Surge in coronavirus cases causing delay in test results and contact tracing; health officials say more staff could be added to help
photo by: Kevin Anderson/Journal-World File Photo
The recent surge in coronavirus cases in Douglas County is slowing down contact tracing and could also be delaying efforts to notify people that they should quarantine, but public health leaders say these efforts are still helping to mitigate the spread of the disease.
Lawrence-Douglas County Public Health Informatics Director Sonia Jordan said that because of the recent surge in cases, public health workers are currently about two days behind on calling Douglas County residents to inform them of their test results. For example, on Friday she said they were still making calls to people whose tests came back on Wednesday and initiating the contact tracing process for those who tested positive.
“When things are moving smoothly, we are able to isolate most contacts before they can become infectious,” Jordan said. “Right now, with the spike and demand on the system, it’s a little delayed, which is why it’s critical for everyone in our community right now to practice smart and safe public health habits to help us get the spread of the virus under control.”
On Friday, Douglas County’s 14-day moving average of new COVID-19 cases per day rose to 49.29, its highest level since the pandemic began, according to local health authorities. Lawrence’s hospital had 25 inpatients with the virus on Friday, more than ever before. About 700 cases are active in the county, and the county’s 14-day average test positivity rate is currently at 13.8%, up from 4.8% in late October. Cases statewide have also been surging, putting strain on the contact tracing process at multiple levels of government.
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People who are awaiting test results should be isolating until they receive a call with the results. However, close contacts of a positive case could be infected with the virus and not know it, and they might not be aware that they should be quarantining until they receive a call from contact tracers. Three main factors determine how long it takes to inform the close contacts of a positive case that they must quarantine: how long it takes the test to be processed; how long it takes the case investigator to call the person who tested positive and figure out their close contacts; and how long it takes contact monitors to call those contacts.
But it’s not as simple as it might sound. Some steps of the contact tracing process are handled by local health departments, and others are done by the Kansas Department of Health and Environment. And there’s no one-size-fits-all statewide model — different counties have different arrangements with the KDHE.
In Douglas County’s case, the local public health department is in charge of calling and informing residents of their test results and initiating the contract tracing process by gathering the names and contact information for their close contacts if their test is positive. KDHE then calls the close contacts to notify them of the exposure, provide quarantine instructions and check in with them throughout their quarantine.
It is difficult to definitively say how long it takes someone exposed to the virus to get a call notifying them to quarantine, because there are many variables involved in the process. Those include where someone takes their test and what kind of test they take.
Jordan said some providers have rapid tests that give results almost immediately, whereas others can take several days to process. Currently, Jordan said tests conducted at the health department take two to three days to process, but she said most of the tests in Douglas County are done by other providers.
What is known is that once labs have processed the tests, it’s currently taking the health department’s disease investigators about two days to call Douglas County residents to inform them of their results and gather the close contacts. Jordan said the goal is for that call to be made within 24 hours. As far as the final step, KDHE spokesperson Kristi Zears said the department does not have data available at this time to indicate how long it is taking to call close contacts statewide. Zears said the goal is to reach out to them within 24 hours of the conversation with disease investigators.
The local health department’s current figures — two to three days to process tests done by the health department and about two days for county investigators to make their calls — suggest that if the KDHE’s 24-hour goal is being met, it might take five or six days from the day someone was tested for their close contacts to be notified to quarantine.
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Another thing that complicates the contact tracing process is the fact that a positive person can infect others before they show any symptoms.
Ideally, Zears said agencies should strive to notify close contacts within three days of a positive test result. She said that’s because many people develop the disease about five to seven days after exposure, and people can be infectious about two days prior to the onset of symptoms. That means in the cases that develop the most quickly, close contacts who have been infected could spread the virus on their own after just three days.
But Zears said that even if that goal isn’t being met, the process still helps lessen the spread of the disease.
The incubation period for the virus can sometimes be short — about five to seven days — but in other people it can last up to 14 days. That means that if contacts are reached anytime before the incubation period ends, isolating them could still prevent other people from being exposed.
“Even if it takes several days to receive the test results and then another couple of days to reach the case and their contacts, the exposed person is generally still in their quarantine period (when KDHE calls them),” Zears said.
Jordan agreed that even with the delays, the contact tracing and quarantining process still helps slow the spread of the disease. Often, she said people reached by Douglas County public health disease investigators had already notified their close contacts before the health department reached out to them.
Still, Jordan said because of the current surge in cases and the delay in initiating contact tracing, it’s critical to practice safe habits such as wearing a mask, following social distancing and limiting close contacts. She noted that some of the recent cases in Douglas County came from Halloween gatherings, and that as the number of cases continues to increase locally, even small gatherings can contribute to the spread.
Because of the surge in cases, Jordan said the health department is receiving assistance from additional disease investigators, including retired personnel and employees who have been internally reassigned. She said the health department is currently assessing staffing and that if cases continue to increase, the department will hire additional people for disease investigations.
“We are kind of at a critical juncture where we are trying to make those decisions right now,” Jordan said.
For its part, Zears said KDHE is working with a contractor to add case investigators and people for contact monitoring. She said the plan is to add another 150 case investigators in increments of 20 to 25 people as needed to address the rise in cases. At this point, she said the current workforce for contact monitoring is sufficient.