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Episode 53: Understanding COVID-19 Contact Tracing in Our Schools

What is contact tracing and how does it work when someone tests positive for COVID-19 in our schools? On this episode of the Supercast, we talk with Salt Lake County Health Department Epidemiologist Annie George who explains the process of contact tracing and how parents can track COVID-19 cases daily by using a COVID-19 Data Dashboard established by Salt Lake County Health.

Superintendent Godfrey:
Hello and welcome to the Supercast. I'm your host, Superintendent Anthony Godfrey. What is contact tracing and how does it work when someone tests positive for COVID-19 in our schools? On this episode of the Supercast, we talk with Salt Lake County Health Department Epidemiologist Annie George, who explains the process of contact tracing and how parents can keep track of COVID-19 cases, data by using a COVID-19 Data Dashboard established by Salt Lake County Health. Annie, thanks very much for taking the time. Let's just start out by talking about contact tracing. Why is it important to do contact tracing to keep everyone safe in our schools?

Annie George:
That's an excellent question. The goal of contact tracing is to stop the spread of a disease. We actually use it for other diseases besides COVID. But the goal there is to let people know who have been exposed to the disease so they can take the appropriate precautions to hopefully contain the spread.

Superintendent Godfrey:
How does contact tracing work?

Annie George:
Specifically for COVID, we look at those who have been in close contact with an individual who's tested positive. We define close contact as within six feet of someone and then if the duration is for longer than 15 minutes. We also are putting in the caveat that this is with or without a mask. We get a lot of questions about that.

Superintendent Godfrey:
Why are we wearing masks if we still have to quarantine?

Annie George:
So, as a lot of studies that have come out recently have shown, not all masks are created equal. Some of them are more effective than others, depending on what they're made out of. And also, it requires the people to be wearing their masks correctly. I've seen as I've gone about out in the community lately, there are a lot of people that will just wear the masks over their mouths with their noses are sticking out. To kind of mitigate the risk there, we keep to that definition of within six feet for longer than 15 minutes.

Superintendent Godfrey:
I have a couple of follow-up questions on that. First of all, I've heard some confusion over time about whether those 15 minutes have to be consecutive or not.

Annie George:
Yes, that's generally the guidelines we use, if it's been consecutive.

Superintendent Godfrey:
So for the most part, it's 15 consecutive minutes, that's the threshold you're looking at to determine whether someone has really, truly been exposed to the Coronavirus or not.

Annie George:
Yes. There’re risk levels that we assign.  Anybody that's over the 15 minutes in a consecutive time block would be considered risk. If it's anything less than 15 minutes, it's considered a lower risk exposure.

Superintendent Godfrey:
My other question is about the masks themselves. You mentioned, of course, that all masks are not created equal, and also the way that masks are worn will vary from person to person. So, wearing the mask is still very important because it helps prevent the spread. But because you don't know exactly how the mask was worn, that doesn't eliminate the risk when you're doing contact tracing.

Annie George:
That's correct. We still very strongly encourage people to wear masks and to wear them correctly because it does help with the spread. So yes, we still do encourage that.

Superintendent Godfrey:
Besides wearing the mask over the mouth and nose, are there other things that people need to be thinking about as they are wearing their mask?

Annie George:
I think most importantly, make sure you can breathe in it. That's important. And then make sure it's got a good fit on your face. If you're breathing too easily and it's not covering adequately and then it's probably not doing its job. Make sure it's got a good fit. You don't want to be putting an adult size mask on a kid because odds are, it's not going to be a good fit.

Superintendent Godfrey:
Okay. Thank you. Going back to contact tracing, does contact tracing help everyone, students, teachers, other employees?

Annie George:
It does. It absolutely does. So, if those that have been exposed to the disease or have the disease are removed from an environment, the risk of spread goes down greatly. So, it absolutely does help.

Superintendent Godfrey:
What are some of the questions that people are asked when you're doing contact tracing? As you mentioned, is it just how long they were around a person who we know is infected? Whether they were both wearing a mask doesn't change things? What are some of the other questions that we've, that we've asked?

Annie George:
At the Health Department, we primarily focus on contacts that these people have had. How many people live in their household? For adults we ask if they have a job or with high school students, a lot of them could have jobs as well. We ask about employment. We do notify workplaces so they can take appropriate precautions as well. If they've been there within 48 hours prior to their symptom onset, we've asked about where they've been. We need to know if they've been in a healthcare setting previously or just their whereabouts so we can track where they've been and notify those that need to be notified.

Superintendent Godfrey:
If someone has been exposed, they would be quarantined, and those who are infected may be isolated. Is that correct?

Annie George:
Yes, you got it.

