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COVID-19: Tracing Contacts, 4/30 · The SHEA Podcast

• 0:08
  SPEAKER_00: Welcome to the Rapid Response Podcast, brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:25
  SPEAKER_00: I'm Dr.
• 0:26
  SPEAKER_00: Cindy Prince, Associate Professor of Epidemiology at the University of Florida, and I'll serve as your moderator.
• 0:33
  SPEAKER_00: The discussion on the podcast does not reflect Shay's perspective, but facilitates a communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:43
  SPEAKER_00: Shay is excited to launch the 11th episode of this podcast COVID-19 update what we know now.
• 0:50
  SPEAKER_00: Today's episode will focus on tracing contacts.
• 0:53
  SPEAKER_00: Our speakers are Dr.
• 0:54
  SPEAKER_00: Sonia Rasmussen, Professor, Department of Pediatrics and Epidemiology at the University of Florida, Ms.
• 1:01
  SPEAKER_00: Journey Shapiro, lecturer, Department of Epidemiology at the University of Florida.
• 1:07
  SPEAKER_00: Thank you for joining us today.
• 1:09
  SPEAKER_00: Before we start our discussion on tracing contacts, I'll get us started with a news and guidance update of the week.
• 1:15
  SPEAKER_00: In the news this week, the U.S.
• 1:17
  SPEAKER_00: passed one million known COVID-19 infections with over 218,000 deaths.
• 1:23
  SPEAKER_00: IDSA released guidelines on infection prevention in patients with suspected or known COVID-19.
• 1:29
  SPEAKER_00: The guideline panel made recommendations on aid questions regarding the use of PPE when caring for suspected or known COVID-19 patients in healthcare settings.
• 1:39
  SPEAKER_00: The recommendations are made for routine care and for aerosol generating procedures, and were considered for both conventional settings and for contingency or crisis capacity settings.
• 1:50
  SPEAKER_00: All recommendations for the use of surgical masks, N95 or N99 respirators or PAPRS are for use in addition to other appropriate PPE, including eye protection, gowns, and gloves.
• 2:03
  SPEAKER_00: For routine care in conventional settings, the panel strongly recommended the use of a surgical mask, an N95 or N99 respirator, or a PAPR.
• 2:13
  SPEAKER_00: In a contingency or crisis capacity setting where PPE shortages exist, the use of a surgical mask or reprocessed respirator was strongly recommended over no mask used for routine patient care.
• 2:26
  SPEAKER_00: In all settings, the panel noted a knowledge gap and therefore made no recommendations in the use of double gloves instead of single gloves and in the use of shoe covers versus no shoe covers for routine patient care.
• 2:39
  SPEAKER_00: During aerosol generating procedures in conventional settings, the use of an N95 or N99 respirator or a PAPR was strongly recommended over the use of a surgical mask.
• 2:51
  SPEAKER_00: While in contingency or crisis capacity settings with respirator shortages, a conditional recommendation was made for the use of a reprocessed N95 respirator instead of a surgical mask.
• 3:02
  SPEAKER_00: And the panel also strongly recommended the use of a phase shield or surgical mask over the N95 respirator to extend the period of use.
• 3:10
  SPEAKER_00: A conditional recommendation was made for the use of a phase shield or surgical mask over the N95 respirator to allow for reuse of the respirator.
• 3:19
  SPEAKER_00: Also this week, the CDC released guidance for the use of elastomeric respirators as alternatives to disposable respirators like N95s.
• 3:27
  SPEAKER_00: Elastomeric respirators may be half phase a piece or full phase piece and have replaceable cartridges or filters.
• 3:34
  SPEAKER_00: Healthcare workers who use these respirators must be medically evaluated, trained, and fit tested in line with requirements for respiratory protection programs.
• 3:43
  SPEAKER_00: Videos are available from the CDC and OSHA to demonstrate donning and doffing of these respirators.
• 3:49
  SPEAKER_00: In the MMWR this week, there was a report of the response to clusters of COVID-19 in five homeless shelters in the US in Boston, San Francisco, and Seattle in late March and early April.
• 4:01
  SPEAKER_00: Testing in the affected shelters, as well as other shelters with single cases or no known cases, was carried out.
• 4:07
  SPEAKER_00: Of the five shelters with clusters of COVID-19 cases, subsequent testing of residents identified 17% positive in three Seattle shelters, 30 60% positive in one Boston shelter, and 66% positive in one San Francisco shelter among staff.
• 4:24
  SPEAKER_00: 60% were positive in the Seattle facilities, 15% in Boston, and 10% in San Francisco.
• 4:31
  SPEAKER_00: In a Seattle shelter with one known case, testing identified that 5% of residents and 1% of staff were positive.
