BY JAIMIE JULIA WINTERS
As barber shops, hair salons, non-essential retail, day-care centers, churches, and health clubs get set to reopen in June, the state is preparing for an uptick in coronavirus cases and is hiring contact tracers to identify those who have been exposed, so immediate action can be taken.
With more residents spending time in close contact with people outside of their household in close quarters — the general rule for positive exposure is closer than six feet, for 10 minutes or more — contact tracing will be used more often to contain the virus’ spread.
Officials say the state needs 20 to 30 contact tracers per 100,000 population, which equates to a need of about 3,000 in New Jersey. Right now, throughout the state, there are 900 contact tracers in local health departments.
For years, health officials have used a three-pronged approach to contain the spread of any communicable disease: testing, contact tracing, and isolation/quarantine.
“The most important containment activity that we have is isolation and quarantine. But in order to do that, you need to test people, find the positives, isolate the positives, and find their contacts and isolate or quarantine, depending on their symptoms. That’s the best tool we have in our tool kit to stop the spread,” said New Jersey Health Commissioner Judy Persichilli.
In years past, contact tracing has been used to help contain the spread of tuberculosis, sexually transmitted diseases, and, most recently, an outbreak of measles over the last two years.
Until a COVID-19 vaccine is available, contact tracing is a crucial step in slowing down the spread and in discovering virus hot spots. Montclair’s Health Department, which also oversees the health of residents from Cedar Grove and Verona, currently has 10 officials trained in contact tracing, said public health nurse Cheryl Tomassello.
Although the number of positive cases is decreasing in Montclair — even with a large increase in residents getting tested — Tomassello said that as things open up the department is expecting to see a rise in positives.
Recent rises in cases in Montclair have been one or two a day, compared to single-day peaks like the seven new cases on March 26, and five on March 18.
HOW CONTACT TRACING WORKS
In a contact tracing investigation, public health staff work with a patient they have been notified tested positive to help them recall everyone they have had close contact with during the time they might have been infectious. Tomassello said that includes people they have been in contact with for more than 10 minutes closer than six feet apart.
Public health staff then begin calling those individuals and warning them of their potential exposure as “rapidly and sensitively as possible.” To protect patient privacy, contacts are only informed that they may have been exposed to a patient with the infection. They are not told the identity of the patient who may have exposed them.
Tomassello said that in most cases the patient has already had co-workers, family members, or close friends that the patient has been in contact with.
Contacts are provided with information and support to understand their risk, and are told to separate themselves from others who were not exposed, to monitor themselves for illness, and to realize the possibility that they could spread the infection to others even if they themselves do not feel ill.
Contacts are encouraged to stay home and maintain social distance from others (at least six feet) until 14 days after their last exposure, in case they also become ill. They should monitor themselves by checking their temperature twice daily and watching for a cough or shortness of breath. Contacts who develop symptoms are told to promptly isolate themselves and notify public health staff and their doctor.
The state has contracted with a technology firm, Dimagi, to bring its CommCare front-line worker patient-screening and contact-tracing platform to New Jersey before the end of June.
The state is also hiring more contact tracers, and has already received more than 100 applications to help local departments with staffing. It is partnering with the Rutgers University School of Public Health and several other universities to train public health graduate students and alumni to engage in contact tracing activities in their home communities.
The state is concerned that some may not feel comfortable being contacted and may not respond or cooperate. In Montclair, there have only been a few residents who have not responded or called the Health Department back, Tomassello said. Most have been cooperative.
State officials are looking for individuals who can build community trust, out of concern that engagement of the public with case investigators and contact tracers must be widely accepted to protect friends, family, and community members from future potential infections.
To be successful, a community will need public awareness, understanding and acceptance of case investigation and contact tracing, and the need for contacts to separate themselves from others who are not exposed, according to CDC officials.
“Our goal is to recruit culturally competent and multilingual individuals from communities across the state,” Persichilli said. “Training will include cultural sensitivity, cultural bias, and historic cultural context training, to ensure that when contact tracers are connecting with exposed individuals from diverse communities, they have cultural awareness and aptitude.”
New Jersey has an application process and free training course on its COVID-19 website for jobs that pay $20 to $25 an hour. Contact tracing is a full-time commitment at 35 hours. Tracers’ scheduling will revolve around a seven-day-a-week schedule between 8 a.m. and 8 p.m.
The state has listed the requisite knowledge and skills for case investigators and contact tracers, including but not limited to:
- An understanding of patient confidentiality, including the ability to conduct interviews without violating confidentiality (e.g., to those who might overhear their conversations).
- Understanding of the medical terms and principles of exposure, infection, infectious period, potentially infectious interactions, symptoms of disease, pre-symptomatic and asymptomatic infection.
- Excellent and sensitive interpersonal, cultural sensitivity and interviewing skills such that tracers can build and maintain trust with patients and contacts.
- Basic skills of crisis counseling, and the ability to confidently refer patients and contacts for further care if needed.
- Resourcefulness in locating patients and contacts who may be difficult to reach or reluctant to engage in conversation.
- Understanding of when to refer individuals or situations to medical, social, or supervisory resources.
- Cultural competency appropriate to the local community.
“We think, I think collectively, even if we bat 1.000 on reopening the state responsibly, we’re going to have flare-up periods, and so we’re preparing for that,” said Gov. Phil Murphy. “Tony Fauci gave the most optimistic assessment of a second wave that I’ve heard from his mouth, from his lips at least.
“And it wasn’t any different assessment as to the probability of a second wave. It was through testing, infrastructure, and contact tracing infrastructure and isolation capacity, that we were far better equipped to deal with a second wave than we either were for the first wave as a country, or than we had been prepared in the past for second waves of things like H1N1.”