HJNO Jul/Aug 2020

DIALOGUE 10 JUL / AUG 2020 I  HEALTHCARE JOURNAL OF NEW ORLEANS   Editor What is contact tracing? Besides COVID-19, what do we use contact trac- ing for? Theresa Sokol Contact tracing is a decades- old fundamental public health tool that relies on identifying and contacting indi- viduals who may have unknowingly been exposed to an infectious disease. Contacts are identified through an interview with an individual who has received a positive lab result for an infectious disease such as COVID-19, but also other infectious dis- eases such as hepatitis A, tuberculosis, and measles. These contacts may be individu- als who were in contact with someone who has tested positive for the disease before they had any symptoms. Close contact for COVID-19 is defined as contact of 15 min- utes or more within a distance of six feet, meaning chance passing in public settings are not likely to generate contacts. Editor  How does contact tracing for COVID- 19 differ from contact tracing for other diseases? Sokol  One important difference between contact tracing for COVID-19 and other diseases is the scope of the response. Pre- COVID-19, our biggest contact tracing effort in Louisiana was for cases of the ongoing hepatitis A outbreak. At the height of the hepatitis A response, we were able to han- dle all work within the department. We hired a couple of additional epidemiologists, but were able to sustain the response over a long period of time with internal resources. Public health recommendations made to contacts are different too. Contact tracers for measles and hepatitis A can offer a vaccine to help prevent individuals who have been exposed from developing the disease. For meningococcal meningitis, we recommend that those who have been exposed receive an antibiotic. For COVID-19, we do not yet have a vaccine or prophylactic treatment, so we interrupt the chain of transmission through self-quarantine of close contacts who have been exposed. Editor  Besides information on testing and how to self-quarantine, what other support is provided to contacts? Sokol  If a resource need is identified through a contact tracing interview, the case is flagged for follow up froma resource coordinator social worker who can connect individuals with a wide assortment of avail- able resources, includingmedication, masks, food assistance, and even help locating alter- native housing. The resource coordinators work through infrastructure provided by Louisiana 211, and provide ongoing case management throughout the course of an individual’s quarantine period to ensure they have access to the resources they need to safely and successfully quarantine. Editor  Tell us about the evolution of Loui- siana’s contact tracing efforts, as it relates to COVID-19. Sokol  As COVID-19 spread across the Greater New Orleans region (at one point having the fastest growing number of cases in the world), efforts shifted from contact tracing to community mitigation, and a focus on specific congregate settings. As the rate of transmission began to fall, and Loui- siana began to consider reopening sectors of the economy, the governor directed that a robust systemof testing and contact trac- ing be put in place to ensure health officials could remain informed about any increase in COVID-19 transmission across the state. To accomplish this, Louisiana spoke with individuals from theMassachusetts Depart- ment of Health to learn about their recent success using anAccenture configuration of the Salesforce Customer RelationshipMan- ager (CRM), to serve as a database support- ing expanded contact tracing efforts. Four Louisiana-based call centers were tasked with providing remote call center staff, who were all to be Louisiana residents, to train on this new system as it was being imple- mented, in advance of Louisiana’s mov- ing into phase one of the governor’s Road- map to a Resilient Louisiana. ByMay 15, the Salesforce CRMwas in place, with over 350 call center agents hired. While the May 15 launch ensured the CRM was in place, fur- ther iterations of the platform continue to be developed to ensure necessary function- ality is added to the system to make it as efficient as possible, including features like inbound calling. As of mid-June 2020, over 500 agents have been hired to be available for contact tracing, with over 300 actively conducting contact tracing outreach. Editor What do you learn to become a con- tact tracer? Sokol  Louisiana uses the Johns Hopkins University online training curriculum to train contact tracers on basics about infec- tious diseases (and COVID-19 in particular), background on the importance of contact tracing and its epidemiological importance, motivational interviewing techniques, and how to help identify and define contacts for individuals being contacted. In addition, Health Insurance Portability and Account- abilityAct (HIPAA) training is required, along with training for the Salesforce platform from which agents make calls and docu- ment information. Editor  How do you respond to anyone struggling with coronavirus quarantine fatigue? Sokol  Early on, I was exposed to someone with COVID-19. I self-quarantined in my bedroom at home, apart from my children and husband for the duration of my quar- antine period. I worked from there, slept there, and used the adjoining bathroom. I will admit that it was difficult, and I appre- ciate that many Louisianans do not have the same privilege of having that space to