"The eradication of smallpox, for example, was achieved not by universal immunization alone, but by exhaustive contact tracing to find all infected persons," said Susan Varnes, the director of patient care at the Wayne County Health Department.
The county health department performs contact tracing on a daily basis for a wide variety of communicable diseases, which are diseases that can be transmitted from one person to another either through contact with blood and bodily fluids, breathing in an airborne virus, or by being bitten by an insect.
Prior to the COVID-19 outbreak, the Wayne County Health Department had one full-time and one part-time communicable disease nurse dedicated to contact tracing. Two more nurses are now assisting to follow up with every confirmed case that is reported to the agency.
"They are very busy," said Varnes, who is helping with contact tracing on a part-time basis during the pandemic.
Currently, the health department is managing contact tracing internally, but it has received numerous phone calls and emails from people wanting to serve as contact tracers. Their contact information is being saved and if the situation evolves, the health agency will reach out to them.
The goals of contact tracing are to interrupt the ongoing transmission of the disease and reduce the spread of infection; alert contacts to the possibility of infection and offer preventative counseling or care; offer diagnosis, counseling and treatment to already infected individuals; and if the infection is treatable, help prevent reinfection of the originally infected individual.
Contact tracing also helps the health care community learn more about the causes of a disease, its patterns of transmission and how it affects particular populations.
An exhaustive contact tracing effort helped to eradicate smallpox in the mid-20th century along with universal immunization. Contact tracers found all infected individuals, who were then isolated and the surrounding community and contacts at-risk of contracting smallpox were immunized.
The Wayne County Health Department doesn't learn about an infectious disease case unless that person seeks medical care and/or has lab work done.
The majority of the health agency's case load (99.6%) falls under class B notifiable diseases — AIDS, hepatitis, influenza and Lyme disease — which don't have to be reported until the end of the next business day. Class A diseases, such as measles or meningococcal disease, require notification within 24 hours.
How contact tracing works
An outbreak situation like COVID-19 is treated with high priority, according to Varnes. An aggressive investigative approach is implemented to contain the number of people affected and protect those at risk.Contact tracing happens on a daily basis, predominantly through phone calls, though some at-risk individuals receive a notification in the mail. Phone numbers and addresses come through a demographic report taken by the health agency of the infected person.
The contact tracers will ask the infected person the last day she went to work, her occupation, when she got sick, and if she knows the source of exposure. Sometimes the patient is in the hospital and the health department will call to confirm the patient's status.
In previous situations, the health department would have trouble reaching a spouse if they were in the hospital with their significant other. Since the hospitals are limiting visitors during the coronavirus pandemic, family members are usually home.
Higher risk patients like health care workers are asked what patients they've seen, what other workers they've come in contact with, and if they work in a COVID-19 unit or in an emergency department.
The Ohio Department of Health warned of scammers posing as contact tracers. The Wayne County Health Department and other legitimate health agencies will never ask for a person's Social Security or bank account information. The state health department also said to never click on a link or respond to a text saying you have been exposed to COVID-19.
The Wayne County Health Department will only know if a person is positive for COVID-19 if they reach out to a health care provider. Varnes noted several populations in the county that likely won't reach out for testing and therefore will never be counted.
"Internally, we have them on our radar but we have to be careful not to discriminate," Varnes said. "The undocumented population may not reach out. Certain cohorts likely won't reach out for medical-related services unless extremely ill."
Testing only provides a small window into the spread of the virus, but the unfortunate spread in several nursing homes has given the health department a better idea of how asymptomatic people can transmit the disease. These facilities locked down early before any confirmed cases of COVID-19, and Varnes said it's likely an asymptomatic worker brought the virus inside.
They likely "carried it in innocently and unknowingly," Varnes said. "It's a good way to measure community spread with asymptomatic people. It's scary too."
The outbreak of novel coronavirus 2019 began in Wuhan, China, in December. The first U.S. confirmed case was in Washington state on Jan. 21, and Ohio confirmed its first cases on March 9 in Cuyahoga County. Wayne County reported its first confirmed case on March 24.
— Reach Emily at 330-287-1632 or emorgan@the-daily-record.com. On Twitter: @mogie242
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