June 29, 2020
Anyone who comes into close contact with someone who has Covid-19 is at a higher risk of becoming infected with the virus and of potentially infecting others.
The U.S. Centers for Disease Control and Prevention said contact tracing can help prevent further transmission of the virus by identifying and informing people who might be infected so they can take steps not to infect others. The CDC said a person might be contagious 48 to 72 hours before he or she starts experiencing Covid-19 symptoms.
Dr. Lea Yerby is associate professor and vice chair of the Department of Community Medicine and Population Health at The University of Alabama College of Community Health Sciences, which operates University Medical Center. She is also a researcher with the College’s Institute for Rural Health Research and conducts community-based research with underserved populations and those with special health-care needs.
Yerby said contact tracing begins with identifying people recently diagnosed with Covid-19 who have been in contact with others since they became contagious and asking them to identify people with whom they have been in close contact. She explained that contract tracers then contact those people potentially exposed, explain the symptoms they should watch for and encourage them to isolate and seek medical care if they start experiencing symptoms. She said contact tracing is conducted for close contacts who were within six feet of an infected person for at least 15 minutes.
Yerby said the department was created to teach students and health-care professionals how to bridge the individual work of doctors caring for patients with impacts to the health of communities. She said while physicians care for the “patient in front of them, and that’s what you want a doctor to do, how do you bridge what a physician might do in a clinic with what is going on in the community? How do you work with public health workers who are actively monitoring the health of the community? How do you collect the data that helps take care of a group of people? How do you get the information that a physician needs clinically to best take care of a patient, and how do you get that information back to the community?” She said community medicine and population health explores those questions and brings those different groups together to find solutions that improve health of populations of people.
The College is in its second year of a master’s degree in population health, Yerby said. The degree program is designed for both doctors and other clinicians who “might want to know how to best manage their diabetic patients or patients with high blood pressure, or if they’re looking to be part of a value-based health-care system or an accountable care organization. For someone who is not a clinician but who wants to work with health-care data and figure out how to help a hospital or a medical system better take care of their patients, our (degree) program would also be a good fit for them.”
Yerby said one important factor that sets the program apart is that it is offered by a UA College that is a regional campus of the University of Alabama School of Medicine. “That means we have different disciplines, research, a lot of community relationships and our own clinic and patient population,” she said. Yerby said the College educates and trains medical students and resident physicians “so everyone can learn together and figure out, ‘How do I not operate in a silo? How do I work alongside physicians? And how do I get medical and health research to physicians in a way that will allow them to use it in their practices.’”
The Institute for Rural Health Research, Yerby said, has traditionally focused its research on the health inequalities in Alabama’s rural populations. “The Institute for Rural Health Research was formed to do research that tries to eliminate that disparity in the health care that someone living in Greensboro or Marion or Pineapple or Kennedy, Alabama, where my family is from – how do we give them the same chance at receiving quality health care as someone in Tuscaloosa or Birmingham. That is really our mission and our purpose.”
“It’s taken our skills, and our information and research, and made it even more important, more urgent,” Yerby said. She said populations in rural Alabama are underserved populations and have difficulty accessing care because some of the state’s counties have few doctors, and several counties have no hospitals. “That is the reality we had before Covid and it has become more urgent – how do we acknowledge their health-care needs and what can we do to prevent an unnecessarily disproportionate amount of deaths in those communities, or the amount of sickness in those communities?”
Yerby said research that the Institute for Rural Health Research has done provides information about where people in Alabama’s rural communities access care, how they receive information, who they trust for health-care information “and where they might be willing to go for a test. That information has been really critical right now.”
Yerby said nurses and resident physicians from University Medical Center, and staff from the Institute for Rural Health Research, are using UA’s Mobile Outreach Unit and traveling to rural Alabama Black Belt communities to provide Covid-19 screening and testing. “We have been to about five different Black Belt counties. We screen everyone who shows up, and we provide education for everyone who shows up. Based on the screening, if they meet the criteria for a test, they get a test,” she said. Yerby said the initiative has screened more than 500 people, tested more than 300 people, “and from that has had 46 people test positive in our rural counties. We have been able to inform them and to do our best to connect them to care.”
