CORONAVIRUS

Contact tracers struggle as Iowa's coronavirus cases surge

Local agencies rely on partners, public for exposure notification in many cases

Jill Asprey is a contact tracer with Linn County Public Health, working part-time in addition to her role as a school nu
Jill Asprey is a contact tracer with Linn County Public Health, working part-time in addition to her role as a school nurse with the Cedar Rapids Community School District. Photographed at Washington High School in Cedar Rapids on Friday, Nov. 13, 2020. (Liz Martin/The Gazette)
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As coronavirus cases in Iowa reach totals not seen before in the pandemic — driving an alarming number of patients into hospitals and raising concerns about further spread during the upcoming holiday season — those tasked with breaking the virus’ transmission are finding it harder to do than ever before.

Throughout the pandemic, local contact tracers have worked within Linn and Johnson counties’ public health agencies to track spread among community members by identifying those who have been exposed to an active case of the novel coronavirus and notifying those people.

Early in the pandemic, it was typical for local contact tracers to keep busy when the positive COVID-19 cases across the state were reaching 200 or 300 infected people a day. Four hundred new daily cases was “a crazy week,” local public health officials say.

But in recent weeks, as Iowa has topped more than 4,000 daily cases a day, contact tracers worry about their ability to keep up with the new demand.

“I’m very concerned about the capacity to handle the numbers,” said Jill Asprey, a school nurse with Cedar Rapids Community School District and part-time contact tracer at Linn County Public Health.

“We don’t have enough bodies, and I’m concerned about the fatigue level of those people who are doing this day after day. It’s intensive work, it can wear on people who are doing it full time.”

» IOWA NEEDS HELP: Iowa makes emergency request for contact tracing help

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Lag in response, refusal to cooperate lead to delays

The increase in COVID-19 cases over a short period of time has led to delays in the contact-tracing process, officials say. In many cases, tracing several hundred cases a day causes a lag in response, meaning it could take multiple days for contact tracers to reach out after an individual has tested positive.

“We do our best to inform persons as quickly as possible and provide them the guidance or information they need to make the best decisions for their health and their contacts,” said Sam Jarvis, community health division manager for Johnson County Public Health.

The sheer number of new cases are not the only concern. Linn County Public Health official Heather Meador said contact tracers are “being screamed at with vulgar language, including strong profanity” by those they call.

“People hang up on them, refuse to answer questions on close contacts and (the contact tracers) are lied to,” Meador said during an Oct. 30 news conference.

Delays also occur when public health officials can’t get in touch with residents.

“We think the election fatigue didn’t help due to the increase of texts (and) calls everyone received and many are probably screening calls at a higher rate than they normally would,” Jarvis said.

Some contact tracers said the investigation also has become more complicated in recent months. According to Taya Westfield, a contact tracer with Johnson County Public Health and a University of Iowa College of Public Health student, there’s more likely to be a higher volume of people that have come into contact with a case.

“Now that the pandemic has progressed and has gone on for so many months, people are more comfortable hanging out with their friends or seeing their family,” Westfield said. “... I personally have seen cases get a little more complex in terms of the number of people being exposed.”

Meador emphasized local public health agencies cannot protect the community from further infection without cooperation. But as new cases continue to rise exponentially, can contact tracers effectively help stop the spread locally?

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“It’s a huge concern for us,” Meador said in an interview with The Gazette. “Our goal is to protect the community. We want our community to be healthy and productive and safe, so it is a concern when it is that high.”

Despite these challenges and the number of cases, local contact tracers say the effort still is important to help put a stop to the community spread.

“We do still catch so many people who might be exposed and are out and about doing things and haven’t yet exhibited symptoms,” said Madison Snitker, a Johnson County contact tracer and a graduate student with the University of Iowa College of Public Health.

“The chain gets broken when we do contact tracing,” Snitker said. “The virus doesn’t keep going from John to Sarah to Tim to Tyler. If we intervene, Tyler stays home so he doesn’t expose someone else.”

