Contact tracing helps slow the spread of COVID-19, but are contacts required to help epidemiologists?
In hopes of slowing down the spread of the coronavirus, health departments across the country have turned to contact tracing. Finding those who have been exposed to COVID-19 and monitoring their symptoms is being done by epidemiologists from state to state.
Melanie Myers, public information officer of Huron County Public Health in Norwalk, Ohio, said those in close contact with someone who is infected with COVID-19 are at higher risk of being infected themselves.
She then went on to explain that contact tracing has three steps: contact identification, contact listing and contact follow-up.
With contact identification, Myers said once someone is confirmed as infected, contacts are identified by asking about the person’s activities and people around them since becoming sick.
“Contacts can be anyone who has been in contact with an infected person: family members, work colleagues, friends, or health care providers,” she said. “All people considered to have contact with the infected person are listed as contacts. Efforts are then made to identify every listed contact and to inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms.”
Those who are contacted are also provided with information about preventative measures to take. Myers said during the current pandemic, quarantine or isolation guidance is provided for high-risk contacts.
“Regular follow-up is conducted with all contacts to monitor for symptoms and test for signs of infection,” Myers said. “Contact tracing is being completed for all Huron County residents diagnosed with COVID-19, including symptom monitoring.”
Myers said contact tracing is voluntary but is vital in helping prevent the spread of the disease. She said positive cases and their contacts are contacted daily by the health department’s epidemiologists until their investigation is complete.
In Florida, individuals who have been exposed to a positive COVID-19 case are asked to quarantine and are monitored daily for the duration of their quarantine period. Tammy Yzaguirre, public information officer for Lee County, said contact investigations are covered by Florida statute and the health department may conduct an epidemiological investigation and follow up the diagnosis, treatment and causes of viruses to determine methods of communicable disease control.
“Businesses are required to cooperate with the department’s epidemiological investigation,” Yzaguirre said. “Any person who violates any rule … any isolation or quarantine order, or any requirement adopted by the department pursuant to a declared public health emergency commits a misdemeanor of the second degree.”
Yzaguirre said the department’s orders may also be enforced through actions filed in the proper circuit court.
Meanwhile, in Michigan, those who have been identified as coming in contact with a positive COVID-19 case do not have to comply with their local health departments, but they are encouraged to do so. Lynn Sutfin, public information officer of Michigan Department of Health and Human Services, said there are no legal requirements for someone who is identified as close contact and each local health department may handle the situations differently.
“If a business is determined to be an exposure location, the local health department could send out a public notification if it determines that to be the appropriate action,” Sutfin said. “If an individual is identified as a contact and the health department doesn’t hear from them, they do various things including sending a certified letter.”
Peter Schade, the health commissioner for Erie County, Ohio, said those who have been identified as a contact of someone positively diagnosed with COVID-19 must comply with the health department via the Ohio Revised Code.
Schade said the department contacts patients daily — and sometimes twice a day — to check in and monitor their symptoms. He said sometimes isolation and quarantines extend beyond 14 days.
When an employee tests positive for the coronavirus, there is a minimum of a 14-day isolation period and he or she must show no symptoms before returning to work. Schade said the employer must monitor all other employees as usual.
“We always reach out; we do not rely on a case to contact us ever,” he said. “If there is no phone contact, we go to (their) residence in person, and ratchet up law enforcement if there is no response or no compliance.”
In Allen County, Ind., Megan Hubartt, director of communications for the county health department, said they do have the authority to seek a court action to require compliance to prevent the spread of COVID-19.
“While language such as ‘recommend’ and ‘request’ are often used when we discuss isolation and quarantine, if we felt people were not planning to be compliant or found they were willingly going against our advice, we do have the authority to seek a court action to require compliance,” Hubartt said. “For the most part, folks are compliant and we do not have to take these steps.”
She said the Indiana State Department of Health is utilizing a texting system to reach out to contacts daily to request their response regarding how they’re feeling or if they’ve developed symptoms. She said information is given to contacts on how to be tested and what to do if symptoms worsen.
“While there are no specific laws on what a business must do when an employee tests positive, most local health departments work proactively through issues with employers with cases in their establishment,” Hubartt said. “We guide them on cleaning and work through questions such as who the person may have had close contact with so those folks can be quarantined to watch for development of symptoms and slow the spread of the virus. The requirements are generally put on the person who has tested positive to be responsible for following vs. the business they happen to work for.”
Hubartt said if there was a blatant disregard for the recommendations given, the department has the authority to intervene and issue orders to prevent the spread of COVID-19.
“Indiana is a Home Rule state, she explained. “So while the authorities in State Code and State Administrative Code are the same throughout the state, each county may handle situations slightly differently. For the most part, though, it is likely the information shared is followed fairly consistently across the state.”
Rachel Feeley, a public information specialist with the Ohio Department of Health, said contact tracing is done to notify individuals of their exposure to a contagious disease. She said while participation is voluntary, she believes it’s necessary to interrupt the chain of infection.
“Participation in contact tracing is voluntary,” Freely said. “When individuals are engaged in contact tracing, they will either be asked to monitor and report symptoms (if they occur) on a daily basis, or it is possible that contact may simply be asked to check back in with the local health department if symptoms occur. This is done so that proper referrals can be made and resources provided if needed.”
She said those who are identified as contacts of someone who has been diagnosed are contacted by the health department to notify them of exposure to COVID-19. They then provide information about the coronavirus and how to stay safe and keep others safe.
“The health department may reach out in a variety of ways: phone, text or email, and sometimes in person,” Feeley said. “Ohio is a home-rule state. Each health jurisdiction follows the same basic guidance for contact tracing, however each has its own protocol and processes.”
Nate Wardle, press secretary for the Pennsylvania Department of Health, said state law requires cooperation with disease control measures, but if someone refuses to speak with the department, they do not take any action against them.
“The department’s focus is providing necessary information to exposed individuals and obtaining information relating to contacts for the protection of those contacts,” Wardle said. “At times, the department has publicly posted information relating to an event or business in order to notify affected persons of their possible exposure.”
The state has developed an electronic contact tracing system called Sara Alert for automated check-ins.
“If the individual chooses not to be included in Sara Alert, a contact tracer would call the close contact to check with them daily,” he said. “Identified contacts are required to quarantine, and strongly encouraged to participate in daily check-ins with the department.”
In Kansas, Kristi Zears, the director of communications for the state’s Department of Health and Environment, said it’s in the best interest of the community to help mitigate the spread of COVID-19 but the community is also not legally required to cooperate with the guidelines.
“A local health officer could require the contact to be tested or quarantined,” she explained. “Some businesses or individuals are required to report positive tests to the local health department. Other businesses do not have a legal duty to report.”
The penalty for not reporting a positive result in Kansas is a fine of $25 to $100.