HEALTHCARE SPECIAL SECTION
Tracking the Pandemic
Contact tracing ramps up as COVID-19 cases continue to increase
By Vanessa Orr
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y late-October, more than 11,600 Alaska residents had tested positive for COVID-19, and the numbers were steadily increasing. Because the virus is so highly communicable, there’s a good chance that those who were infected passed it onto others, who may or may not be symptomatic. Those people, in turn, could be passing it on to more people and so on—making it an extremely difficult virus to contain.

To identify potential carriers and slow the spread, the state, working with a number of different partners, instituted a COVID-19-specific contact tracing program to help identify positive cases and get them into isolation, as well as reach out to close contacts of those patients to educate them about the quarantining process.

How Does Contact Tracing Work?
When a person is given a positive COVID-19 diagnosis, case investigators from a variety of organizations attempt to identify every single person who has been in contact with the infected person while they were contagious. According to the Alaska Department of Health and Social Services (DHSS) website, those with COVID-19 are considered contagious starting two days before symptoms occurred, or, if they are asymptomatic, two days prior to receiving a positive test.
Those who test positive are asked to provide contact information for anyone with whom they’ve been in close contact, and those individuals are contacted by phone to let them know that they were potentially exposed, though the person who tested positive is not identified. These people are asked to quarantine for fourteen days and to watch for symptoms. If they leave quarantine or have visitors, contact tracers must then also work to identify any additional individuals with whom they may have come into contact.

“In addition to identifying people who have been exposed to the disease, we talk to people about the steps they need to take to monitor their health, how to quarantine, and where to get follow-up testing,” says Brian Lefferts, Yukon Kuskokwim Health Corporation’s (YKHC) director for the Office of Environmental Health and Engineering; he oversees the contact tracing team as part of YKHC’s COVID-19 response team. “We also identify people who are at greater risk of developing the disease, and we check in with them regularly and offer additional medical support if needed. Our goal is not only to identify possible infection but to offer support while doing it.”

He adds that everyone who is identified is listed in two categories: they are either close contacts or general population contacts.

“We try to reach out to both groups, though our main focus is on close contacts, who are defined as being less than 6 feet away from the infected person for more than a cumulative 15 minutes,” he explains, adding that other conditions are also taken into account, such as if the people were exercising, which puts them at higher risk, or meeting for an extended period of time in a place without good air circulation.

“There are lengthy guidelines that the CDC puts out, and we also contact the state epidemiologists to help with more questionable situations,” says Lefferts. “If someone is determined to be at high risk, we schedule them for follow-up testing and quarantine.”

According to the DHSS website, as of mid-October, case investigators had been able to contact 95 percent of the positive cases within two hours of the Section of Epidemiology being notified of a positive test. And, as cases continue to rise in the state, contract tracing becomes an even more important step toward preventing Alaskans from getting and spreading this virus.

Since Alaska began contact tracing in March, the number of people serving as contact tracers has grown from 75 to approximately 235 people throughout the state. If COVID-19 cases continue on their current upward trajectory, that number could expand to roughly 500 people which would include DHSS staff, as well as trained professionals working for partner organizations such as the Anchorage Health Department, Anchorage School District, Maniilaq Association, North Slope Borough, CDC Arctic Investigations Program, Yukon Kuskokwim Health Corporation, Alaska Native Tribal Health Consortium, Fairbanks Memorial Hospital, the Alaska National Guard/Air National Guard, the UAA College of Health, and Kenai Peninsula Borough School District, among others.

Training and Technology
As the need for contact tracers grew, it became imperative to have a fast, efficient way to train this new workforce. While some organizations, such as the YKHC, established their own training program, many others took advantage of training set up by UAA.
COVID-19 testing taking place at Yukon-Kuskokwim Health Corporation’s airport tent site.

Yukon-Kuskokwim Health Corporation

“We began having conversations in May with the state about training contact tracers, and since then have expanded our role in supporting their efforts by hiring, onboarding, and deploying surge workforce teams,” says Gloria Burnett, director of the Alaska Center for Rural Health and Health Workforce. “Our training includes onboarding, job shadowing, working with live calls, and running weekly ECHO sessions so that training doesn’t stop even after someone gets hired.”

The 16-hour, self-directed, online training program is offered through the UAA College of Health through a collaborative effort with DHSS’ Division of Public Health. The creation and implementation of the curriculum was developed by the Alaska Center for Rural Health and Health Workforce and the Division of Population Health Sciences, both housed within the College of Health.

“As a society, we’re all collectively exhausted by the pandemic, but it’s working on its own timeline. Because of how interconnected we are, individual actions have a collective response. It’s going to take everyone’s efforts to move beyond the pandemic.”
Tiffany Zulkosky, Vice President of Communications, YKHC
“The evidence-informed training offers a crash course on the basics of infectious diseases; US and Alaska public health systems; and the principles of contact tracing,” says Kristin Bogue, assistant professor of health sciences at UAA. “It also includes information on HIPAA [Health Insurance Portability and Accountability Act of 1996] and public health ethics and privacy laws.” Participants also receive an overview of CommCare, a public health electronic health record recently adopted by the state to document COVID-19 investigations.

Once training is complete, contact tracers are assigned to one of three tiers, depending on their level of experience. While there are a lot of people applying to work as contract tracers, Burnett says that there is a specific need for more licensed healthcare professionals.

College of Health Division of Population Health Sciences

UAA Alaska Center for Rural Health and Health Workforce
COVID-19 Contact Tracing in Alaska
UAA Course Outline
Self-Guided
Complete this online course consisting of content organized into 3 sessions (approx 16 hours).

