Contact tracing — could it be telling us more?

Contact tracing — could it be telling us more?

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Bill Stanley, Cheshire Economic Development Commission chairperson, says a precise strategy to track the spread of COVID-19 would be less damaging to businesses looking to reopen.

“I run into people every day that express extreme caution about doing anything, (like) venturing out,” he said, when public contact in a restaurant or store with a mask may not be a significant source of transmission.

“It would be a great piece of knowledge,” he said, “that would help people probably come to grips with the fact that we can go out, we can do things that people have been hesitant to do in the past.”

Stanley, 67, is a retired small business owner who keeps busy as president of the Cheshire Land Trust and chairperson of the state Home Inspection Licensing Board.

He said he wondered if ContaCT, the state’s contact tracing platform, could show the public where and how the virus is spreading — beyond the system’s primary function of tracking and contacting people who may be infected with the coronavirus.

“I understand that early on — when we didn't know a lot, we weren't sure how it all worked — an abundance of caution is appropriate,” Stanley said. “But … if we're learning that some of those initial concerns were not valid, and, in fact, it's not as dangerous if you follow these protocols, why aren’t we willing to say that? I think it's probably time to say it.”

A recent surge in COVID-19 cases has caused the state’s positivity rate to rise sharply.

“Maybe the contact tracing can help us with that,” Stanley said. “… What is it telling us? What are we finding out? It went from 1 (percent positivity rate) to 4 (percent)? Where did those cases get picked up in a relatively short period of time? What happened? And if they're really tracking these things down, that should be really valuable information.”

What is contact tracing?

The purpose of contact tracing is to slow the spread of illness and disease. When a person tests positive for COVID-19, their contact information is provided by physicians and laboratories and uploaded into ContaCT.

Jaime Krasnitski, an epidemiologist at the state Department of Public Health, is in charge of resource coordination for ContaCT, ensuring that DPH has the ability to do contact tracing effectively.

She said that although there’s a distinction between case investigation and contact tracing, the state performs them together.

“Many states do those activities separately,” she said. “Here in Connecticut, when we use the term contact tracing, we're referring to the combination of case investigation as well as contact tracing.”

State contact tracers are trained to do the case investigation, which involves the infected person, as well as contact tracing, which involves those the person has been in contact with.

Contact tracing is a collaborative effort between local health departments and DPH. Once there's a record of a positive case uploaded into ContaCT, either a local health department could initiate follow up or a state tracer picks it up and performs an initial assessment.

“We have very specific scripts that follow along with the ContaCT system,” Krasnitski said. Tracers explain why they’re calling, confirm the infected person’s identity and address, ask about symptoms and about any unmet needs.

“Through contact tracing, we’re able to connect people to resources, if they would otherwise struggle, to be able to isolate or quarantine appropriately,” she said. “We want to make sure that they have the resources to be able to stay home.”

Although tracers collect general information during an interview, asking about places the infected person may have been in the two weeks prior to their illness, it's not the primary function of contact tracing to try to determine where somebody got sick, nor is it used to show where and how the virus is spreading.

The main way DPH identifies what they call locations of concern is through calls from local health departments who have conducted interviews with people and found a common location.

Jaime Krasnitski, left, epidemiologist at the state Department of Public Health, and Lynn Sosa, right, deputy state epidemiologist at the Department of Public Health

Dr. Lynn Sosa, DPH’s deputy state epidemiologist, said that even though tracers ask about where infected people went, it doesn't mean that any given location is where they were definitely exposed and infected.

“We don't want to say, ‘oh look at all these people that went to this restaurant,’ when maybe that's just a really popular restaurant,” Sosa said. “That said, we do look at this information … to see if common places show up.”

Incomplete information

Part of the interview involves questions about potential exposures.

Tracers ask who the infected person has had close contact with two days before the onset of illness through 14 days after onset. Close contact is defined by the Centers for Disease Control and Prevention as coming within 6 feet for a total of 15 minutes or more.

Krasnitski said that sometimes people are hesitant to disclose who they’ve been in close contact with, or offer to reach out to their close contacts themselves.

“We certainly encourage them to,” she said. “We suggest some language that they can use to notify (them), but ideally, we would collect name and basic demographic information, as much as the case has, for each of their contacts.”

Infected people may not want to answer other questions, such as about their employment.

Krasnitski said that while DPH doesn’t generally run reports on the number of people who give partial information or decline to participate, officials do look at the attempt rate and success rate.

Success rate measures completed initial interviews. People still have the ability to decline to answer some of the questions and still have it count toward the success rate.

For the week of March 21-27, the attempt rate for reaching out to an infected person within the first 48 hours was 97 percent, and the attempt rate for reaching contacts in the same time period was 93.5 percent.

The success rate — a completed initial interview with an infected person within the first 48 hours — was 56 percent, and the success rate for contacts in the same time period was 65.5 percent.

Future of contact tracing program

Krasnitski said that when the contact tracing program began last spring, it was completely volunteer based, consisting of 125 college students with approximately seven team leaders.

Toward the end of the summer, when many of the students returned to school full time, DPH worked with a staffing contractor to provide help desk assistance in the command center.

The contractor manages the paid tracers, as well as oversees and provides support for the volunteer team. Currently, the team of paid staff — all Connecticut residents — and the volunteers has reached 373 people.

A special group of contact tracers, called community outreach specialists, was recruited from 11 communities that were considered to be of higher risk of transmission.

"Having someone from those communities, who speaks the language and knows the culture, has really helped significantly with contact tracing."

-Jaime Krasnitski

“Having someone from those communities,” Krasnitski said, “who speaks the language and knows the culture, has really helped significantly with contact tracing … We do provide translation assistance for contact tracers on the telephone, but that's a very different experience than being able to talk one-on-one with somebody in your native language.”

DPH is in the middle of a one-year contract with the staffing contractor that expires in August. Some of the contact tracers already have been pivoted over to help support the vaccine effort.

“The needs for each of those programs ebbs and flows from week to week,” Krasnitski said, “and so all of the contact tracers were actually trained on how to use the systems involved with the vaccine appointment assistant line.”

Some tracers came to the program last year after leaving their jobs — some due to their own health issues or a health issue of a household member.

“I think we are starting to lose some folks who are returning to the workforces that they left previously,” Krasnitski said. “Even though they (were) getting paid for it, they just feel so happy and proud to be doing their own little part of helping to keep the residents of Connecticut safe and healthy during these really difficult times.”


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