Here are key takeaways from an episode of Kentucky Health focusing on contact tracing for COVID-19 in Kentucky. Host Dr. Wayne Tuckson welcomed Mark Carter, executive policy advisor at the Kentucky Cabinet for Health and Family Services.
Steps to Contact Tracing: Diagnosis, Advice, and Outreach
Carter, former CEO of Passport Health Plan, joined CHFS in May 2020 to work on Kentucky’s contact tracing plan as it ramped up during the first weeks of the pandemic. “It’s been a high-stress endeavor, but at the same time, I’ve met a lot of real heroes,” Carter says. “Public health directors, local health departments across the state, epidemiologists in Frankfort – just a whole host of people who have really dedicated their lives trying to protect their fellow citizens from this disease and others.”
According to Carter, contact tracing is a key component of a broader public health campaign to contain infectious diseases. “It’s been used by public health departments for just about as long as there have been public health departments,” he says.
The overall process begins with the first step: disease investigation. Carter says when a Kentuckian tests positive for COVID-19, the lab is required to report that positive result to their local health department. Once it is received, a clinician at the department will contact the patient to discuss their symptoms and connect them to medical services.
The clinician will also gather a list of contacts the patient had during the period they were infectious. “That information is handed off to a contact tracer, which becomes the second step,” Carter says. He explains that the contact tracer does not need to be a clinician, but rather a professional with good communication skills. The contact tracer will prioritize the contacts from the list and determine which ones are at highest risk of exposure from the patient, and then call each contact and explain their risk and what steps to take.
“That will be to advise them on what they need to do to quarantine so they don’t spread the disease to their family and friends and fellow citizens,” Carter says. The tracer will also discuss what symptoms to be aware of in case the contacted person starts feeling sick and, lastly, ask about their daily needs if they do need to quarantine. They will gather information on groceries, drug prescriptions, childcare and other essentials and connect the person to services to help them.
Patients who are already hospitalized when they receive a COVID-19 positive will still receive a disease investigation, Carter says. The hospital will report the test result to the local health department and contact tracing will still occur while the patient is isolated and treated by doctors and staff using PPE (personal protective equipment).
Contact tracers follow what Carter calls an “interview guide” when reaching out to persons who have interacted with the infected patient. He says that the CHFS staff has revised the guidelines for contact tracing over the past several months as new research has added to their understanding of COVID-19.
“We’ve learned a lot about (COVID-19) since it first emerged back in the winter, and part of the reason for that is because of the information that has been gathered around the world,” Carter says.
Forming a Statewide Strategy to Help Contain the Spread
“People have historically been very cooperative with contact tracing,” Carter says. “It’s only been with this pandemic and the press coverage we’ve had and the politics involved in it, where we’ve found some non-compliance.”
Most of the objections Carter’s team have heard stem from worries people have about not being able to work if they are advised to quarantine, he says. “Some of it, I think, is legitimate human concern about what they have to do and the sacrifices they have to make to prevent the spread,” he says. “In other cases, health department directors around the state – and this has received publicity – they’ve been subjected to some really harassing type of behaviors, and in some cases I think that’s just driven by the media coverage, some of the politics and some of the things that have been said in the public space that people take their cues from.”
Carter says that despite that resistance, the contact tracing staff at CHFS was notifying enough people to contain COVID-19 in Kentucky until late in the fall of 2020. “But you can’t rely on contact tracing to stop the disease, just like you can’t rely on testing,” he says. “Testing, facial coverings, social distancing, and contact tracing all have to work together as a system. And if you just try to do one of those things, or two of them, but you don’t do the other ones, you get overwhelmed, and that’s what’s happened to us.”
According to Carter, there are 1,600 staff working as contact tracers, disease investigators, social support connectors, and other team members. These staff members are deployed to 61 local health departments across the state. If a person wants to apply for a job as a contact tracer, they can get information on openings via the CHFS COVID-19 page.
Using federal aid, Carter says CHFS has been able to implement a standard software program for all participating health departments to use for contact tracing, which is a huge benefit as relying on the same technology allows the state to move personnel around to areas where they are needed most.
“The interesting thing about this is that in the long run, that system will have tremendous value for the commonwealth, because it can be used for any kind of contact tracing effort or any containment effort around an infectious disease well into the future,” Carter says. “We’ll be much better prepared as a result of the investment we made in that system for the next pandemic.”
Black and Latino populations in Kentucky are at higher risk of developing severe complications from COVID-19, and they have been traditionally harder to reach by public health departments, Carter says. He credits the Louisville Metro Public Health Department for bolstering testing and contact tracing for the city’s Black population, and points out that many of Kentucky’s Latinos live in rural, agricultural areas, which presents a different challenge for local health departments.
“That population may tend to live together in homes in larger groups than we are accustomed to, and therefore the potential for spread is greater,” Carter says. “We’ve translated all of our materials to Spanish as well as a number of other foreign languages, and we have bilingual tracers and disease investigators that can work with that population.”
Carter says that the data collected during contact tracing is kept with public health departments but that there is also a state database. “The data is not sold to anybody, it’s not distributed outside of the commonwealth,” he says. Any data subsequently used for COVID-19 research projects is “de-identified,” he adds.
Social security numbers and financial information of patients and contacts are not collected. “If someone receives a call from someone asking those kinds of questions, they should just hang up immediately and call the attorney general’s fraud hotline,” Carter says. On the other hand, if a Kentucky citizen receives a call from 1-844-KYTRACE, Carter says that they should accept the call as it is coming from a state contact tracer.
