Public health nurses leading area’s contact tracing effort 

  • In this Friday, April 10, 2020 file photo, public health nurse Lee Cherie Booth conducts a test for COVID-19 outside of the Salt Lake City Public Health Center, accompanied by Salt Lake County infectious disease nurse Travis Langston. When a swab test comes back positive, contact tracing starts. Local health departments try to reach and assess everyone a person has come in contact with from two days before symptoms to the time test results come back. Experts say contact tracing is key to getting the pandemic under control.  THE DESERT NEWS via AP/SCOTT G. WINTERTON

Staff Writer
Published: 5/6/2020 6:22:57 PM

NORTHAMPTON — After Michael Kurland moved from Connecticut to retire in Goshen five years ago, he joined his town’s board of health, never suspecting the three-member panel would someday face a pandemic. And he saw how few resources the board received from the state.

“We didn’t have office supplies, we didn’t have a stapler. I came from a place where I managed a staff of 200 people,” he said, referencing his time as the director of health services at University of Connecticut in Storrs. “I came here, and I was like, how do I send a letter? They said there’s no money in the budget for postage stamps.”

He added, “The beauty of a small town is you have fewer problems. But you also have fewer resources.”

That lack of resources for rural boards of health was on Kurland’s mind in mid-March, as COVID-19 began to spread in the United States and Goshen officials held a socially-distant meeting at town hall one Saturday.

“We got nervous,” Kurland recalled. “I particularly got nervous because there are only three of us on the health board.”

A major COVID-19-related responsibility facing the board of health was contact tracing — or interviewing individuals with the illness — to track those with whom they had been in close contact, notify them of possible exposure, educate people about the illness and tell them to stay home.

Northampton health officials anticipated that contact tracing during a pandemic might be more difficult for smaller, more rural towns. That is one reason why they reached out to neighboring cities and towns and asked if they would be interested in being part of a collaborative where a pool of public health nurses would do contact tracing for cases from a number of municipalities, said Northampton’s public health director, Merridith O’Leary.

“If we put this together, would you want to take part?” O’Leary asked those officials in nearby towns. “Overwhelmingly, the response was, ‘yes, yes, yes.’”

The public health nursing collaborative, led by the Northampton Health Department, hired and trained nine nurses to handle cases for a dozen cities and towns: Northampton, Whately, Goshen, Westhampton, Williamsburg, Easthampton, Worthington, Plainfield, Huntington, Chesterfield, Middlefield and East Longmeadow. The state released millions in funding to cities, public health districts that serve towns and other organizations, such as regional planning agencies, that distributed funding to municipalities, according to a state Department of Public Health spokesperson. Participating cities and towns put a portion of that money into the collaborative, O’Leary said.

According to the Centers for Disease Control and Prevention (CDC), contact tracing is a key strategy for preventing further spread of COVID-19. The federal agency urges communities to ramp up their tracing capacity. “If communities are unable to effectively isolate patients and ensure contacts can separate themselves from others,” the CDC states on its website, “rapid community spread of COVID-19 is likely to increase to the point that strict mitigation strategies will again be needed to contain the virus.”

When someone in Massachusetts tests positive for COVID-19, their case gets recorded in MAVEN — the Massachusetts Virtual Epidemiologic Network. Public health nurses start with the “index case,” the person who tested positive, and support them through their isolation.

The nurse and person with COVID-19 discuss signs and symptoms. Sometimes, they discuss “the disconnect” between information given by the public health nurses and what the individuals “might be hearing in the media” about the disease, said Jenny Meyer, Northampton’s public health nurse, who oversees the collaborative.

A key question nurses ask, Meyer said, is, “Who are all your close contacts you’ve been around two days prior to getting ill?” The CDC defines a close contact as “someone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before illness onset until the time the patient is isolated.”

Public health nurses then call all the close contacts to inform them they were exposed to someone who tested positive for COVID-19, though they don’t reveal the name of the person who tested positive to protect their confidentiality. The nurses tell these people to stay home for 14 days and to make sure they have a supply of food and any medications they need. These interviews can last anywhere from 20 minutes to one hour, Meyer said, “because there is a lot of nuance to isolation and quarantine, and people are pretty isolated and scared.”

Nurses follow their assigned cases through the end of a person’s isolation or quarantine. “That’s two to three weeks they talk to this nurse,” Meyer said. “It feels really personal sometimes. We get to know these people, their lives, and what they are going through,” she said.

For those sick or potentially exposed to the virus, having someone guide them through isolation or quarantine is helpful, Meyer said. The process can also be intense for the nurses.

“You’re in these people’s lives sometimes for an extended period of time, and they are going through a lot,” Meyer said. “It’s emotionally super hard sometimes to be on the other end of the phone and not have all the answers.”

Help on the way

Since the pandemic, contact tracing has entered into the lexicon of many Americans. But the technique is not unique to COVID-19, Meyer said.

“Contact tracing is something that we do as public health nurses and local boards of health. It is one of the aspects of what we do for any infectious disease, not just COVID,” she said, giving the examples of measles and mumps.

For small towns like Goshen and Williamsburg, the collaborative has been helpful, town officials say. Williamsburg had a nurse who did contact tracing of residents, but when she died several years ago, a replacement was never found, said Donna Gibson, chairwoman of the town’s board of health.

She and another member of the board are nurses, so they handled contact tracing for other diseases. That worked — until the pandemic struck.

“We can kind of deal with it,” said Gibson, who’s been on the board for more than three decades, “up until this coronavirus situation. Now it’s over and above what we’re capable of doing. I’m still working, and the other person is pretty busy with her life and her work. So we need the extra help.”

Gibson worries that warmer weather will bring more cases into Williamsburg and other Hilltowns in western Massachusetts where “people have second homes,” she said. “People out of big cities rent places, B&Bs — there’s a lot of them in the Hilltowns. Come summer and warmer weather, people will be moving and traveling.”

More help with contact tracing is on the way. Gov. Charlie Baker announced last month that nearly 1,000 people would be hired for a new contact tracing initiative, the COVID-19 Community Tracing Collaborative (CTC). Partners in Health, a Boston-based nonprofit focused on global health, is working on the project with the state.

The program launched last month and is being rolled out across the state. CTC tracers have not yet started taking on cases from the Northampton-led regional public health nursing program, but the two groups are planning out how they will work together, Meyer said.

In general, “local boards of health identify cases they can handle, and the collaborative takes the remaining cases,” Jason Lefferts, a spokesperson for Massachusetts Health Connector, wrote in an email to the Gazette.

If you get a call from certain area codes, he added, it may be a contact tracer. “We are very actively working to let people know that, if the MA COVID Team calls from an 833 or 857 area code, they should answer the phone,” he wrote. “It’s an opportunity to help stop the spread of the virus in Massachusetts.”

The additional tracers in the CTC program will be particularly helpful when officials start to relax some social distancing rules, Meyer said.

“I think where this initiative is really good is, as things start ‘going back to normal,’ whatever that does look like, our job gets bigger — not smaller,” Meyer explained.

When contact tracers ask people with COVID-19 who they have been in close contact with, “most people are like, ‘Oh, my partner,’ ‘Oh, my kid.’ It’s a very small circle,” Meyer said.

“As we start reopening things,” she said, “those social networks, even unknowingly, become bigger.”

Greta Jochem can be reached at gjochem@gazettenet.com.


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