Yerby said screening is about having a conversation with people and asking if they have been exposed to someone who is positive for Covid-19, if they have symptoms and if they have diabetes, lung disease, kidney disease or asthma. She said the information gathered from the screening, as well as guidelines from the Alabama Department of Public Health and the U.S. Centers for Disease Control and Prevention, determine whether a person should be tested for the virus.
There are a number of symptoms to watch for, Yerby said, including shortness of breath, cough, fever, the loss of taste and smell, and some people report nausea, vomiting and diarrhea. “Some people think (Covid-19) is only respiratory and might say, ‘I’m not coughing I don’t have a fever so I’m fine.’ But those aren’t the only symptoms,” she said.
If a screener determines that someone needs to be tested, that person, who remains in his or her car at all times, then drives to the next station for testing, which is conducted by a nurse in full personal protective equipment, Yerby said. She said it takes two to three days to get a test result back.
“We tell everyone who tests that we recommend they make the choice to isolate for at least 14 days out from their symptoms; we go ahead and give them information and counseling as though they are positive,” Yerby said. For those whose test results are positive, “our nurse calls them so that they have a licensed health-care professional there to discuss that with them,” Yerby said. Those whose test results are negative also receive a phone call “and we provide them with education and information about whether they should continue their isolation and how to monitor for symptoms,” she said.
Yerby said the trends they are seeing are what they expected. “The folks who are essential workers, those who have a lot of people who live with them in their homes, and the folks who don’t have the option to work from home, that is who a lot of our positives in the community have been.” In addition, she said people with underlying and chronic health conditions, such as diabetes, high blood pressure, asthma and chronic obstructive pulmonary disease (COPD) “tend to have more symptoms, a worse case, or have a longer time of really being sick.” Yerby said younger people who are positive tend to be asymptomatic, or if they do have symptoms, those symptoms last for only a short time. “This just really drives home that being respectful and protective of the people on the front lines, people working in our grocery stores, people making our food and showing up to produce our goods, these are the people that we need to make sure we are protecting. We need to make sure that we are protecting our vulnerable populations – those with chronic disease or illness – and our elders, our parents and our grandparents,” she said. “We need to take all the precautions that we can and make sure that we don’t get sick and spread (Covid-19), that we are wearing our masks and that we are on their team and looking out for them.”
Yerby said contact tracing involves finding and contacting individuals who were in close contact with someone who has been diagnosed with Covid-19 and who might have been exposed to the virus. She said close contact is defined as being within six feet or less of an infected person for 15 minutes. “In that situation, you would need to stay home, if at all possible,” Yerby said. “You would need to be tested. You would need to act and behave as though you had the virus and take action to protect other people.”
“Right now, we only go with close contact because that is where the risk really is, and those are the individuals who really need to take action to protect others,” Yerby said. She said contract tracers continue to follow up with these close contacts to learn if they have developed symptoms and if they have been able to stay home.
Yerby said the Institute is currently providing contact tracing for the UA campus – for faculty, staff and students. She said the hope is to expand those efforts beyond the UA population because students and employees are also part of off-campus populations.
Yerby said the Institute for Rural Health Research provides training for contract tracers, but the work is really about having a conversation with someone you don’t know. “Can you call a person who is potentially sick and have a kind conversation with them that makes sure they’re OK, that they have what they need and that they’re able to stay home and not expose people in the community?” she said. “And then can you ask them, if they have tested positive, if they have told the people in their life and those that they might have come into contact with? It does require a person who is not afraid to call a stranger on the phone and have a compassionate conversation.” Yerby said the work is often referred to as gum shoe public health. “We don’t have a vaccine, so right now all we really have to protect our community is contact tracing and our own protective behaviors.”