Written by Michelle Ries
As COVID-19 cases continue to rise in North Carolina, officials are expanding contact tracing, a key method of identifying individuals who may have been exposed to the virus. In this blog post, we explain the goals of contact tracing, state status of contact tracing capacity and workforce, and considerations for the future of contact tracing.
What is contact tracing and why is it done?
Loosely defined, contact tracing is a method used by public health workers to identify people who have been in close contact with those infected with an illness. Public health staff works with a person who has a suspected or confirmed infection to identify other individuals with whom the person was in close contact during the time they were infectious. Staff then works to inform those individuals about their exposure and provide information about next steps. Exposed individuals are not told who exposed them. For COVID-19, exposed individuals are advised to stay home for 14 days after the time they were exposed, and to maintain social distance of at least 6 feet if they must leave home. They are also advised to monitor themselves for symptoms, including checking temperatures twice daily and looking out for cough or shortness of breath. Staff also provides information and resources for what to do if a person begins experiencing symptoms, including where and how to access medical care.
Because contact tracing helps to identify people who have been exposed and inform them that they should stay home and closely monitor themselves for symptoms, it is an effective method of reducing the spread of illness.
What is North Carolina doing?
Currently, the North Carolina Department of Health and Human Services is partnering with local health departments to improve capacity for contact tracing. Tracers and support staff are called the COVID-19 Community Team.
COVID-19 Community Team members contact individuals who test positive for COVID-19 and ask them about people with whom they have recently been in close contact [1]. The Team will then notify these individuals via text, phone call, or email, and provide information and resources about staying home, monitoring symptoms, and seeking testing or medical care if necessary. This process is confidential and no names or personal information are shared by the Team.
The statewide tracing Team is hired through the Carolina Community Tracing Collaborative, a partnership of Community Care of North Carolina and North Carolina Area Health Education Centers. As of June 18, NC DHHS reported 1,500 people working as contact tracers throughout the state, and is planning to hire up to 140 additional staff to meet the need for adequate contact tracing. Of the 309 new contract tracers hired by the Collaborative since April, 44% are bilingual (mostly Spanish-speaking), 35% are White, 29% are Black or African American, and 22% are Hispanic or Latino.
Many counties, including Wake, Durham, and Johnston counties, are using the additional tracers provided by the state, in addition to those working through local health departments, to address higher caseloads. Other county employees are also being pulled in for this work: in Wake, 110 librarians have been trained as contact tracers, with 55 working each day in rotation.
A recent analysis out of George Washington University estimated that North Carolina will need a total of 7,100 contact tracers statewide to keep up with recent cases. This analysis assumes that contact tracers will need to call 10 contacts per positive case and follow up on these calls every other day; however, this may be a conservative estimate because the number of close contacts per positive case can quickly grow as social distancing measures are eased throughout the state.
What’s next for contact tracing?
State officials are continuing to hire additional contact tracers, especially as the state’s rising cases indicate a greater need. In addition, officials and public health experts emphasize that contact tracing is always confidential, and encourage the public to answer calls, texts, and emails from contact tracers. They advise people who receive a call from a contact tracer to answer questions thoroughly and honestly, and adhere to guidance about staying at home and monitoring symptoms.
Nationally, the Centers for Disease Control and Prevention is working to identify digital contact tracing tools that may allow electronic self-reporting by individuals with the virus and their contacts and/or use location data to identify contacts unknown to an individual. Digital contact tracing holds promise for vastly increasing contact tracing capacity, and digital tools have been used to some success internationally. However, privacy concerns and legal and regulatory issues must be addressed before widespread adoption. In the U.S., Google and Apple announced development of a contact tracing app that uses Bluetooth-based proximity detection and would hold information on users’ smartphones. Neither Google nor Apple are covered entities under HIPAA [2], so HIPAA privacy requirements would not apply to data collected by the app. Some states’ laws provide protection specific to this situation, but there are not yet federal regulations. On May 7, federal lawmakers introduced the COVID-19 Consumer Data Protection Act of 2020, which would govern apps operated by entities not covered by HIPAA. This act would require transparency about data collection and use, individuals’ express consent, and a right to opt out of data collection. Some experts are concerned that provisions included in the COVID-19 Consumer Data Protection Act of 2020 could interfere with HIPAA, in that the new act provides both more and fewer consumer protections, depending on the provision. For potential collaborations between entities governed by HIPAA and entities covered by the new act, which privacy regulation would need to be followed? Going forward, thoughtful and complementary regulation will be needed to ensure privacy is maintained by digital contact tracing technology, even as it boosts ability to track and address public health needs.
[1] For COVID-19, the NC Department of Health and Human Services is defining “close contact” as being within 6 feet, for at least 15 minutes, with a person who has tested positive for COVID-19
[2] HIPAA: Health Insurance Portability and Accountability Act of 1996. This is a federal law that required national standards for protection of patient health information and prevention of disclosure of health information without a patient’s consent and knowledge.