  • Assessment
  • Contact Tracing Foundations
  • Technology for Documenting Investigations
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Industry-Aligned Curriculum
Study the most current available information regarding COVID-19 contract tracing.

Certificate of Completion
Receive a certificate upon successful completion of the course.

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Priority Registration
Licensed clinicians, nurses, public health professionals and COH students who can commit a minimum of 16 hours per week register at https://bit.ly/AK_COVID_Training

Course Waitlist
All others can request to be added to our course waitlist at https://bit.ly/AK_COVID_Tracing

Inquiries can be sent to [email protected]

“We need more experienced recruits; we have enough Tier 1 tracers, but we need licensed clinicians, social workers, counselors, and public health professionals with investigative backgrounds to work in the higher tiers, which require more complex skills,” she says.

Up until October, YKHC, which began its training before the UAA program became available, only used its own employees as contact tracers. Those employees were provided with training from the State Department of Epidemiology and online training from the CDC.

“Now we are recruiting individuals who are familiar with the region and the communities in our region,” says Lefferts, adding that the organization is looking for people with some understanding of medical terms, good interpersonal skills, and the ability to build rapport and trust.

“They also need to be very organized, because there is a lot of follow-up required,” he adds. “We record and track all information and there are so many interviews—you need to say on top of things to check all the boxes.”

According to YKHC’s Vice President of Communications Tiffany Zulkosky, the corporation is using CARES Act funding to hire additional contact tracers.

“We had hoped that Alaska as a state would see COVID-19 cases trending down so that we would not need to deploy additional resources, but, unfortunately, we’re seeing more and more cases,” she says. “Our region, much like the state, had a delayed exposure to the virus because of geographic advantage, especially since much of it is not connected to the road system. But as statewide cases increase, we’re beginning to see widespread transmission and increasing case numbers.”

Contact Tracing Challenges
Even though the names of those who have contracted COVID-19 are not being released, it’s not always easy to get cooperation from those contacted or to reach out to all of the people that may have become infected.

“I can’t speak to what everyone is seeing, but our teams are having to deal with the fact that COVID-19 has become a politicized issue instead of a public health issue, so some of the calls can be challenging,” says Bogue, adding that tracers are trained in motivational interviewing and effective communication skills to build rapport. “We appreciate that the state is working with other entities, including their own public relations division, to help the general population understand the purpose of contact tracing as a way to reduce the spread of disease across the state.”

Bogue adds that there are other obstacles, including language barriers, blocked or private numbers, people avoiding the phone due to political calls, and certain unique circumstances where the available educational materials that contact tracers are providing don’t apply.

“Due to having more communities off the road system than any other state, it can make it a challenge for people to follow the typical guidance we provide for isolation and quarantine,” says Bogue. “Some places do not have the space in their communities for people to be alone; in Anchorage, for example, if a person needs to isolate away from home, we have options such as hotels or motels. This may not be an option in rural communities, and we need to be cognizant of that.

“In some geographic regions of Alaska, it’s not easy to get to a healthcare provider, a testing site, or homes may not have running water,” she adds. “Contact tracers have to adjust in the moment, which is why it’s so important for them to have strong communication skills and to provide education relevant to the situation.”

She adds that people who need extra assistance are directed to local or regional centers that have more information on local help.

As with any phone contact, Burnett says people need to be cautious. “There are a lot of spammers out there who want to take advantage,” she says, giving the example of a voicemail that someone received that didn’t include a callback number. “If someone from the state of Alaska or one of its partners calls you, they will identify themselves, and they will always leave you a callback number. If not, that’s a red flag that something else is going on.”

While technology does make the job easier, it also presents its own unique challenges.

“Because the mail system is taking a lot longer than pre-COVID, we’re seeing delays in getting our equipment out to remote locations, which is causing delays in getting people onboarded and working,” Burnett says. “Technology is a blessing, but at times it can also inhibit people from getting onboarded more quickly; some people are not as tech savvy, and they’re having to navigate a complex system between two big bureaucratic organizations [the university and the state] to get up to speed.”

What Can You Do to Help?
While contact tracers are working hard helping to track and (hopefully) contain the spread of the virus, Alaskans must play their part to keep the population safe, say the state’s healthcare experts.

“We need people to put all of their political affiliations aside and understand that this is a public health effort for the betterment of our state,” says Burnett. “If you know you have been exposed, stay home and follow CDC and state protocols.

“With the projections we’re seeing right now, it’s clear that far too many people are not taking it seriously,” she adds. “Keep to your social bubbles, wash your hands, practice social distancing, and wear a mask—if you do all of this, it will make all of our lives easier, especially in terms of this work.”

Bogue encourages people to visit the DHSS website and data dashboard to educate themselves on the virus and to keep tabs on the current state of COVID-19 in Alaska. The organization also regularly updates its Facebook page with new information and resources.

“It’s hard to know when prevention efforts are working, especially when we see cases increasing,” says Lefferts. “But when we talk to people and they say that they feel like they’re being cared for, and that we’re connecting them with the resources they need like hotel rooms, or meals delivered through our partners, or medical care—it’s these little wins that make us feel like we’re being successful.”

“Never before has there been a public health emergency that shows us how interconnected we all are,” adds Zulkosky. “The virus doesn’t have legs, but people who get infected do, and we can see how it moves from community to community.

“As a society, we’re all collectively exhausted by the pandemic, but it’s working on its own timeline,” she adds. “Because of how interconnected we are, individual actions have a collective response. It’s going to take everyone’s efforts to move beyond the pandemic.”