to self-isolate for 10 days after the onset of symptoms.
Both must go at least 72 hours without fever and fever-reducing medicine and show improvement in other symptoms to be considered “recovered.”
Miller said improvement is monitored as a joint effort between patient and healthcare provider. “A follow up visit to confirm ‘cure’ isn’t warranted, especially if the patient experienced mild symptoms.”
She learns if patients displayed COVID-19 symptoms from healthcare provider notes or through tracing if provider notes aren’t readily available.
Contact tracers help COVID-19 patients recount who they had contact with in a 48-hour period, asking them where they went, if they wore a mask, when they were at work and other questions.
If the patient is asymptomatic, the 48 hours is the two days immediately before the day the patient’s specimen was collected by nasal swab for testing. If the patient displays COVID-19 symptoms, it’s the 48 hours ending immediately prior to the person becoming symptomatic.
“I feel like we get good cooperation from people. A lot of the people we work with are Tyson employees who wear masks and use social distancing at work. They continue wearing their masks when they go to the grocery store and otherwise don’t go gallivanting around. They work hard and don’t get out in public that much,” she said.
“Some families get together more than others for birthday parties and other gatherings,” said Miller, adding that this is when contact tracing can become more complicated.
She records the names of apparent close contacts, when contact occurred and other relevant information. “Then, we call the people who were identified as contacts. We don’t tell them who identified them but a lot know,” said Miller.
“We ask them how they’re feeling and if they have (COVID-19) symptoms. We give them recommendations on self-quarantine and guide them through the process of testing, but they don’t have to be tested.”
As of May 18, a person who had close contact with an asymptomatic COVID-19 patient can still work as long as the person wears a mask, maintains social distancing and self-monitors for symptoms. Asymptomatic patients had to self-quarantine at home for 14 days before May 18, as they must still do if close contact was with a COVID-19 patient who displays symptoms.
Self-quarantine self-isolation both mean staying home for a certain period, but a person in isolation stays away from others at home.
The health department can provide people with letters explaining to their employers why they’re missing work.
Miller said contact tracers strive to notify close contacts as fast as possible to help prevent the virus from spreading, while maintaining sensitivity.
Close contacts are told what they should do to separate themselves from others not exposed, how to monitor themselves for illness and that they could spread the virus to others even if they don’t feel ill.
She said the process of talking to a COVID-19 patient to address the person’s needs, identify close contacts and call close contacts to tell them what they need to know and provide support often only takes about an hour.
She said a single case can also drag on for days, especially if employers get involved and insist on talking to the close contacts.
“Depending on when one tested positive or was identified as a close contact, the education and guidance they got for isolation and self-quarantine may differ from those contacted most recently,” said Miller.
“It’s frustrating for employers to have it change…. Plus, it can differ among states,” said Miller.
These changes result from education and instructions reflecting the latest guidance from the U.S. Centers for Disease Control and Prevention and requirements from the state. She said revisions result from more becoming known about the virus.