Virus Outbreak Tracing

In this April 20, 2020 photo, Catherine Hopkins, Director of Community Outreach and School Health at St. Joseph's Hospital, right, performs a test on a patient in a COVID-19 triage tent at St. Joseph's Hospital in Yonkers, N.Y. New York’s plan for taming the coronavirus hinges on taking a time-tested practice to an extraordinary level: hiring an “army” of people to try to trace everyone who might be infected. It's part of a common approach to controlling infectious diseases -- testing, tracing contacts and isolating those infected. But the scope is staggering even for a public health system that used the technique to combat AIDS and tuberculosis. 

The state of Delaware will be teaming up with the University of Chicago's non-partisan National Opinion Research Center (NORC) to establish the First State's contact tracing infrastructure. 

“To safely reopen our economy, we need to be able to quickly identify positive COVID-19 cases and reach out to those residents who may have been exposed. This contact tracing program brings us one step closer to returning Delaware to a new normal,” said Governor John Carney. “We’ve been working with Maryland to coordinate our reopening efforts, and this partnership will build on that collaboration. Going forward, hiring a contact tracing workforce of Delawareans that reflects the diversity of our state will be a top priority.”

Carney announced ahead of his bi-weekly novel coronavirus COVID-19 update Tuesday that 200 Delawareans would be hired to work as contact tracers to determine where the disease may have been in an effort to "contain COVID-19, limit Delawareans’ exposure to the disease, and restart Delaware’s economy."

Delaware and Maryland will share data to track coronavirus spread across state lines.

"The situation with the poultry plants, we had a lot of peopel crossing lines--employed in one state and living in another state--and to be able to track people across state lines is important," said Dr. Karyl Rattay, director for the Division of Public Health.

During the Tuesday press conference, Rattay said, while the organization coming in to assist with contact tracing efforts would be from out-of-state, the organization would be looking to hire Delawareans, primarily, as tracers and for support staff roles for the endeavor. Announcements regarding those jobs would be posted on the state's coronavirus page in the coming weeks.

It would be an important priority, Carney said, for a number of contact tracers to be bilingual so they can communicate with as much of Delaware's diverse population as possible. 

Contact tracing is crucial to ensuring the overall health of the community in Delaware, Carney said. 

"You can't have a healthy community without a healthy economy and vice versa. You can't have a healthy economy without a healthy community and, in this case, the healthy community has to come first and enable us to reopen the various economic and business sectors. It's not one without the other. You have to have both. It's not an either-or proposition," Carney said. "[You] have to trace contacts that people who test positive have made over a period of time, a number of days that the public health interviewers determine, and they reach out and make those contacts, have those folks tested, self-quarantine or isolate, and on and on. And that's how you protect from the spread of the virus and protect the public health as you reopen sectors of your common economy, so we are."

The contact tracing will build on the governor's previously announced efforts to test 80,000 state residents a month for COVID-19. Rattay pointed out this is important because of the frequency with which the virus has been determined to be able to spread via asymptomatic people who have no clue they're passing it along. 

The Delaware National Guard will also play a large role in assisting with the contact tracing efforts and are already undergoing training so they'll be ready to track down where the virus has been and where it might be heading. 

"I'm really grateful now that we are able to ramp up our testing, so that we can test asymptomatic people. It is really critical for us to identify as many people as we can to really, really contain the spread of this infection," she said. "We've never ramped up contact tracing in any comparable fashion to the way we are doing it now," she said. "We're really grateful for the Delaware National Guard to be helping us. Right now, we're training members of the guard on contact tracing while we're building our own--smaller scale--data system to be able to do this work, and this is going to be able to get us through at least the next four weeks or so."

Initially, contact tracers, who already work for the Delaware Division of Public Health were doing this work, but they couldn't keep up with community spread of the disease.

"From then on it was like a wildfire...spending all of our time trying to put out the fire and install fire breaks, and at some point, pretty early on, the contact tracers that we had got overwhelmed," said Carney.

Some of the logistics will require those who've tested positive for the virus to think about who they've come into contact with recently. Close contact is fined by being within six feet of one another for a period 10 minutes or longer.  Then, contact tracers begin working backwards.  

"Once they're tracked down, they're to self-monitor," she said. "Contact tracers will talk them through what quarantine means and what self-monitoring means, and we'll contact them every few days, and if they develop symptoms during that time, they're to immediately contact DPH for testing and isolation guidance. If they don't develop symptoms--and this is what we were talking about with asymptomatic people--we want them to be tested anyhow just to ensure that they that they don't have coronavirus before they leave their quarantine."

About 80% of the entire process is handled via the telephone while the other 20% is through field work. 

The program will cost "a lot" Carney said, though he didn't have an exact figure available. He noted that funding from the federal CARES Act would be used for this and expanded testing efforts.

"We don't have an exact budget for that yet," Carney said. "Both the testing program and the contact tracing program will be the biggest part of the expenditures for that."