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Methods behind contact tracing revealed

Maui health officials have digital resource as backup but prefer the human touch

Maui District Health Office epidemiological specialists Takako Nakaaki and Spencer Headley are hard at work in their office in Wailuku. They are part of the team doing contact tracing and follow-ups of COVID-19 cases. Photo courtesy of the Maui District Health Office

Should Maui experience a surge or second wave in positive COVID-19 cases, the state Department of Health now has access to a new digital contact tracing tool that will help the department quantify investigations and follow-ups with individuals who have had close contact with a person identified as having the virus.

At the moment though, local health officials have opted to do it the old fashioned way — doing follow-ups via phone interviews because there is sufficient numbers of personnel and volunteers.

“Right now, we have it under control; we’re able to follow up with all of the contacts that we need to,” said Sara Hauptman, DOH Maui District public health educator. “However, we do prefer the in-person phone call. . . . It’s almost like a warmer way to reach out to somebody who may be feeling isolated.

“We find that it’s very beneficial to talk to them person to person.”

Although there is a downward trajectory in coronavirus cases on the Valley Isle, Hauptman said that it’s “very reassuring” to have the digital platform as a backup if cases exceed personnel capacity. She added that there are currently 20 more contact tracers being trained to meet any future demand.

Hauptman and a Maui Memorial Medical Center official described the contact-tracing process — critical in tracking the spread of the coronavirus — and the tools they have at their disposal.

According to a news release, the DOH contracted with HealthSpace, a cloud-based platform that offers data solutions to local and state public health agencies, to make the digital tracing tool accessible in Hawaii.

Oahu has implemented the application, which will improve the efficiency and quantity of data collection by public health staff. The digital tool is beneficial for departments that may not have enough manpower to conduct daily person-to-person contact tracings or for higher-risk areas.

With the application, the individuals being monitored would be responsible for inputting and uploading health status information via a five-minute online survey, which is transmitted directly and securely to the DOH.

Similar to a typical contact tracing interview conducted by epidemiologists, the survey would ask for a temperature reading and symptoms that could be signs of COVID-19 including fever, cough and shortness of breath.

The individual will be asked to provide an email or cellphone number to automatically receive a daily survey.

All information is encrypted to protect the privacy of the individual and will only be viewed by DOH staff and not shared with any other organization. The link expires after 24 hours, and responses are then stored on a secure privacy-compliant server.

Maui County’s current tracing procedures by DOH staff and the epidemiology team include notifying individuals and facilities of their possible exposure to a COVID-19 positive individual by phone. People contacted are required to quarantine at home and monitor their health for 14 days from the last contact with the case.

During self-isolation, DOH staff call both the COVID-19 positive individual and their contacts every day for symptom assessment and to ensure that they are taking two temperature checks daily.

These calls are also beneficial to hear out any additional concerns that the person may have, Hauptman said.

“If there is a positive case, and you had contact with that individual, or if you were at the same place at the same time as that individual, the Department of Health is working tirelessly to contact you and let you know about the potential exposure,” she said.

She added it’s also “absolutely vital” that people, businesses, schools, hospitals, airlines and other entities communicate any suspected cases and potential contacts, and to self-isolate immediately.

“We do have a system in place purely for the purpose of monitoring and tracking these individuals,” she said. “The scary thing about COVID-19 is that someone can be infected, but they don’t have any symptoms, they could be asymptomatic, and they could still be engaging in the community and spreading COVID-19 unknowingly.”

The DOH works collaboratively with the Maui Memorial Medical Center daily. The agency that completes the investigations and reaches out to potentially exposed individuals is determined on a case-by-case basis, she said.

Seriously ill patients likely end up at Maui Memorial. The hospital also has been connected to a cluster of cornoavirus cases involving more than 50 health care workers and patients.

Maui Health System spokeswoman Tracy Dallarda said Maui Memorial has its own contact tracing team (CTT) that is activated when a patient tests positive for COVID-19. Essentially, a master list is generated and sent to the DOH for community follow-up. This list is updated as people are discharged from the hospital.

“The team uses a multitude of avenues to collect possible contacts,” Dallarda said.

Once identification is complete, the tracing team reaches out to the manager/supervisor of the area in the hospital to assist in collecting any other names that may be missed.

Admitted patients are notified by their attending physician and outside agencies are notified by Maui Memorial.

“Those identified by any of the previous methods are sent a personal alert while units are sent a more general message that encourage people to reach out to the CTT if they have questions about possibly being exposed,” she said.

Maui Health’s electronic medical records system also has a new module called Bugsy, which can trace and verify patients as well as any possible roommates. The IT team can run different reports within the internal system to compare and verify names that Bugsy populates.

While positive case numbers and contact tracings are under control on Maui, Hauptman said that “we need to be very intentional and respectful of social distancing” when businesses begin to reopen.

After Maui County Mayor Michael Victorino on Wednesday announced the list of facilities and activities that may be authorized for reopening in the coming weeks, Hauptman suggested that each operation needs to have detailed protocols and policies, such as incorporating capacity limits, social distancing guidelines, and wearing personal protective equipment.

She said that the community also needs to continue being “very mindful that if you have symptoms, or if for whatever reason you think you’ve been infected, it’s really important to respect the community and acknowledge that you should be staying home even if society is carrying on.”

* Dakota Grossman can be reached at dgrossman@mauinews.com.

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