Alaska’s contact tracing capacity — which had been strained since June — is currently in a healthy place, public health officials said this week.
That’s because daily COVID-19 case counts have begun trending down in recent days, and a growing team of new contact tracers has recently come onboard.
“People are (now) getting outreached within 24 hours,” said Dr. Louisa Castrodale, an Alaska state epidemiologist.
Whether the state’s contact tracing capacity will be sufficient to weather the ups and downs of the pandemic largely depends on what Alaskans and public officials do to curb the spread of the coronavirus.
Contact tracing — the investigative process of tracking how a virus moves through a population — is key to slowing the spread of COVID-19, public health experts have said.
Contact tracers’ ability to work quickly and effectively can be affected by high infection rates in a community and by how many close contacts a person has. That’s reflected in how contact tracing capacity has fluctuated at different stages of the pandemic in Anchorage and in Alaska.
For example, in March when many businesses were closed and limits on social gatherings were in place, those who tested positive for the virus in Anchorage had just a few close contacts, making outreach more manageable, according to city health officials.
Daily case numbers started increasing gradually after most pandemic-related restrictions on businesses and gatherings were lifted in May. State contact tracers, approaching capacity, were still able to contact 95% of cases within two hours of the state hearing about a positive test result, Tari O’Connor, deputy director of the state’s Division of Public Health, said in mid-June. In Anchorage, contact tracing faced significant strain: Officials at that time described the state of contact tracing as being at or past capacity.
By the end of June, with people mixing in groups and going out more often, those who tested positive for COVID-19 in Anchorage increasingly reported having dozens of contacts or being in locations with dozens of people who contact tracers were unable to track down, the Anchorage Health Department director said in early July.
The state later in July even asked health providers to instruct patients who tested positive to start reaching out to their own close contacts.
A few weeks ago, contact tracers started prioritizing cases and stopped following up with everyone, O’Connor said, and that’s still the case now. The state’s contact tracers want to make sure that they don’t get behind and that they have enough capacity to deal with clusters that take more time and effort, O’Connor said.
“Part of the initial issue was that we were not able to get to all the cases in time,” O’Connor said. “And I think that we have solved that problem.”
It’s hard to say exactly what the delays were like — they’re still moving their work into a new electronic system. More groups of tracers are in the system now, she said, “but we’re still kind of early on in learning how to monitor those kinds of metrics in a real time.”
Public health officials have attributed lower daily case numbers in August in part to pandemic-related restrictions reinstated in Anchorage, the state’s largest city, which can drive statewide case trends. The most recent round of closures and restrictions, described as a “four-week reset,” is set to expire at the end of the month.
A ‘pretty intense’ job
Around late June, Rhonda Johnson, a recently retired professor of public health, signed up to be a contact tracer “as a way to be productively involved in the response from the safety of my own home,” she said.
She, along with hundreds of other people, registered for a training program certifying contact tracers that was being offered through the University of Alaska Anchorage.
She now spends her days making calls to Alaskans who have tested positive for COVID-19 and to their close contacts.
“The purpose of the call is to help answer questions, to make sure they have enough information to be safe, and then to identify their contacts. And also to understand the source of their infection,” she explained.
Johnson and her team work closely with the state of Alaska as well as local health departments, she said.
It’s part-time work, always less than 30 hours a week, but Johnson said it can still feel “pretty intense.” She juggles her days reaching out to dozens of new cases and checking in on existing ones.
Mostly, she said, she finds the work rewarding.
“It’s very interesting every day,” she said. “You know, you never know what’s going to be on the other end of the phone call.”
Johnson said the vast majority of the people she speaks with are both cooperative and curious.
“Most are happy to try and think through what’s happening, and what they should do,” she said.
She is often thanked for checking in on people, she said, and has learned a lot from the job.
“Having done calls in almost every region of the state now, you really do see the real cost of the pandemic,” she said.
Before the addition of the contact tracing surge workforce, Alaska already had a group of people scattered throughout the state who were contacting new COVID-19 cases.
Public health nurses fill a different role in the state’s health care system from someone like an intensive care unit nurse who may work with an individual patient and family, said Lorne Carroll, a public health nurse at the Homer Public Health Center.
“Our primary client is the entire population,” Carroll said. “So we have 730,000 clients.”
Statewide, health care providers and labs have to report certain conditions to the state’s Section of Epidemiology, which then shares it with local public health nurses. Those nurses then start a source case investigation and contact investigation, he said. That’s been going on with tuberculosis and botulism for decades.
And Carroll said though almost all public health resources are targeting COVID-19, there are other life-threatening diseases that they still have to manage.
“Tuberculosis, of course, doesn’t stop because there’s a pandemic,” Carroll said. “And those services that we provide are very unique, so we have to keep those going no matter what.”
Helping with communicable disease at a local level is part of his job — the skills they use for sexually transmitted infections and water- or food-borne illnesses transfer over to COVID-19.
“COVID is very much in our position description,” he said.
How contact tracing in Alaska works
“Really, (contact tracing) all starts with a cold call,” Carroll said.
Usually, he begins with a lot of questions to start establishing a relationship. Getting COVID-19 might feel embarrassing and stressful, he said.
Carroll will typically have a big calendar near him and a headset on to keep his hands free, and he’ll ask the person on the other line to help “basically rebuild the recent past,” he said.
During the case investigation, contact tracers use the date the person tested positive as their starting point. Then they move backward — looking for when the person started having symptoms and if they’ve been within 6 feet of anyone for 10 minutes or longer, he said.
They try to figure out who is a high-priority case — for example, people who might have a high risk for spreading the illness, like someone who lives in a congregate setting or works in health care and has close contact with people who are vulnerable to COVID-19. Additionally, someone with an increased chance of death or hospitalization might be considered higher priority, he said.
Those cases also get a follow-up call every day.
The low-priority cases are asked to isolate and receive information about how to talk to their close contacts about quarantining.
The contact tracers spend more time with the high-priority cases, listing out contacts within their infectious period.
“And then when we’re done with that telephone call, we actually pick the phone right back up and start calling each of the contacts one by one,” Carroll said.
The conversations are confidential. They don’t share the name of the person who tested positive, which he says helps reduce the stigma around COVID-19.
“That’s a particular skill or a set of communication strategies that feels new to some people, but for public health nurses, we’ve been doing it with tuberculosis and other communicable diseases for decades,” Carroll said.
Alaskans can help contact tracers by keeping a log of everyone they are in close contact with, and by keeping that list short, public health officials have said.
Johnson, the retired public health professor, added that timing matters when identifying close contacts.
Generally, anyone who came into close contact with the infected person in the two days before someone tests positive are people that individual may have infected.
For anyone the person came into close contact with earlier than that — up to approximately two weeks — they are more likely to have been the potential source of the person’s infection, Johnson explained.
Her advice for someone who has tested positive is to isolate for at least 10 days after a positive lab test, even if they are asymptomatic.
“If you are symptomatic, the isolation period is longer,” she said.
If you are a close contact of someone who has tested positive, Johnson said her advice is usually to self-quarantine at home and limit contact with others.
“Monitor yourself for symptoms,” she said.