Superintendent Godfrey:
We do hear confusion about those two terms a fair amount. Would you define for us what those two means?

Annie George:
Sure. Like you said, we call it isolation if you are either diagnosed with the disease. You have to be sick to be on isolation, when you're either diagnosed with the disease or you're symptomatic, or maybe you're waiting for a test result to come back. That would be considered isolation. For quarantine, it's that you have a known exposure with an individual that has the virus, but you are not, or maybe are not yet exhibiting symptoms.

Superintendent Godfrey:
That's the difference between isolation and quarantine. There's a difference in length also, though isolation tends to be 10 days, quarantine is 14 days. Why the difference?

Annie George:
Isolation will necessarily be limited to 10 days. It can be longer than that. We're waiting for this person's symptoms to resolve and for every person, that's different. One of the things that we thought was very strange about COVID to begin with was people would start to show kind of milder symptoms towards the beginning and then between days like 5 to 10.  Sometimes people would just tank and get a whole lot worse and maybe end up in the hospital. So that's what we're watching out for. The technical definition is, you can't have a fever for 24 hours before you can return to school or work. And that needs to be without the use of Tylenol or other fever, reducing medication. It might not necessarily be 10 days. It could be longer than that. But that's kind of the baseline of the majority, looking at the collected data, looking at the majority of cases, most people's symptoms resolved by date day 10.

Superintendent Godfrey:
That's isolation, specifically, that you're talking about?

Annie George:
Yes. For isolation. So that is based off of a disease's incubation period. Again, from looking at research, it has been decided that the incubation period is 14 days. They have had a case where someone was exposed and went home and quarantined like they should, and they developed the coronavirus on day 13, after they hadn't had exposure to anybody else. So, it is possible for it to take that long.

Superintendent Godfrey:
Is that super common?

Annie George:
No, generally not. If people are going to develop symptoms, it's typically quicker than that.  But that's why we use the length of the disease infection or infection period to determine that.

Superintendent Godfrey:
So, 14 days is the time it can take to develop those symptoms. But many times it will happen at least a few days earlier than that. Okay, now the Salt Lake County Health Department launched a Data Dashboard for the county. Can you tell us how to access that and tell us a little bit about the information that's presented there?  There's a lot of information, not just about schools, but about the county, more broadly.

Annie George:
Yes. So the Dashboard itself was launched several months ago. The school's specific portion was what was launched last week. It can be found on our website at slc.org/health/. There's a Coronavirus information page you can click on. I'm actually part of the team that helped develop it. So it's been kind of an interesting process we've gone on through the months. We've determined different needs that we have. We've made a lot of changes to the Dashboard, but if you haven't had a chance to check it out, I would greatly encourage it. There's a lot of very helpful information on there. Our goal in developing the Dashboard Board was to be transparent about the number of cases that we have.

We've had a lot of people criticize that scene. That's not really the number of total cases. That's actually just the number of positive tests and people can test positive for a long time. We've already taken that into consideration, and those are actual case count numbers of people that have had Coronavirus within Salt Lake County. We also have provided the ability on there for people to drill down to smaller than just the County level data. The State Health Department also has a Dashboard and it's all County-level data, but we wanted to give Salt Lake County residents the ability to drill down to smaller level data. You can actually look at city level data. You can look at zip code, and specific data for the larger cities that encompass multiple zip codes.

So there is a lot of data that shows our case counts every day. It shows outbreak information as well. And then, like you said, last week, we rolled out a new school site. We've had this question a lot. Parents will call in and say their kid's school isn't on there.

Superintendent Godfrey:
So how is this accurate?

Annie George:
It's actually a good thing if your kid's school isn't on there. That means that there are no cases at the school, which is what we want to see. So other than that, we don't show exact case counts at the school level due to privacy concerns. We use the 15, either less than 15 or greater than, or equal to 15 threshold that was developed by State leadership to kind of mask the exact number of cases. The exact case count of every school district is available on there. It's a good resource. I think that I would encourage parents to look at it.

Superintendent Godfrey:
How frequently is the Data Dashboard updated, and at what time of day?

Annie George:
It's updated every day, Monday through Saturday, and the update refreshes every day at 2:00 PM. If you get on site a little after two, it should be up to date. It encompasses data up through midnight the night before. So you won't have any data from today on there. It will all be yesterday's data.  When the number of cases or any of the information is posted on there, it's really from the previous day up through midnight.

We'll take a quick break and when we come back, more with Annie George, Infectious Disease Epidemiologist with Salt Lake County Health.

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Superintendent Godfrey:
I'm sure you're getting a lot of calls. You've had a lot of conversations with people and a lot of different circumstances. Tell me, what are some of the misconceptions that you're hearing out there?

