The phone rings. A call from an unknown number.
“Hello, my name is Karen Karnes, I’m a nurse at the Anne Arundel Department of Health, and I’m calling to inform you that you’ve tested positive for COVID-19,” says a voice on the other end of the phone.
In Anne Arundel County, nurses like Karnes make this call daily to more than 100 residents who have tested positive for the novel coronavirus, a feat that elevates the county’s contact tracing operation to one of the state’s most successful.
Contact tracing is simply finding positive cases and asking where they have been and with whom they have interacted.
“The process is relatively simple but at the same time extremely important,” said Karen Karnes, epidemiology program supervisor at Anne Arundel County’s health department.
By retracing the steps of people who are confirmed positive, contact tracing becomes key for containing the deadly coronavirus’ spread and lowering hospitalization rates. It’s a routine procedure that epidemiologists and infectious disease detectives have done for decades, but tracking coronavirus requires an unprecedented intensity compared to other infectious diseases. And yet, Anne Arundel County has tracked all 1,571 cases as of Tuesday.
“As far as the investigation is concerned and the contact tracing, we’re just at another level right now,” Karnes said.
Jurisdictions across the state and country are facing challenges about how to expand contact tracing to stay on pace with the rising number of positive coronavirus cases.
At its core, contact tracing stops a virus’s transmission by keeping sick people away from healthy people and keeping potentially sick people in quarantine until it’s certain they’re not infected. It’s a process that must become widespread before Maryland’s economy can reopen, state officials say.
But contact tracing is expensive and time-consuming. Its success depends on a jurisdiction’s resources, amount of positive cases, and the ability to support sick residents and monitor their exposed contacts.
The Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials estimated the United States needs 100,000 paid or volunteer contact tracers to manage the epidemic and that Congress will need to allocate around $3.6 billion in emergency funding to state and local health departments.
Anne Arundel County plans to use a portion of $101 million it received from the federal Coronavirus Aid, Relief, and Economic Security Act, for contact tracing. The health department currently provides food and personal protective equipment for individuals who need it while in isolation and quarantine. That money is part of $150 billion approved by the federal government to help state and local governments.
“Really critical to making this work for the isolation and quarantine (is) food, transportation, income, job security, housing, space to isolate or quarantine — all of those are critical for that success — and we’re doing a lot of case management,” said Health Officer Dr. Nilesh Kalyanaraman
Statewide, Gov. Larry Hogan authorized a contract with the National Opinion Research Center on April 22 to “quadruple (Maryland’s) disease investigation capacity in order to contact up to 1,000 new cases per day,” spokeswoman Kata Hall said in a tweet. The announcement comes after Hogan secured 500,000 coronavirus tests from South Korea the same week.
For every test that comes back positive, that person and their close contacts must be traced. A close contact can be anyone who was in 6 feet of that person for at least 10 minutes. On average, every positive case has three close contacts.
County and statewide testing remains slow, despite the state’s recent purchase of half a million tests. County Executive Steuart Pittman said Tuesday he doesn’t know when those tests will be available in the county.
When those test kits are finally deployed and testing ramped up, contact tracing will follow suit. NORC workers have been called in to lend a hand.
In Anne Arundel County, those additional workers aren’t as needed. The county is already tracing 100% of positive cases. The health department, led by Kalyanaraman, propped up a contact tracing operation early and expanded it widely, a step ahead of some neighboring jurisdictions.
The state health department is assessing Anne Arundel County’s contact tracing model, along with other counties, to incorporate in a new, statewide contact tracing technology platform called COVID Link.
“We’re actually the trailblazers and people are looking to us and calling us to see how we’re doing what we’re doing,” Karnes said.
School nurses, recently out of work since Maryland public schools closed on March 16, were quickly trained and staffed as contact tracers along with disease prevention and behavioral health nurses. The county department is now running with 10 full-time teams and two part-time teams of contact tracers. Seven employees act as bilingual personnel for the county’s Hispanic population.
Around 90 people call residents and alert them they’ve tested positive for coronavirus. An individual’s contacts are collected, and a health assistant checks in with the sick person and their contacts every day to monitor symptoms.
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If symptomatic, the sick person is told to isolate until fever-free for 72 hours with all other symptoms resolved or isolate for seven days since the onset of symptoms, whichever comes first. If one of their contacts become symptomatic and tests positive, that contact becomes a new case.
People positive with coronavirus must self-isolate in a room away from their family, ideally with their own bathroom. This can be a challenge.
Sick people who share a bathroom or kitchen must wear a mask, keep six feet apart from roommates, and sanitize what they touch if they emerge from their room. In certain circumstances, the health department will put the sick individual in a hotel. The person’s close contacts must quarantine for 14 days and take their temperature twice a day. If they don’t have a mask or a thermometer, county health workers will deliver one. If a contact can’t be reached by phone, a health worker will deliver a letter.
The health department has delivered nearly 1,400 surgical masks and 250 thermometers since March to residents who tested positive.
If they live alone, a case is closed once a sick person is out of isolation. For their close contacts, the case is closed once their 14-day quarantine lapses with no reported symptoms.
State modeling shows a surge of COVID-19 patients to hit hospitals between late May and early June, though Kalyanaraman said the exact peak is unclear.