Close Contact Tracing Team Fights on Front Lines of COVID-19 Care

 Aug. 19, 2020 | BY Riley Eversull

For more than six months, Naval Medical Center Camp Lejeune has been battling the COVID-19 pandemic. While epidemiologists work around the clock to better understand the coronavirus, the medical center's laboratory technicians, pharmacists, nurses and paramedics must translate information quickly for their patients and the public.

"We pay close attention to lessons learned and best practices outlined by the Centers for Disease Control and Prevention and Department of Defense health experts," Navy Lt. Eric Green said, addressing a recent contact tracing course at Camp Lejeune. "Our contact tracing has revealed some local trends that we immediately act upon to educate our forces and beneficiaries, as well as develop our own local best practices."

Green serves as the medical center's preventive medicine department head and as assistant public health emergency officer for Marine Corps Installations East. As COVID-19 took just a matter of weeks to permeate eastern North Carolina, Green and the preventive medicine department quickly determined the undeniable need for a team dedicated to tracing close contacts of COVID-19-positive patients.

"Our team of close contact tracers are working shifts seven-days a week, 12 or more hours a day, to track down possible close contacts of confirmed COVID-19 patients," Green said. "Because of the contact tracing team's hard work, there is an impressive synergy between Marine Corps operational units [ in Marine Corps Installations East] and local and state health department officials to thoroughly investigate each case."

Preventive medicine has hosted a series of contact tracing courses over the past five months. The most recent course, held on Aug. 5, brought together medical professionals from Navy and Marine Corps units, Marine Corps Community Services, child development centers and Department of Defense Education Activity schools. The class breaks down what preventive medicine has learned about COVID-19 and the novel, yet effective, process for tracking close contacts. Class participants can then take these methods back to their units or organizations to apply to their daily COVID-19 prevention routines.

"What we are learning is that if you have COVID-19, you could potentially infect an average of two people, then those two people could infect four people, and so on," Green said. "People assume because they aren't showing symptoms right away, they don't have it. However, we are seeing that the incubation period for COVID is two to 14 days, and by Day 6 or 7 after exposure – boom. That's often when those symptoms are hitting, or the symptoms are so mild the person may believe it is just allergies or the common cold."

To keep close contact tracing operational each week, a team of Marines from the 2nd Marine Expeditionary Force and Marine Corps Base Camp Lejeune was trained to aid the contact tracing team. Each morning, shifts begin in the same manner: dozens upon dozens of phone calls.

"We have six or seven sailors and Marines working each shift, and these are the guidelines and questions we use when calling possible close contacts," explains Navy Seaman Demetria Garvin, a hospital corpsman, as she pulled up a collage of colorful charts and lists on her computer screen. "We speak directly with the patient, and then we start contacting individuals that the patient tells us about. We inform them that they have been identified as a close contact and to self-quarantine and monitor for symptoms."

Garvin explained that identified close contacts are then called every 24 to 48 hours for symptom checks. When asked what defines a close contact, Garvin immediately pulled up the most current information on COVID-19 epidemiology.

"Were you within 6 feet for at least 15 minutes or longer of someone who has COVID-19?" Garvin said, communicating a couple of the questions asked of potential close contacts. "Have you had direct physical contact with someone who has COVID-19?"

If a person is identified as a close contact, contact tracers then convey the symptoms to monitor. The individual will be advised to remain home for 14 days to watch for current or possible development of symptoms. Close contacts are given information on the medical center's COVID-19 phone help line, the active-duty COVID-19 screening site and the medical center’s acute respiratory clinic. Contact who notice symptoms can confer with a medical professional about further testing, if necessary.

"We want to surround positive cases, isolate them and quarantine their close contacts," Green said. "The quicker we can do this, the more effective we can be in stopping an outbreak. What we are seeing is that we can't necessarily control cases from happening, but we can control the cluster that comes from cases."

Green described contact tracing as a sort of "box it in" process. In four steps, personnel are surrounding a COVID-19 case by testing a patient, isolating the sick, finding close contacts and having patients quarantine 14 days from the date of exposure.

"So far, we have been effective at controlling the explosive spread of the virus that we have seen occur throughout other parts of the world and nation," Green said. "We attribute part of that success to early and effective contact tracing and getting close contacts into quarantine quickly before they themselves become infected and subsequently infect others. It is a tedious and often an imperfect process, but we have undoubtedly seen these efforts slow the spread of the virus locally."

After more than 100 days spent contact tracing and refining methods, the contact tracing team has identified what they call avoidable traits, or the "Big Four," in not contracting COVID-19:

• If you are sick, stay home.
• Avoid large gatherings, especially with people you know to have or possibly have COVID-19.
• If you were a known close contact of someone with COVID-19, self-quarantine for 14 days from the last exposure date.
• If you have a COVID-19 test taken and are waiting for results, isolate at home until you get the results.

Each day, the team reports numbers of positive cases and other pertinent information to local health departments. While COVID-19 will not likely disappear soon, Green said, the contact tracing team is not only helping to "box in" cases, but also is expanding knowledge of how to prevent falling ill with COVID-19.

"By having this contact tracing process that works, this rapid response is mitigating further propagation of the disease," he said. "By doing well at contact tracing, we can flatten our local curve and keep more people from becoming sick."

What counts as a close contact? Check out these points from the medical center's contact tracing team:

• You were within 6 feet of someone who has COVID-19 for at least 15 minutes.
• You provided care at home to someone who is sick with COVID-19.
• You had direct physical contact with that person (touched, kissed or hugged).
• You shared eating or drinking utensils.
• The person sneezed, coughed or somehow got respiratory droplets on you.

(Riley Eversull is assigned to Naval Medical Center Camp Lejeune.)