Contact tracing has been a key part of the Test, Trace and Isolate strategy for slowing the spread of the novel coronavirus. During the shelter-in-place period, physical contact with people beyond one’s immediate household has been sharply curtailed. As a result, contact tracing has been relatively straightforward and manageable for communities with limited outbreaks and with the expertise and resources to conduct tracing.
However, intensified tracing efforts will be required as social distancing restrictions are eased and people resume their daily activities. The number of physical contacts per person will multiply as people attend school, commute to their place of work, receive routine medical care, etc.
Several studies have recommended a substantial increase in resources devoted to contact tracing. A study published last month by The Center for Health Security at Johns Hopkins University and the Association of State and Territorial Health Officials (ASTHO) estimates a need for an additional 100,000 contact investigators in the United States. This figure is based on a standard benchmark of 30 workers per 100,000 people.
Several states, including Illinois, have announced new contact-tracing initiatives. Illinois recently announced that it will initially hire 300 case investigators and contact tracers and may ultimately hire 3,800 workers.
Much of the responsibility for managing the spread of coronavirus, including contact tracing, falls to county and community public health departments. Evanston has its own certified public health department, as do three other communities within Suburban Cook County.
Ike Ogbo, Director of Health and Human Services for Evanston, said contact tracing began in mid- March, after the first COVID-19 case was identified.
Seven staff members of the Evanston Health Department have done much of the contact tracing work. “Evanston Health Department is blessed with a number of knowledgeable public health practitioners who we can draw on for their knowledge and health expertise,” explained Director Ogbo.
These staff members have other responsibilities, including work with high-risk groups such as long term care centers and responding to questions in the community. As a result, members of the Medical Reserve Corps (MRC) have assisted in the tracing effort. The MRC is a volunteer group of both medical and non-medical professionals who have an interest in serving in public health emergencies and in health-related events.
About 25 to 30 members of the MRC have expressed interest in helping in some capacity said Director Ogbo. “The MRCs have been of tremendous assistance with contact tracing and interviews during this pandemic.”
Tracers are working diligently, and contact tracing occurs seven days a week because, “disease transmission does not wait,” said Director Ogbo.
Case investigators receive information about new positive COVID-19 cases from the Illinois National Electronic Disease Surveillance System (I-NEDDS) or directly from hospital staff or the healthcare provider. Contact tracers first interview the patient (“case”) to obtain the names and contact information of people at risk of being infectious (“contacts”). They inform these individuals that they may be infectious and become ill, and they issue quarantine orders if appropriate. Contacts are asked to self-monitor and to call the public health department if they develop symptoms or call their doctor or go to the hospital if they become very sick.
Contacts of identified cases are not necessarily tested, said Director Ogbo. Guidelines have changed recently and now state that anyone who has been in close proximity to someone with COVID-19 should consider getting tested. CDC and State guidelines change daily as new information about the virus becomes available, explained Director Ogbo.
As of Monday, April 27, 611 residents had been issued quarantine orders and 318 total positive cases were reported in Evanston. Quarantine orders last 14 days from the last time of contact. Director Ogbo said compliance has been good, with only two instances of people not obeying quarantine orders.
Director Ogbo’s goal is to reach each contact within 24 hours of identification. “We move swiftly and promptly to get in touch with those who have been identified as close contacts,” he emphasized. Actual experience can be longer, due to absence of or incorrect contact information, failure of contacts to return calls, and other obstacles. Cook County Department of Public Health (CCDPH) said it usually takes a few days to a few weeks for their tracing program to identify and reach all the close contacts of a confirmed case.
Currently, no new, contact tracing-specific technology is being used by Evanston to leverage what is a manual and very labor-intensive process. This may change as a result of the new Illinois state contact tracing initiative on May 1. Dr. Wayne Duffus, an infectious disease specialist with the CDC, will lead the initiative and employ a hub-and-spoke strategy. The State will provide “consistency across several resource areas such as curriculum and technology” to local public health departments that will continue to carry out the day-to-day tracing, contact and communication, Dr. Duffus explained during Governor Pritzker’s press conference on Friday.
The use of the information gathered as part of the contact-tracing program in Evanston has been limited to some key demographic data to plan public health response. The department’s focus has been on isolating the sick and issuing quarantine orders for identified contacts, Director Ogbo said. More in-depth data analysis is a lower priority but will be done, he said. “We collect the data, we have the data, and, as soon as we can, we will analyze the data.”
Evanston’s public health department is relatively small and relies on federal and state grants for some of its funding. The department recently applied for a “COVID-19 Crisis Grant” and is assured of receiving the grant, said Director Ogbo. The Health Department has not yet received details of support that may be available to Evanston as part of the new State initiative.
Director Ogbo said Evanston’s Health Department is well equipped to manage the virus spread. “We have been managing well from when we received our first confirmed case in mid-March up till today and we continue to do so.” “We are well prepared to handle an influx of more cases than what we have been receiving,” he said.
“A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US,” Center for Health Security at Johns Hopkins University and the Association of State and Territorial Health Officials (ASTHO), April 2020.