Annie George:
One of the big ones is that this doesn't affect children, but it's not something that we have a clear answer on. If you think back to the beginning of this, when Coronavirus first arrived on US soil, one of the first things that we shut down was our schools to help eliminate the risk of spread there in school. That's still kind of an unknown that I think people need to consider. We know there hasn't been nearly as many fatalities in children and that's something that is excellent, but we also still have to keep in mind that asymptomatic transmission does occur. It's also kind of scary going when kids maybe get home from school and their parents aren't there yet, and they go visit grandma and grandpa for a while. They're interacting with the high-risk population. So, I think those are all things that need to be kept on people's radar.

Superintendent Godfrey:
Any other misconceptions or common questions that you're getting?

Annie George:
Sure, we had a lot when the CDC released data about the 6% of deaths. That was the only number they had where Coronaviruses was specifically listed on people's death certificates. We had a lot of questions around that, whether really the number of the 244 deaths listed on Salt Lake County Health Department's Dashboard was really only 6% accurate, and that is not true. I think what people need to know about it is that the number is likely very under-reported. Sometimes the main cause of will be that a person has a cardiovascular issue or acute respiratory failure or something like that. And those can all be conditions as a result of having COVID-19.

So, I think that's one of the big misconceptions that we've dealt with as of late. Another one that's been in the media is that they hope to have a vaccine rolled out at the beginning of November and people are kind of holding onto that date. But people need to be aware that, even if that does come to fruition, we've seen in some of the vaccine trials that there's been a delay because of adverse reactions. So even if one does make it on the market by November 1st, it's not like there's going to be enough to go around. We're kind of in a holding pattern until enough of the vaccine is available. So, if you want an example of that, we also track influenza cases very heavily here at the Health Department, and every year the CDC meets in February. The flu season isn't even technically over yet, but in order to make enough vaccines for the next flu season, they meet in February and decide what strains are going to be included in that virus because it takes that amount of time from February until they roll them out, in generally August, to create that many vaccines. So, I don't want people to have false hopes that come mid-November, we're all going to be trolling back to our lives as normal. I don't think that's going to happen.

Superintendent Godfrey:
We're all learning a lot through this pandemic. If we look back to Friday the 13th of March, when we closed schools, there's a lot we've learned since then. What are some of the lessons that you would share with parents and employees who might be listening to the podcast?

Annie George:
I think one of the biggest things is that our message really hasn't changed over that course of time. There's been some small things, but we are encouraging very same things that we were encouraging at the beginning. Wearing masks, that criteria came a little bit later, but really, making sure that you're washing your hands and using appropriate respiratory etiquette. Covering your mouth when you sneeze or cough and making sure that you wash your hands frequently. That message has not changed.

And, as this has kind of gone on, we've learned about social distancing. I think that has surprised me almost more than anything, the importance of social distancing. Because I am involved in pulling the Dashboard Data and updating that every day, I see the spikes that happen after every holiday or we'll see evidence after a family reunion at Bear Lake. We've seen where people, a lot of people are gathered close together, how very quickly it can spread,

Superintendent Godfrey:
What are some of the really positive things that you've seen in terms of the way people have reacted and kind of risen to the challenge of trying to manage the pandemic?

Annie George:
I think that's one of the things that has inspired me most. Watching the unified effort that has taken place to fight Coronavirus. I saw that here at the Health Department level where we pulled in everybody. They stopped doing their normal day jobs and came to help us out. We had environmental health scientists that are normally watching air quality or doing restaurant inspections. They came to help us contact trace because the Infectious Disease, Epidemiology Bureau simply couldn't keep up with the demand anymore to do contact tracing. That's given us an opportunity to interact with people from other areas of the Health Department. We were all unified in an effort and that was empowering because, to be quite honest, it's been very difficult. We have worked really long hours and it's been for months now. So, it does put kind of a drain on you after a while, but it's also been empowering that we're all after the same mission. We've also had that experience to interact with other people in the community through this. I've worked with a lot of first responders, getting them data to help keep them safe. Being able to develop new community partnerships as well, has been awesome.

Superintendent Godfrey:
I've observed the same thing. Employees, parents, students, members of the community, just pitching in to make the best of things and it's really inspiring to see. Annie, thank you very much for joining us. We really appreciate your time. Annie George, Infectious Disease Epidemiologist with Salt Lake County Health Department, thanks again for being on the Supercast.

Annie George:
You're welcome.

Superintendent Godfrey:
Thanks for joining us on another episode of the Supercast and remember, education is the most important thing you'll do today. We'll see out there.

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