Contact Tracing: Training New Workers and Connecting with Rural Residents
THE RURAL MONITOR | by Allee Mead | September 9, 2020
The Whiteriver Indian Hospital in eastern Arizona saw its first COVID-19 case on April 1. Physician epidemiologist Ryan Close, MD, MPH, said that the hospital’s service area, about 18,000 American Indian people on the Fort Apache Indian Reservation, “had some of the highest case counts per day as anywhere seen in the country.” Contact tracing was an important step to help bring these numbers down.
In addition to treating COVID-19 patients, Close said that the hospital’s role was to make sure residents could access testing and to proactively test those in close contact with individuals with COVID-19. The hospital’s contact tracing initiative starts with a phone call, in which the contact tracer explains that the person receiving the call has tested positive for COVID-19 and asks to meet in person to discuss contact history.
Every day, a team of contact tracers wearing personal protective equipment visits high-risk individuals and assesses their symptoms. “High-risk” outreach is focused on those who have tested positive for COVID-19 and are at particular risk for poor outcomes and deterioration. This daily effort requires its own team of about four to six people, who meet with the larger contact tracing team twice a day.
Besides checking symptoms, Whiteriver Indian Hospital conducts in-person contact tracing because its service area has poor cell phone reception and not everyone has landlines. This was not news to the hospital’s public health nurses, who were already conducting in-person contact tracing for other communicable diseases. Their expertise led to the hospital’s COVID-19 contact tracing strategy. Close added that the hospital had to “quickly double and triple [its] contact tracing capacity to be able to send people into the field.”
Across the country, contact tracing continues to be an important step in combatting the coronavirus pandemic, especially as schools and businesses open up and as community members become more active outside the home.
In addition, ethnic minority populations have been disproportionately affectedby the pandemic. For example, 1.3% of COVID-19 cases (in which race and ethnicity were known) reported to the Centers for Disease Control and Prevention (CDC) were among American Indian and Alaska Native (AI/AN) people, even though they make up 0.7% of the United States population. The cumulative incidence (or cumulative cases of COVID-19 per 100,000 population) among AI/AN people was 3.5 times the incidence among white people.
In-Person Contact Tracing
Whiteriver Indian Hospital’s contact tracing teams travel with pulse oximeters to test all household members’ oxygen saturation, regardless of whether a person feels sick. Close has reported cases in which people have not felt sick but had low oxygen levels: “At the peak of the epidemic for us, in one in five households that we would trace, we would find someone who unexpectedly had low oxygen and had to be hospitalized.” Now, he said, that happens one in 20 households.
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