Public health agencies relying on community partnerships

Linn County Public Health, which employs about 30 contact tracers, has come to rely on partnerships with agencies throughout the community to assist in identifying and notifying close contacts, including long-term care facilities, schools and colleges.

Meador said some local employers also have aided their work.

Both the city of Marion and the city of Cedar Rapids have taken on the effort to notify its employees if they had been exposed to the virus through another staff member while at the job, officials say.

The human resources department “contacts employees about exposures, determines the need for quarantine and ensures exposed areas within city facilities are properly sanitized,” said Teresa Feldmann, human resources director for the city of Cedar Rapids. “The city works in partnership with Linn County Public Health to conduct contract tracing for the public and contact those individuals when necessary.”

Marion City Manager Lon Pluckhahn noted this is different from contact tracing, which identifies contacts both inside and outside work. Employers do not have authority to be involved with health matters outside of work, he said.

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“From our perspective, the issues that Linn County’s tracers are dealing with are just making it harder to address it quickly,” he said in an email. “The faster we can do the employee notifications, the fewer people they come in contact with, and the workload for LCPH is reduced. It benefits us both as we can do it more rapidly internally, but then they have fewer people to follow up with.”

Other local municipalities, including the city of Iowa City, said they are not actively engaged in contact-tracing efforts.

Because they can’t always call all contacts, Asprey said contract tracers work to educate the person with COVID-19 about the risk she or he poses to others.

“If they’ve been in contact with someone for 15 minutes within six feet of distance, they are a contact and we tell them to please notify those people they are a contact,” Asprey said.

There is no rule that members of the public have to follow guidance from contact tracers, and therefore no system of accountability to ensure they are letting people around them know they could be at risk.

However, Asprey said she is finding there’s less stigma around the virus, and people are more forthcoming about their own infection.

“Usually when I talk to people, they’ve already started contacting people, or they already know they were exposed,” she said. “That communication is happening.”

Linn County Public Health recently has hired more contact tracers, and Meador said they are prioritizing notification for people who have underlying medical conditions, have certain risk factors or are otherwise at a higher risk of severe complications from an infection.

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Johnson County Public Health plans to maintain its 50 or so contact tracers. About 45 of them are students with the University of Iowa College of Public Health who work on a part-time basis with the agency, including Westfield and Snitker.

But public health officials are emphasizing the importance of the community’s help with disease investigation.

“We need people to respond (in a timely manner) and coordinate with us,” Jarvis said. “It’s really a partnership to stop disease transmission.”

Linn County Public Health announced this week it updated its guidance to follow federal public health guidelines on identifying close COVID-19 contacts and on quarantine and isolation for those people.

The change is in response to the unprecedented number of confirmed cases of the novel coronavirus both in Linn County and across the state. Officials say they are concerned that the spike in new cases over a short amount of time will push local health care systems to a critical level, “affecting bed and staff capacity to care for ill patients.”

Here are some details of the guidelines Linn County residents are now following.

When should you quarantine?

Quarantine guidelines apply to someone who is a close contact of someone infected with the novel coronavirus or is living in the same household as someone who has tested positive. It is meant to keep someone who may have been exposed to COVID-19 away from others.

A close contact is defined as someone who:

Was within 6 feet of someone with COVID-19 for 15 minutes or more in a 24-hour period, two days before symptom onset

Is living in the same household

Had direct physical contact

Came in contact with respiratory droplets from an infected individual.

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A close contact — regardless of mask use — will be asked to quarantine for 14 days after last known exposure.

When should you isolate?

If someone develops symptoms of COVID-19 or tests positive, they should isolate. Those in isolation should stay home until it is safe for them to be around others, and should even separate themselves from those in their household if possible.

Infected people must remain in isolation until they meet all of the following criteria:

No fever for 24 hours without the use of medication to reduce fevers

Symptoms have improved

At least 10 days have passed since symptoms first appeared.

Gazette reporters Marissa Payne, Gage Miskimen and Lee Hermiston contributed to this report.

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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