As Whatcom emerges from COVID-19 lockdown, these disease detectives will play key role
There’s been a lot of talk about how rapid case investigation and contact tracing will be key as Whatcom County and the rest of Washington state emerge from the statewide lockdown put into place to slow the spread of COVID-19.
But what do those terms mean? And how well is Whatcom County prepared, given that cases of the respiratory illness are expected to increase as social distancing eases?
To explain, The Bellingham Herald gathered information from the Whatcom County Health Department, Whatcom Unified Command and the Washington State Department of Health.
What is case investigation and contact tracing?
Think of it as disease detective work.
“A disease investigation identifies people who have or might have COVID-19 so that they can isolate or quarantine themselves,” according to the Whatcom County Health Department. “Extensive disease investigations will allow us to dial back social distancing measures and help limit the virus from making a comeback.”
Even before the COVID-19 pandemic, this practice has, for decades, been common for public health officials working to slow the spread of an infectious disease — measles or sexually transmitted diseases, for example — or prevent an outbreak.
“This is work we do day in and day out, whether it’s COVID or some other reportable disease,” Erika Lautenbach, director of the Whatcom County Health Department, said in a media briefing on Monday, May 18.
How does it work?
First, you should know the process is voluntary.
Let’s say you test positive for COVID-19. Your confirmed illness becomes a case, and that information is shared with the Whatcom County Health Department.
The information could come from a health care provider or the Washington State Department of Health, which is tracking the illness, along with the county health department.
Once you’ve been diagnosed, county health department employees will interview you during what’s called the case investigation.
They will ask you when your symptoms started, where you went in the community and whether you have health conditions that could increase your risk of severe illness because of COVID-19, according to the Whatcom County Health Department. They’ll also ask about people who were in “close contact” with you while you were infectious.
A close contact is someone who was within 6 feet of you for more than 10 minutes. It includes someone who was near your coughs and sneezes, shares a home with you or cared for you.
Most people can point to friends and family who were close contacts. If you can’t identify specific contacts, investigators might talk to event organizers, your employer, a health care facility or businesses where you might have been while you were sick and infectious.
Once your close contacts have been identified, investigators then reach out to those people — this is the contact tracing part — to let them know they’ve been exposed to the new coronavirus, to find out if they have symptoms of COVID-19, and to provide information about testing and about their risks of getting sick.
The investigators, or interviewers, won’t reveal your name as the person who tested positive for COVID-19 when speaking to your close contacts.
You and your close contacts are also given information on how to voluntarily isolate or quarantine so you don’t infect others.
How does the Whatcom County Health Department reach close contacts?
“We start with a phone call to close contacts first, then follow up with a text, but we use whatever information we get from the person with a confirmed case, including emails, letters and even a home visit if needed,” said Claudia Murphy, spokesperson for Whatcom Unified Command, which is the multi-governmental agency handling the local pandemic response.
The way in which people are contacted came under fire recently when Gov. Jay Inslee initially required diners to provide their contact information when eating in reopened restaurants to aid in contact tracing for COVID-19 exposure.
The governor subsequently walked back that controversial mandate, saying instead that diners can voluntarily provide that information.
What other information will interviewers ask of you?
Requested information includes date of birth, address, gender at birth, race and ethnicity.
They won’t ask for nor will they write down immigration status, Social Security number, marital status or financial information.
Only public health agencies will use the information that’s collected, the state Department of Health said.
How many people does Whatcom County have for its disease investigation work?
Officials have said that widespread testing and ramped-up contact tracing are necessary for a gradual, safe return to public life. Those tools are necessary to quickly find people who need to be isolated or quarantined so they don’t spread the respiratory illness to others.
Local health departments will do that work, with help from the state Department of Health.
Whatcom County has 25 employees who are trained to interview people who test positive for COVID-19 as well as their close contacts, according to Murphy.
All are Whatcom County Health Department workers from different divisions. They include dietitians and public health nurses from the Community Health Division, environmental health specialists and public health nurses and disease investigation specialists from the Communicable Disease Division.
Volunteers soon will be recruited and trained should more interviewers be needed, Murphy said.
Toward that end, Whatcom County is hiring a temporary volunteer coordinator.
Lautenbach said the health department now has the ability to follow up with cases on the same day that it’s notified of their test results and with their contacts within one to two days, which aligns with the state Department of Health goals.
Lautenbach said that was a benchmark the county health department is proud of.
How long does it take to interview people?
“Our investigators are finding that case investigations can take 30-90 minutes depending on the number of close contacts,” Murphy said.
“Contact interviews are generally shorter as they are primarily instructions for quarantine,” she added, adding these take 10 to 30 minutes depending on such factors as the person’s health literacy, English language skills and anxiety.
Are there interviewers who speak a language other than English?
“We are able to perform contact tracing in Punjabi, Spanish and Russian,” Murphy said. “We also use phone-based language interpreters as needed.”
What help might Whatcom County get from the state with contact tracing?
“Washington state has trained nearly 1,400 contact tracers, who will be available to counties if they are needed,” Murphy said.
“The contact tracers include members of the Washington State National Guard, the Department of Licensing, and state and local health officials,” she added.
In Whatcom County, how many interviewers might be needed to contact people for the low end of disease transmission vs. the worst-case scenario, especially as the economy starts to open back up?
“We are managing now with two to three interviewers per day and have the capacity to manage five to seven times that amount with internal staff as we continue to develop our program in alignment with The Department of Health,” Murphy said.
