After an 82-year-old woman died of COVID-19 in South Georgia, the state epidemiologist wants to warn anyone who might have been infected. He traced his path to the Sunday service which was attended by about 60 people in March at Waycross.
Usually, under the epidemiological detective work method known as contact tracing, anyone in orbit near the woman when she is transmitted will be identified and told to take steps to avoid infecting others.
But the usual method won’t do it, given the possibility that highly contagious coronaviruses are spread by people without symptoms and risks quickly taking control of local hospitals. So the Department of Public Health took the extreme step of posting a public announcement in early April: “If you or someone you know recently attended the New Mount Pleasant Baptist Church in Waycross, Georgia, you might have been exposed to COVID-19.”
Over the past two months new coronaviruses have reached so far in the state, health experts have questioned whether Georgia can make a substantial investment to track patients to patients. Country now expanding his contact tracking program as part of Governor Brian Kemp’s plan to restart public life. Health officials hope the investment, coupled with the increased availability of test kits, can reduce the spread of society because more people roam outside their homes.
But the challenges associated with coronavirus are enormous, and many search protocols have long had to be changed or abandoned, experts warn. The case of the Waycross church reveals limitations in the ability to track contacts – a process normally carried out outside the public view – to compensate for this disease.
“In a typical contact search, you can be on the road, go to someone’s house, knock on doors, leave notes and find them on the basketball court or hair salon,” said Brian Castrucci, CEO of the Maryland-based company Beaumont Foundation, who helped local and state public health agencies. “It will be different.”
Public Health Commissioner Kathleen Toomey said the department plans to involve as many as 1,000 people for the task, which according to the Atlanta-based Centers for Disease Control and Prevention should be immediately improved. But some experts say the country needs to train thousands, not hundreds, of fast trackers to catch up to the virus which continues to grow to 700 people per day.
Georgia recently signed a five-year contract with the technology services company MTX Group for a new online platform to help with its efforts.
“This is more than just epidemiological activity, this is the distribution of logistics,” Toomey said, Thursday.
Officials also need to build support from the public who are often suspicious of the government and are unlikely to accept a more invasive form of surveillance that has been deployed with some success in Southeast Asia.
Large-scale efforts will not succeed without a strong diagnostic testing system on the side, experts say. Georgia ranked 30th nationally in per capita testing on Tuesday, according to the AJC analysis of national testing figures, an increase from the 33rd rank last week and 45th in the past few weeks.
“Although contact tracing may be a pillar of public health and the response of infectious diseases, testing is the foundation,” said Castrucci, a former public health official.
In the Waycross case, Reverend Hooper said the woman who died was a visitor at two services. More than half a dozen people from his congregation later fell ill with coronaviruses, he said. Some were hospitalized, and a 62-year-old church member died on April 8.
“It was very, very devastating for us,” Hooper said, “because he is a dedicated delivery man, and we cannot have the service for him as we wish. We have to have a grave. “
The state-based epidemiologist Waycross will not talk about this case in detail in an interview with AJC last month. The public service announcement is one of four issued by the Southeast Health District about Baptist churches in the Ware, Pierce and Coffee region which held services at the end of March.
“Contact tracing is difficult to do with impossible,” Trevor Thomas, coordinator of infectious diseases in the health district, said, “and a wise step, historically in this case, is to make greater notice to larger groups attending the event.”
Two months ago, a worst case scenario occurred in Albany, where a sick guest turned a funeral into a super spreader event, a catalyst for an outbreak that killed hundreds of people in southwest Georgia. In a March 26 interview, the district health director said the virus had spread so far, his office no longer tried to trace its origin, but stopped it from tearing hospitals and nursing homes.
“At this point, this is not a wise way to spend our resources, looking back on what happened,” Southwest Health District Director Charles Ruis.
For decades, Georgia has been used contact tracking to limit transmission of infectious diseases such as tuberculosis, measles and HIV. It had around 250 trackers on staff before the pandemic arrived.
For coronavirus, the current CDC recommend a that the tracker contacted anyone within six feet of the infected person for at least 15 minutes starting from 48 hours before the onset of the disease. These people are isolated, and if they are positive, this process will repeat for their contact.
This work is not only boring, but also requires personal sensitivity to a very strict timeline. Trackers need to quickly build trust with contacts so they are willing to share personal health information and isolate for two weeks to stop the spread of the virus.
Building trust can be a challenge, especially with people who are suspicious of public authorities and vulnerable populations who are more likely to have pre-existing conditions.