• 4:38
  SPEAKER_00: While in two shelters in Atlanta with no known cases, testing identified that 4% of residents and 2% of staff were positive.
• 4:46
  SPEAKER_00: Infection control measures and regular testing in shelters before clusters of cases occur were recommended.
• 4:52
  SPEAKER_00: I now want to move into a discussion with Dr.
• 4:54
  SPEAKER_00: Sonia Raspuisson.
• 4:56
  unknown: Dr.
• 4:57
  SPEAKER_00: Raspuesen, what is contact tracing?
• 5:00
  SPEAKER_01: Contact tracing is really a core measure of disease control.
• 5:04
  SPEAKER_01: It's used in other things other than COVID-19 as well.
• 5:07
  SPEAKER_01: For example, it was used in the Ebola response because similarly with Ebola response in 2014-15, we didn't have a vaccine at that point.
• 5:17
  SPEAKER_01: We didn't have good medications.
• 5:19
  SPEAKER_01: And so what we had was contact tracing.
• 5:21
  SPEAKER_01: It is a way that we can identify patients that are sick and then look at their contacts, look at people who they've been around two days before they got symptoms and then up until they were identified as having the infection and making sure those people are quarantined so they don't spread it to other people.
• 5:40
  SPEAKER_00: And why is contact tracing so important for COVID-19?
• 5:44
  SPEAKER_01: Well, COVID-19 is kind of a unique situation.
• 5:48
  SPEAKER_01: It's a brand new virus, and so we don't have as much information as we need, but we also don't have a lot of the tools that we usually have.
• 5:55
  SPEAKER_01: With seasonal flu, we have medications to protect patients that are high risk.
• 6:00
  SPEAKER_01: We have antiviral medications, and we have a vaccine.
• 6:03
  SPEAKER_01: And patients have seen this virus before.
• 6:06
  SPEAKER_01: They have some level of immunity to the virus.
• 6:09
  SPEAKER_01: That's different from COVID-19.
• 6:11
  SPEAKER_01: And so, really, all we have left is these community mitigation and social distancing and contact tracing kinds of measures to protect us.
• 6:21
  SPEAKER_01: And that's what's going to help us to fight the COVID-19 pandemic until there's a vaccine available.
• 6:27
  SPEAKER_00: Thank you.
• 6:27
  SPEAKER_00: What are the skills needed to be a contact tracer?
• 6:30
  SPEAKER_01: Yeah, I think it's important to realize that not anybody can be a good contact tracer.
• 6:35
  SPEAKER_01: It really is a specialized kind of skill.
• 6:38
  SPEAKER_01: People need to understand the infection.
• 6:40
  SPEAKER_01: They need to understand what's known about COVID-19 and how it spreads.
• 6:44
  SPEAKER_01: They need to understand the importance of patient confidentiality.
• 6:48
  SPEAKER_01: They need to understand that it's not going to be easy to talk to people who are sick and just learned they had COVID-19 and may not be feeling very well to suddenly be asking them all these details about who you saw several days ago.
• 7:02
  SPEAKER_01: And they need to be able to give people tips as to how you can remember who you saw several days ago?
• 7:07
  SPEAKER_01: What are ways to stimulate people's memories so that they can think of those people that they saw and give contact information?
• 7:14
  SPEAKER_01: Because they also need to give contact information about those people so they can be reached later on.
• 7:19
  SPEAKER_01: They also need to be understanding.
• 7:22
  SPEAKER_01: So they need to be understanding of these are people that sometimes are actually in crisis.
• 7:27
  SPEAKER_01: They're very upset about this diagnosis and they may not know what their next steps are.
• 7:32
  SPEAKER_01: They may be worried about how they're going to get groceries or how where they're going to stay or how they're going to keep their family members safe.
• 7:39
  SPEAKER_01: And that contact tracer needs to help them with all of those issues too.
• 7:43
  SPEAKER_00: Great.
• 7:44
  SPEAKER_00: Thank you for being with us.
• 7:46
  SPEAKER_00: Oh, thanks, Cindy.
• 7:47
  SPEAKER_00: Thanks so much for having me.
• 7:48
  SPEAKER_00: It's my pleasure.
• 7:50
  SPEAKER_00: Journey, you have a lot of experience doing contact tracing with the health department.
• 7:54
  SPEAKER_00: Can you tell us some of the different ways of doing contact tracing?
• 7:58
  SPEAKER_02: Absolutely.
• 8:00
  SPEAKER_02: We have a multitude of different ways that we're able to conduct contact tracing in this day and age.
• 8:08
  SPEAKER_02: So the old school method, if you would, would be where we have boots on the ground, we're interviewing patients that are positive face to face and finding out who they've been in contact with during the period where that initial case was infective.
