Health officials underscore importance of contact tracing

By Candace Paris

Disease contact tracing is a key factor in limiting the spread of serious communicable diseases. Even during non-pandemic times, contact tracing is an important function of the Canton Board of Health. Public Health Nurse Cindy Bonner said hepatitis (typically caused by a virus from another person) is one example of a communicable disease she tracks. She also tracks Lyme disease, which results from animal (tick)-human contagion. For either disease, public health action may be needed — recommendations for isolation or quarantine in the case of hepatitis exposure or potentially, tick mitigation efforts for Lyme disease clusters.

During the COVID-19 pandemic, contact tracing has become a critical weapon against a disease for which there is currently no vaccine or specific treatment. Bonner and Barbara Reardon, Canton’s director of public health, explained that the Canton effort is part of a commonwealth-wide system set up last spring. The Massachusetts Department of Public Health created the Contact Tracing Collaborative, a huge coordinated effort in partnership with the Boston-based international nonprofit Partners in Health.

Any time a Canton resident tests positive for COVID-19, regardless of testing location or residence of the person (or persons) who may be the suspected source of infection, the lab immediately uploads that information to the Collaborative site. It is then forwarded to the Canton Board of Health. The process is similar when a Canton resident tests positive out of state.

Once notification about a new case arrives, Bonner said that she, or one of the other two staff members doing contact tracing, is on the phone, checking in with the person. Calls are made within 24 hours.

“Time is of the essence in stopping the spread,” noted Reardon.

The calls, taking up to 40 minutes each, involve detailed questioning. They begin with determining when the person became infectious, clarifying the timeframe of potential spread. Questions are asked about circumstances of initial exposure (inside or outside, for how long, proximity, whether masks were worn, etc.), when symptoms developed, and who the individual could have passed the virus on to.

Bonner also discusses the importance of quarantining or isolating, depending on the case, and answers any questions. The more questions a person has, the more time the call takes. Bonner also addresses needs, if any, for groceries or supplies. If the person’s family or living situation is complex, Bonner can provide access to resources through the Canton Council on Aging, enabling people to better follow the limitations imposed by quarantining or isolating.

Bonner said that while some people don’t return contact tracing calls, most people are very cooperative and often have many questions and concerns. She stressed that contact tracing does not place blame. “We’re not here to yell or be punitive,” she said. “We just want to avoid spread and educate because there’s so much unknown.”

While people generally respond well, contact tracers do encounter misconceptions, such as confusion over isolation versus quarantine. Isolation applies to people, with or without symptoms, who have tested positive and live with others. They must avoid contact as much as possible, preferably staying in a separate, closed-off room and using a designated bathroom and separate dishes. Quarantining means that people who have been exposed must stay home without any visitors for 14 days.

People often ask if they must continue quarantining if they have a negative test, but Bonner explained, “It’s not possible to test out of quarantine even if you’re feeling well — coronavirus can take up to 14 days to develop.” Another source of confusion, Reardon said, is the different kinds of tests available. She said the PCR is the “gold standard” and that the antigen (rapid) test is not as sensitive and must be confirmed by the PCR.

Because contact tracing is mandated and coordinated by the commonwealth, it’s a very similar process throughout Massachusetts. Training and work responsibilities of contact tracers are the same, with the only difference that some offices use non-nursing staff, unlike Canton. Reardon said, “I think people enjoy speaking with a nurse.”

The team emphasizes privacy: all sites used are secure and information is carefully controlled.

Another key function of the Board of Health during the pandemic is acting as a resource for the schools in determining protocol when cases arise. Reardon said that so far, Canton has not seen “in-school transmission,” noting that it’s happening through extracurricular activities and in the larger community. She pointed out that because an individual can be infectious for 48 hours before any symptoms develop, a school may have to quarantine even if it’s not the original source of the infection. The goal, Reardon said, is “not giving the virus another host.”

“All of the schools and the School Committee have been great,” Reardon said. She noted that the pandemic has presented a complex situation. What people want is clear-cut, written protocol, but every case is different, and it’s always a judgment call.

“We wouldn’t be serving people well to say it’s black and white — there’s a lot of nuance,” Reardon noted.

Bonner estimated that contact tracing can take up 75 percent of a work day. The Collaborative has provided some back-up assistance when the workload is heavy, and a Board of Health staffing increase is planned with the addition of a full-time, temporary school liaison position and a part-time, per-diem public health nurse.

For details of daily and weekly updates to COVID-19 data, go to www.town.canton.ma.us/139/Board-of-Health.

Share This Post

Short URL: https://www.thecantoncitizen.com/?p=70828