The College of Public Health at the University of Arkansas for Medical Sciences will begin tracing persons who’ve come into contact with COVID-19-positive staff at the Cummins Unit of the Arkansas Department of Correction, Dr. Ben Amick, the associate dean for research at the college, said today. To date, 35 members of Cummins’ staff have tested positive, Secretary of Health Dr. Nate Smith announced at today’s coronavirus update.
The Arkansas Department of Health has been tracing persons who might have been exposed to the virus even before Arkansas’s first diagnosed case, reaching out to people who had traveled in countries or gatherings where the virus had raised its highly infectious head. Contact tracing is essential in managing the outbreak, especially because the novel coronavirus can be transmitted by asymptomatic people. The quicker the state can identify who has the virus and who has been exposed, the better it will be able to halt transmission of the disease.
Nearly 2,500 people in Arkansas have tested positive for COVID-19 to date. (That number does not include the 687 inmates that have tested positive at Cummins). Multiply that number by the people they’ve come into contact with and you’ve got an enormous population to trace. A study by the Johns Hopkins Bloomberg School of Public Health said the nation would need 100,000 contact investigators. Smith said in a Monday interview that Johns Hopkins estimated Arkansas’s workforce need at 919. “I don’t know if that’s right or not,” Smith said. “We’ll need as many as we’ll need.”
The Arkansas Department of Health, which Smith directs, is “building our small army of contract tracing personnel,” he said, training 100 to 120 new contact tracers this week. ADH should have 260 contact investigators on board by the end of the week, Smith said. Investigators will include medical students, volunteers and ADH employees, including disease interventional specialists who normally do such tracing for HIV and syphilis. The Centers for Disease Control and Prevention is expanding its workforce with CARES Act federal emergency funds, and will likely provide investigators, as well, Smith said. Investigators will be able to use the Sara Alert monitoring app to automate some of the process.
Contact tracing “is a lot of work,” Dr. Amick said. “You have to talk to them, then their direct contacts, then manage the direct contacts for 14 days … that could be a large workload.”
ADH has developed interview scripts for investigators, but there is more to the work than just asking a series of questions, Amick said. “You have to be polite and listen. A lot are very anxious.” Some will be alarmed to learn they’ve come into contact with someone who is COVID-19 positive. “It’s a conversation, not an interview.” Amick said. “Most aren’t quick.” Some calls will take more than an hour, and Amick is assuring volunteers that they’re “not being timed.” It’s important, he said, to “leave the interview with the person feeling we paid attention to them.
Some will not want to cooperate at all, Smith said. Those who’ve come in direct contact with a COVID-19 infected friend may not want to hear that they need to quarantine for 14 days; ADH will have to turn to law enforcement for those who refuse to quarantine. Some people may not have a place to quarantine, Smith said, and the investigator will have to help them find a place to do that. Some contacts will present special challenges, such as those who live in multigenerational families, Amick said.
The College of Public Health will start with 20 to 30 people, Amick said, including nurses and physical and occupational therapists whose workload has been reduced by the ban on elective medical procedures. (That ban lifts Monday.) Its task is to work with contacts involving people in health care, long-term care and the correctional system, including inmates after release. ADH will continue to be the first contact for all persons tested positive.
“It’s a great opportunity for us to help — real public health,” Amick said. The college’s epidemiologists will use the data gathered by testing and contact tracing to do a randomized population study to detect the prevalence of the infection in Arkansas. “We’re worried about areas where people more vulnerable,” Amick said, such as in the Delta or among the Marshallese community in Northwest Arkansas.