• 8:23
  SPEAKER_02: Now we're able to reach out and do all of this by phone, right?
• 8:28
  SPEAKER_02: So, and this would still be considered the old school way of contact tracing: calling people, reaching them by telephone, doing a really in-depth investigation with them and seeing who might be at risk for contracting the disease from them.
• 8:43
  SPEAKER_02: We also have other tools, such as social media, where we're able to find people now that are a little harder to reach by telephone, and we can find out if they have Facebook accounts, Twitter accounts, and reach out to them personally and see if we can make a connection to them.
• 9:02
  SPEAKER_02: Another really fascinating way that has been traditionally used somewhat with the STD arena, but is now being used more with the COVID, is if you are in contact, physical proximity, and you've signed up for this app, and that someone that you've been around tests positive, you get a notification that you were around a positive patient.
• 9:27
  SPEAKER_02: So there's some limitations with these new types of apps that are being used.
• 9:32
  SPEAKER_02: So, for example, if it's using Bluetooth technology or GPS tracking device, there can be security issues with this.
• 9:40
  SPEAKER_02: And of course, everyone has to have signed up for the app.
• 9:43
  SPEAKER_02: So you've got to get a large number of people to sign up to be able to use the app.
• 9:49
  SPEAKER_02: And then you've got to also have the trust with the community that that data is going to be safe and secure.
• 9:56
  SPEAKER_02: So we see this being more effective in countries and areas that have better relationships with their government.
• 10:05
  SPEAKER_00: Thank you.
• 10:05
  SPEAKER_00: It's really interesting.
• 10:07
  SPEAKER_00: And as you mentioned having some difficulty sometimes getting hold of populations, how do you do contact tracing in homeless populations?
• 10:16
  SPEAKER_02: The homeless population is probably the hardest group for us to reach.
• 10:20
  SPEAKER_02: And it usually involves going out and meeting folks face to face and trying to see where they might have been and conducting that interview.
• 10:30
  SPEAKER_02: They don't traditionally have cell phones or access to media devices as much.
• 10:37
  SPEAKER_02: So for something like COVID, where we're trying to really minimize person-to-person contact, our homeless population is a unique group that is really difficult for us to penetrate and find out who they've all been around.
• 10:52
  SPEAKER_02: So to answer your question, not as much engagement with contact tracing in this group.
• 11:00
  SPEAKER_00: Thank you.
• 11:01
  SPEAKER_00: With this being a virus that especially has an effect in older populations, what about doing contact tracing in dementia patients?
• 11:09
  SPEAKER_02: So the dementia patients that we've been working with so far have been more in healthcare facilities.
• 11:16
  SPEAKER_02: So we treat this just like we do any other long-term or hospital care facility.
• 11:23
  SPEAKER_02: We're actually going in, we're not doing interviews necessarily with the positive patient because they don't have the memory and the recall to be able to share with this.
• 11:33
  SPEAKER_02: Instead, we're actually going in and we're testing everybody in these facilities.
• 11:39
  SPEAKER_02: So doing the nasopharyngeal screening on them, as well as employees or any visitors that might have come to the facility as well.
• 11:47
  SPEAKER_00: What are you doing to manage bad historians?
• 11:49
  SPEAKER_00: So when people can't remember their symptoms, what do you do with that?
• 11:54
  SPEAKER_02: Yeah, we have a term for this.
• 11:55
  SPEAKER_02: It's called recall bias.
• 11:58
  SPEAKER_02: And it exists for everybody.
• 12:00
  SPEAKER_02: And it's particularly difficult when we're trying to have people remember what they've done for the last 14 days to try to figure out where they might have gotten sick from.
• 12:12
  SPEAKER_02: So it is the investigator's job.
• 12:15
  SPEAKER_02: Uh, and there's tricks that we use, right?
• 12:17
  SPEAKER_02: But it's the investigator's job to really try to get to know the person they're speaking with, get in their head, ask open-ended questions.
• 12:27
  SPEAKER_02: Who might you have been around?
• 12:29
  SPEAKER_02: Where did you go?
• 12:30
  SPEAKER_02: And then we have some extra tools that we can use.
• 12:32
  SPEAKER_02: People take a lot of photos these days with their phones.
• 12:36
  SPEAKER_02: So we can have them look through their photo logs because maybe they took a picture with a friend during the time period that we're interested in.
• 12:44
  SPEAKER_02: We can also have them scroll through their text messages.
• 12:47
  SPEAKER_02: Oh, yeah, that's right.
• 12:48
  SPEAKER_02: I went to that party.
• 12:49
  SPEAKER_02: And they might have text messages to help them remember going back in time.
