App helps county identify possible coronavirus exposure
Success in tracking the close contacts of all people who may have been exposed to COVID-19 means an exponentially multiplying list that can quickly overwhelm public health departments.
Like departments around the country, Okanogan County Public Health has been trying to track close contacts of anyone who’s tested positive for COVID-19 — or of anyone with COVID symptoms — so they can be quarantined during the incubation period to prevent them from potentially spreading the virus to others.
So when Okanogan County Public Health was offered a new, free app that would let them track appreciably more contacts, the agency jumped at the chance. “We made this available to existing clients. Okanogan County was the first — within 24 hours of the offer, they said, ‘Let’s talk about this,’” said Cameron Garrison, HealthSpace USA’s director of business development and operations. The county already had a contract with HealthSpace for an app that is used in restaurant, swimming pool and septic system inspections, Garrison said.
With the app, contacts of anyone who’s had a positive test or is waiting for a test result will get a text or email alerting them that they may have been exposed to someone with COVID, with a link to a questionnaire, Okanogan County Community Health Director Lauri Jones said. “It will be really innovative — I wish we had it a month ago. We can be in touch with people all over the county,” she said.
First adapters
In fact, Okanogan County was the first health department in the country to adopt the app to track COVID exposures, Garrison said. Public Health was able to give input to HealthSpace about information they’d like to collect, Jones said.
The app lets clinics, hospitals, and health departments enter confirmed or suspected cases into an encrypted, cloud-based portal, along with names and contact information. The information is transmitted to Public Health in real-time, Garrison said. The system doesn’t track location or share information with other companies, according to HealthSpace.
Before they began using the app, health care providers had to fax case information to Public Health, where staff entered all the information by hand and then set up a network for contact tracing.
The initial contact is made by phone, to explain the system and encourage cooperation, but after that, the daily check-in — a quick survey about symptoms — is typically by text or email. People seem to prefer the speed and anonymity of the automated check-in, Garrison said.
Anyone who reports symptoms, like a cough, fever, or loss of taste or smell, is flagged so that a public health employee can follow up directly, he said.
In addition to asking about symptoms and whether someone has been out of the house or had any new contacts, the survey asks if a person needs groceries, medications, or mental health counseling. It also alerts Public Health to follow up if someone doesn’t respond.
The app checks in daily for the 14-day incubation period. Anyone who doesn’t become ill is removed from the list after that, but people who are sick will be tracked for longer.
Public Health is still making phone calls. “You need human contact. It’s important to talk to people each day when they’re quarantined or in isolation — people get lonely,” Jones said. Some prefer a call or only have a landline.
“People haven’t been freaking out” when reached by a contact tracer, Jones said. “They’re very willing and generous and want to help.”
The app allowed Okanogan County to more than triple the number of cases it was tracking in just nine days — from 230 on April 21, when the app was activated — to 710 as of April 29. “It doesn’t mean it’s spreading faster. They’re just getting a better handle on what’s out there,” Garrison said.
Since the county started using the app, it has been getting calls about the software from as far away as Michigan and Hawaii, Jones said. Hawaii adopted the system statewide last week, Garrison said.
HealthSpace offered the software for free to existing customers. New customers can use it for free through July, but pay a fee after that, Garrison said.
Essential tool
Contact tracing is an essential tool in the transition to a reopening of society. “As we want to move to different community-mitigation measures and move away from everyone staying home, we need to be able to have a system that can quickly identify folks who are COVID positive and basically get them to stay home, rather than the entire population,” Washington Secretary of Health John Wiesman said at an April 22 news briefing.
While contact tracing is especially important in preventing new infections, because there hasn’t been enough testing, Public Health is also using it to try to piece together the disease spread in the Okanogan County, Jones said.
In addition to following current cases, contact tracers are checking in with people who attended events held the first weekend of March — the last large gatherings before state restrictions shut them all down.
Some 200 ticket buyers, musicians and volunteers at Cascadia’s Musicians of the Methow fundraiser, held March 7, got emails with a link to a survey that asked about symptoms and whether they’d seen a doctor or been tested for COVID-19.
“No one that we know of is sick. We are doing our best to provide full and accurate information to the Department of Health to aid their contact tracing efforts,” Cascadia Executive Director Rebecca Gallivan said in an email to the attendees.
Public Health is also hoping to survey participants in the Winthrop Hot Air Balloon Festival, which drew many people to the valley the first weekend of March.
Jones said the county has heard from a few people who were at Musicians of the Methow who later experienced shortness of breath or muscle aches.
Knowing who may have been exposed — even if they didn’t get sick — will also be helpful once there’s an antibody test, Jones said.
Statewide effort
Case and contact investigations are primarily the responsibility of the state’s 35 local health departments, but they’re part of a statewide effort, Wiesman said.
Washington had 700 contact tracers in the third week of April — all but 200 at local health departments — and plans to hire and train another 800 to have 1,500 by the second week of May. Five hundred of the new tracers will be from the National Guard, and the others will include health professionals and volunteers, Wiesman said.
Each day, contact tracers using the traditional phone-call approach can interview about seven people who’ve tested positive and follow up with 21 contacts, Wiesman said. He noted that they shouldn’t have that many contacts since people should be staying home.
Contact tracing will be a long-term effort, necessary until there’s a COVID vaccine or proof of widespread immunity, Wiesman said.
