As coronavirus restrictions ease, contact tracing is key

CASPER — As loosened restrictions on businesses take effect across Wyoming, health officials say contact tracing will continue to be an important tool to keep infections from spreading, with one county saying it is ramping up efforts to track cases.

When someone tests positive for COVID-19, contact tracers as soon as possible interview that person to decipher who they may have recently been in contact with, and then take steps to have them self-isolate or quarantine to limit the spread of the illness, health officials said.

Now that more businesses will be allowed to operate, that practice will be an important tool to keep new cases contained to smaller groups of people who have already been exposed and not lead to larger outbreaks that could set the state back in its plans to continue to loosen restrictions on commerce.

In Fremont County – where confirmed cases have jumped in the last week, partially due to aggressive testing and contact tracing on the Wind River Reservation – officials say they’ve started to ramp up testing and contact tracing efforts across the county, and that they will play an important role in monitoring the spread of COVID-19 in the county as officials ease restrictions on business.

“Contact tracing, testing, are going to be a big part of what we do going forward as far as the surveillance and trying to squash out any new fires that might happen with them,” said Dr. Brian Gee, the county’s public health office, during a Friday press conference.

On Wednesday, about six people completed training to conduct tracing, Gee said. Another six had previously been trained, with the ability to deputize more health care workers, like retired nurses or those who may be out of work, if needed.

As of Friday afternoon, 112 cases had been reported in Fremont County – the most in the state.

Officials have said one of the primary reasons for that is aggressive contact tracing and the testing tribal health care officials and workers have conducted on the Wind River Reservation and among tribal citizens.

“Part of the reason we’re so aggressive about testing is to find those people that would be missed otherwise (but) it makes our numbers look higher,” said Dr. Paul Ebbert, chief medical officer of the Northern Arapaho Tribe’s Wind River Family & Community Health Care said in a previous interview, adding that the state, county and tribes have worked well together and respectfully in testing and contact tracing.

As Fremont County increases its capability to test and contact trace other county residents, Gee said Friday that he expects the number of confirmed cases to continue to rise before plateauing and eventually decreasing.

While he said officials in Fremont County are seeing encouraging trends, it could be a week or two before they can say whether case numbers are decreasing or leveling out.

Statewide, health officials had confirmed 420 cases of COVID-19.

For Wyoming Department of Health Infectious Disease Epidemiology Unit Manager Clay Van Houten and his team of epidemiologists, that’s meant hectic workdays tracing the origins of each case, and who it may have spread to.

“I think we’re all holding up pretty well ... it has been very long hours and nights and weekends kind of consistently for the last few months, but it’s important work,” he said. “This is why we got into public health, to help in these exact situations.”

Contact tracing is one of the most basic – and important – tools that officials and health professionals have when combating and tracking a pandemic, Van Houten noted.

After a person test positive, he explained, a contact tracer will interview them and ask how many people that person had close – not passing –contact with in the previous couple of days to figure out who may have been infected and catch them before they get sick or further spread the virus.

“Honestly, at its core, contact tracing is fairly simple. It’s identifying cases and getting a hold of those people exposed to make sure we’re limiting transmission as much as possible,” Van Houten said.

States should have 15 contact tracers per 100,000 residents – surging to 30 per 100,000 residents during a pandemic – to adequately monitor infectious diseases like COVID-19, according to a recent recommendation by the National Association of County & City Health Officials.

In Wyoming, that means 86 people should be able to contact trace during normal times and 173 when combating a public health crisis like COVID-19.

Between state health department employees and others working for counties, Van Houten estimated there are about 50 people working on contact tracing across Wyoming.

Before the pandemic hit Wyoming, he said he had several people in his office to conduct contact tracing, often working to trace more common communicable diseases.

But with the increased demand for contact tracing, he said he’s been able to bring other epidemiologists from other health department units to help out, raising the total state contact tracers to about 15.

Counties have also chipped in to help shoulder the responsibilities.

In the case of Fremont County, Gee said he has a stable of retired nurses or nurses who may have been furloughed or laid off to help out in case extra contact tracers are needed.

Regardless of the recommendation, Van Houten believes the state and counties have sufficient numbers to adequately trace any cases in the state and monitor them to limit further spread of the virus.

A spokeswoman also said that there have been preliminary discussions about expanding contact tracing efforts, but no plans have been finalized.

“I feel like we’re in a pretty good place,” Van Houten said. “The counties have done amazing jobs getting extra people lined up in case they need them.”

Even with enough people to perform contact tracing, it’s time-consuming work, Gee said. And other challenges – like dealing with those who haven’t adhered to isolation orders or disregarded social distancing recommendations – can make any work contact tracing moot, he said.

To make life easier for a contact tracer in case you are diagnosed with COVID-19 or come in contact with a confirmed case, Gee said you can keep daily notes of your activities, where you went and who you came in close contact with.

“Contact tracing takes a large amount of people power to do and it can stretch resources significantly. It is a difficult job.”