Crystal O’Dell is a modern-day coronavirus detective. As Henderson County’s nursing director and a COVID-19 contact tracer, she’s responsible for tracking down everyone who has been in contact with a person who has tested positive for the new coronavirus.
It’s anything but easy. After a patient tests positive for COVID-19, O’Dell and her contact tracing team face the daunting task of interviewing sick and scared patients to learn where they may have unknowingly spread the virus and to whom. “It gets difficult when you identify a positive and realize that they’ve had multiple contacts who are now ill that need to be tested, and who probably have multiple contacts as well,” O’Dell says.
As the United States surpasses 1 million cases of the new coronavirus, contact tracing will be vital to containing the spread of COVID-19. Per Gov. Roy Cooper’s three-phase plan to loosen statewide restrictions, contact tracing across North Carolina will need to double in scope to meet the expected need.
The World Health Organization divides contact tracing into three steps. First, contacts, which can include friends, family members, health care providers and work colleagues, must be identified. Next, efforts are made to reach all identified individuals and inform them of their contact status: what it means, where to receive medical support if needed and how to self-isolate for a two-week period. Contact tracers then make regular follow-up calls to monitor for symptoms and signs of infection.
On April 27, the N.C. Department of Health and Human Services announced the formation of the Carolina Community Tracing Collaborative, a partnership with the N.C. Area Health Education Centers and Community Care of North Carolina to increase the state’s contact tracing workforce.
As the state rolls out additional COVID-19 testing, the surge in results will lead to more confirmed cases. That means more contact tracers will be needed to track where the virus has spread, says Paul Mahoney, spokesperson for Community Care of North Carolina.
The collaborative, which builds on the existing efforts of local health departments, will hire and train up to 250 additional staff to work in areas that need outside assistance. Priority will go to parts of the state with large outbreaks and to areas with smaller health departments in need of additional staffing, Mahoney says.
“At this point, we know we need people but we’re assessing exactly where we need them,” Mahoney explains. “The real key is going to be looking not just where the need is at, but where the need is at that exceeds what the local health department can do.”
More than 1,200 applications were submitted within the first 24 hours that the contact tracing positions were listed online, Mahoney says. Ideally, the program will tap into existing local expertise as much as possible; hiring managers will prioritize applicants who have done this type of work before.
Final decisions about the placement of contact tracing staff will be made in the coming weeks after additional testing begins and collaborative partners can assess areas of immediate need, Mahoney says.
NC AHEC will take the lead on developing training materials for both new hires and existing staff across the state, Mahoney noted. MAHEC, the organization’s Western North Carolina outpost, will not be providing training locally, according to spokesperson Jennifer Maurer.
Dialing for diseases
Asheville resident Peter Landis began feeling “crummy” in mid-March. He went to his family doctor and, after testing negative for the flu, was given a test for COVID-19. A week later, the doctor called back: The results were positive.
Half an hour later, Landis, 71, got a second call, this time from the Buncombe County Health and Human Services Department. A contact tracer was on the line, asking where he had gone in the days prior to the onset of his symptoms, whom he had seen and if he’d had contact with anyone from outside the area.
He told the health department that he had been self-isolating since he started feeling sick. Other than attending a rehearsal with the Asheville Choral Society three days before developing symptoms, Landis could not recall being in close contact with anyone. “I couldn’t think of anyone, so there wasn’t much point in going forward,” he says.
Contact tracers focus on contacts made during the 48 hours before symptom onset, says O’Dell with Henderson County, and any contact made after symptoms begin.
Buncombe County health officials are conducting contact tracing on every reported positive COVID-19 case in the county, said Buncombe County interim Health Director Dr. Jennifer Mullendore at an April 27 press conference. The county had assigned seven staff members to contact tracing at that point, and additional staff is on hand to train if the need arises.
The current level of staffing has been, and continues to be, adequate for the number of cases in Buncombe County, says Ellis Vaughan, clinical services coordinator with Buncombe County Public Health. The county will have access to the staff hired by the Carolina Community Tracing Collaborative, he says. If the need for more contact tracers surpasses the county’s in-house capacity, officials will request staff from the collaborative to assist.
In Henderson County, 38 members of the county’s nursing staff assist with contact tracing. Because they rotate duties, there are typically around 12 people actively contact tracing at a given time, O’Dell says.
Bearer of bad news
Like many health care workers, the outbreak has taken an emotional toll on O’Dell and her team of nurses on the front lines doing testing and contact tracing. She feels the gravity of the situation when she’s making calls, especially when delivering bad news to unsuspecting individuals.
“The initial reaction when someone is told they’ve had contact with a positive is, of course, they’re fearful and they’re concerned and they just want some direction of what’s their next step,” O’Dell said. “I think that’s where hearing from us that they’ve been in contact is really helpful, because they do get a nurse that can immediately talk to them about what they need to do next.”
There are times when O’Dell bridges the gap between a public health official and a counselor. Henderson County’s protocol is to inform contacts that due to their risk of exposure, they must quarantine for 14 days. She and her team also make sure to offer resources if the individual needs help obtaining food or medical care.
So far, everyone O’Dell has talked to has been receptive to the self-isolation guidelines. But despite her team’s relative success, she knows there’s a long way to go before they can stop the spread of the virus.