“They might not have access to health care … or they might not have basic things like transportation to get to the test site,” said Grace Bagwell Adams, a health policy professor at Georgia University.
Traditionally, contact tracers would have the time to track people and offer resources to help them be tested and isolated, including food, transportation, shelter and even money to compensate for lost wages. Most of the work for Coronavirus will be completed by telephone or through a new online platform given the guidelines of social distance and the need for speed.
In some cases, contacting veterans who tracked outreach to the corona virus could be easier than for HIV or AIDS, because the tracker did not need to peek at someone’s sexual history or drug use. On the other hand, corona virus spreads more easily, and infectious people may have no symptoms.
Some experts question whether returning two days, as recommended by the CDC, is enough. Colin Smith, an assistant professor at Georgia State University’s School of Public Health, said the ideal tracking should be done in a week.
“But that might be a management problem,” Smith said. “Do you know what you had for breakfast six days ago?”
The state seems to stick to that formula even when it faces a disaster in Vidalia. In March, the first person affected by the corona virus was the old mayor of Ronnie Dixon.
Three days before he was admitted to the hospital, the mayor had stopped by the town hall, checked his papers and chatted with city officials, saying that he was not feeling well. Thirteen days before, he had chaired a city council meeting, attended by 14 other city officials and about 40 spectators including police officers, firefighters, and other city workers.
Dixon, 77, died April 1. No one in the city hall had been contacted by the state epidemiologist, and the only person placed in quarantine was the mayor’s widow, city and district officials told the AJC.
“We are all concerned that it might be contracted out by staff, and it is clear who is related to it,” said City Manager Nick Overstreet. “So far, we are lucky and do not have employees with COVID-19.”
The DPH has kept the details of the contact tracking program tightly expanded, but Toomey said the department plans to employ at least 600 additional staff in the next few weeks and involve more than 200 students. DPH recently posted a list of jobs for full and part time positions of $ 15 per hour – Toomey said 1,000 people had registered – and has reached out to state medical and public health schools to recruit interns.
The surge of interest at the University of Georgia’s College of Public Health helps inspire a course next summer on contact tracing for corona viruses, according to Adams, associate professor. Contact webinar led by students at the Medical College of Georgia at Augusta University attracted around 180 participants last week.
“This is sort of the way we help the medical community, our mentors, fellow doctors the way we can,” said Catherine Waldron, a medical student who graduated from Mercer University who helped lead the webinar. Waldron signed as a voluntary contact tracker in the state’s Coastal Health Area in Savannah in March after his hospital rotation was canceled.
This district has two tracking teams. The first, consisting of epidemiologists, is responsible for contacting and interviewing anyone who tested positive for COVID-19.
Students like Waldron and Rebecca DeCarlo, a fourth-year medical student at the Medical College of Georgia, are part of the second, who calls close contacts.
The team entered information about a person’s symptoms into a database known as SendSS, or Electronic State Notification Disease Control System. If symptoms develop, DeCarlo and his team can update the portal, tell someone’s doctor, ask people to look for tests and isolate themselves and other household members.
“If we can reach them as soon as they have symptoms, we can keep them in quarantine and stop the spread,” DeCarlo said.
State public health districts, including in Savannah and the Atlanta metro, begin testing the new MTX monitoring application last week. It interacts with SendSS and Google Cloud and allows people who are tracking contacts to record their daily symptoms on their smartphone.
The state signed a contract with MTX in early April. The company, headquartered in Texas and New York, has created similar monitoring and tracking platforms for more than a dozen other states over the past two months.
“Everyone wants to know how fast a solution can move so they have a reopening plan in place,” said CEO Das Nobel.
Some privacy advocates have raised concerns about regulations governing health data collected by contact tracking software, especially separate applications jointly developed by Apple and Google that will use Bluetooth to warn people whose cellphones are in close contact with infected people. . .
The MTX platform does not use Bluetooth. The company also does not have access to Georgia’s personal health data, Nobel said.
The DPH refuses to discuss the details of the pilot program or whether the tracker currently has enough bandwidth to focus on all cases or only high-risk ones such as first responders and people in senior centers.
Some experts say that contact tracing will not be a panacea and that the country should have started such an effort before.
“It’s amazing to me that this was only at the initial stage of launch when we started opening a business one and a half weeks ago,” Dr. Harry J. Heiman, a professor at the GSU School of Public Health.
Others say any effort will help.
“You have to start somewhere,” said Nannette C. Turner, professor and chair of the Department of Public Health at the Mercer Health Professional College.
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