Containing the spread of COVID-19 without a vaccine comes down to three tenets: test, trace, and isolate.
A team at the University of Maryland, Baltimore (UMB) that is behind the UMB COVID-19 Hotline and the SAFE on Campus daily symptom monitoring system is ensuring those three steps are being followed for faculty, staff, and students.
Contact tracing is a small but detailed and complex part of their jobs, and it’s one that nobody had experience doing before in a pandemic.
“It is not a solid science. It is ever-changing, evolving,” said Bria Graham Glover, MPH, CIC, infection control epidemiologist at UMB. “We’re learning as we go.”
Graham and Deborah Knepp, BSN, RN, COHNS, COHC, occupational health nurse, are part of a team led by Marianne Cloeren, MD, MPH, FACOEM, FACP, associate professor at the University of Maryland School of Medicine, that’s making sure people with COVID-19-compatible symptoms are not coming to campus through the use of SAFE on Campus and the UMB COVID-19 Hotline.
They’re navigating guidance changes from different agencies and having a sizable portion of faculty, students, and staff being affiliated with more than one institution or workplace. So far, nothing has stopped this team from completing its jobs.
“We couldn’t keep open without them. That’s the bottom line,” said Steven Deck, DM, MBA, ARM, CIH, CSP, CHMM, director of Environmental Health and Safety at UMB. “It’s as important as electricity. Nothing could happen without it.”
What constitutes close contact? Per Centers for Disease Control and Prevention (CDC) guidelines, close contact means “someone who was within 6 feet of an infected person for at least 15 minutes starting from two days before illness onset.” However, there are so many other factors in regard to location, activity, and mask-wearing.
That’s why UMB relies upon the expertise of its infection prevention professionals in making decisions about who should be contacted and who should be required to quarantine.
How Contact Tracing Works
Contact tracing at UMB starts when someone reports a positive COVID-19 test to the University via SAFE on Campus or working with the COVID-19 Hotline.
Knepp implored the UMB community to pay attention to the SAFE on Campus emails after their form is completed each day because instructions could say to call the COVID-19 Hotline.
A nurse case manager from the COVID-19 Hotline will call the person to see if they were on campus, involved in experiential learning off-campus, involved in clinical work, or were in contact with other people, said Cloeren, who oversees the operation of SAFE on Campus and the COVID-19 Hotline.
If there appears to be a potential exposure risk, the case manager will contact Cloeren’s team to get to work.
“We don’t start contact tracing until we know that you are a positive case. Sometimes there’s a delay,” Graham said. “Sometimes you may call the hotline because you have symptoms and want to get tested. So we might not find out that you tested positive until a few days later, and then we’ll start the contact tracing.”
Once the call is made to the COVID-19-positive patient, the team will start asking questions to retrace the person’s steps. Graham finds it best to start with the previous day and work backward.
“It turns more into a conversation, and I feel like that’s the best way to get all the details as opposed to asking yes-or-no questions,” Graham said. “The main point of the conversation for contacts are how long, what kind of personal protective equipment were you wearing, and how close were you to someone. Then we get into what kind of activities were you doing, and where did those activities take place.”
More than likely, a person with a positive case or high-risk exposure will have to answer the same contact tracing questions multiple times.
“It’s especially complicated for us because we are one of possibly four entities that are contacting these people asking the exact same thing,” Graham said.
Someone could spend 20-40 minutes on the phone with each of the University of Maryland Medical Center or other clinical employer, the Maryland State Department of Health, and their local health department, in addition to UMB.
It can be overwhelming remembering who was told what.
“I keep them on track asking guideline questions, and I tell people it’s OK if you don’t remember exactly what you were wearing or how close you were,” Graham said.
Truth and Confidentiality
Overall, students, faculty, and staff being contacted are doing a great job of detailing information.
“The employees, for the vast majority of them, are wanting to solve problems,” Knepp said. “They don’t want this to be an issue on campus. They’re devoted to what they do and are cognizant of their role in the grand scheme of things.”
It can complicate the process if you tell everyone that you tested positive.
“Sometimes that actually leads to some problems because we have all these people who probably didn’t have a significant exposure worrying about it,” Cloeren said. “It’s easier to identify and notify the people who are high-risk, and it’s hard to identify the whole universe of low-risk contacts that people might have.”
Being truthful and forthcoming is the utmost importance regarding potential exposure. The COVID-19 Hotline is a safe space to be honest with the circumstances of an exposure.
“We’re not going to use the information against you; we’re trying to not get you in trouble,” Graham said. “We are just trying to gather enough information so we can safely isolate anyone who may have come in contact with you.”
However, not being honest will cause problems. For example, if the exposure was at an academic or social gathering and a person is trying to hide that there was a gathering and how many people were there, it can delay exposure notifications.
“It does get dicey if they are adamant about their privacy and don’t give us the information that we need to do the job,” Graham said.
Keep Your Distance and Keep Your Mask On
What’s the best piece of advice for UMB to avoid COVID-19 exposure on campus?
“All of us say it together: Stop eating together in break rooms!” Cloeren said.
Colleagues can let their guard down with a co-worker in a lunchroom, take off the mask and chat, and then spread the virus while talking. Reminder: UMB employees should eat alone with their door closed in their office and should not eat with others indoors on-site.
Another reminder the team wants to share: Wear a mask and physical distance. It’s not an either/or proposition.
“In another exposure situation, people are thinking that if they’re both wearing a mask, they can sit a couple feet away from each other and work on the same computer screen for hours,” Cloeren said.
When it comes to masks, Cloeren also encourages people to wear a surgical mask if possible.
“Wearing a cloth mask is not considered sufficient protection by the CDC for someone not to be to quarantined,” she said. “If the person who is positive is wearing a cloth mask, that is relatively OK, because it’s thought to capture the cough, sneeze, and aerosols, but if person who is positive is not wearing something over their face and their colleague wore a cloth mask, then they would still be exposed.”