• 12:54
  SPEAKER_02: And when I was at the party, that's right.
• 12:56
  SPEAKER_02: I hung out with blah, blah, blah, and blah, blah, blah.
• 12:58
  SPEAKER_02: So using these tools, using apps, using the electronic data that they themselves have and they willingly share with us.
• 13:09
  SPEAKER_02: But that takes establishing trust.
• 13:11
  SPEAKER_02: We have to really make sure that people know that we're only using their information to help prevent the spread of further transmission.
• 13:19
  SPEAKER_02: So establishing trust, making good connections.
• 13:23
  SPEAKER_02: So we have to have great people skills for people to share some of the intimate parts of their lives with us and some of the parts that they might not really want to tell us because they know that they shouldn't have been around anybody.
• 13:34
  SPEAKER_02: And we have to let them know that their information is safe with us and that we're never going to tell their contacts actually who was ever infected.
• 13:42
  SPEAKER_02: That is confidential information.
• 13:44
  SPEAKER_00: That's great.
• 13:45
  SPEAKER_00: I think that's really important for people to know as they get calls and are asked to respond to contact tracing.
• 13:51
  SPEAKER_00: I know you're doing this more in the community rather than in the hospital setting, but how do you determine if a healthcare worker got sick treating patients or if it was community acquired?
• 14:01
  SPEAKER_00: Is there a way to distinguish that?
• 14:03
  SPEAKER_02: Well, with some of our pathogens, we are able to distinguish if someone obtained it in the community versus the healthcare setting.
• 14:11
  SPEAKER_02: But this isn't possible to do with COVID currently.
• 14:15
  SPEAKER_02: We have community-wide spread occurring as well as a possible exposure within a hospital setting.
• 14:24
  SPEAKER_02: And we really don't have the sophisticated tools that could maybe look at RNA strain mutations or anything like that yet to help us show directionality.
• 14:33
  SPEAKER_02: So at this point, that level of sophistication is not able to be determined.
• 14:38
  SPEAKER_00: Can you talk about the usefulness of contact tracing with respect to actually having an impact on projected COVID-19 cases?
• 14:46
  SPEAKER_02: Absolutely.
• 14:47
  SPEAKER_02: So contact tracing is a tried untrude method that really works well to stop the chain of transmission in disease outbreaks.
• 14:58
  SPEAKER_02: So public health has been using this for a long time as one of our tools.
• 15:02
  SPEAKER_02: And some interesting modeling that was done from the Emerging Pathogens Institute at the University of Florida.
• 15:09
  SPEAKER_02: And what they did is they looked at Boston and they put out some different models where no contact tracing was done whatsoever.
• 15:19
  SPEAKER_02: And the infection rates per day per 1,000 people look like it's just under 400 people getting sick every single day.
• 15:29
  SPEAKER_02: Now, if we do contact tracing and we are only effective 20% of the time, which, you know, that's pretty low.
• 15:39
  SPEAKER_02: I think we can do better than that, but only 20% of the time, we drop those infections per day all the way down to about a hundred cases per day.
• 15:49
  SPEAKER_02: And if we are successful doing contact tracing, it's projected at 40% of the time, then we drop those numbers down.
• 15:56
  SPEAKER_02: It looks like almost to 50 per day.
• 15:59
  SPEAKER_02: So when we're thinking about surge capacity for our healthcare facilities, this is a really life-changing difference to make sure there's ICU beds available and people can be admitted to the hospital and receive the care that they need.
• 16:15
  SPEAKER_02: So contact tracing works.
• 16:18
  SPEAKER_02: It's not perfect for COVID because we have those asymptomatic individuals, but it can absolutely reduce the number of people that are going to get infected and keep those numbers low enough to make sure that we have the healthcare facilities available to treat them.
• 16:38
  SPEAKER_00: I really appreciate it.
• 16:40
  SPEAKER_00: Oh, it was my pleasure and thank you very much to our speakers for sharing your perspectives and experiences.
• 16:47
  SPEAKER_00: And a sincere thank you from Shay to all healthcare personnel for all that you're doing to respond to COVID-19.
• 16:54
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 17:01
  SPEAKER_00: You'll also find additional resources such as the recorded webinars at the healthcare facility outbreak preparedness and the Shay COVID-19 town hall.
• 17:09
  SPEAKER_00: Additional resources available on Learning CE pertinent to this pandemic include Shay CDC Outbreak Response Training Program, ORTB, and the prevention course in HAI Knowledge and Control Prevention Check.
• 17:22
  SPEAKER_00: This concludes this episode of the Rapid Response Podcast.
• 17:26
  SPEAKER_00: Thank you for tuning in.