Lexington Health Dept. stops contact tracing as COVID-19 cases balloon. What that means.
“Sustained transmission” of novel coronavirus is now evident in Lexington. That means local public health officials will no longer retroactively trace everyone who came into direct contact with an infected person, signaling a strain on already limited resources as public health officials respond to the county’s ballooning number of cases.
Sustained transmission refers to positive cases that “do not have any connection to previously known cases or have traveled outside the community,” Lexington-Fayette County Public Health Commissioner Dr. Kraig Humbaugh said Tuesday, barely two weeks after Lexington confirmed its first case.
“Because we are getting more cases, and each one has its own contacts, sometimes many, the department will be concentrating more on just the [confirmed] cases,” he said.
And going forward, rather than rely on local epidemiologists to track down and then for health care providers to monitor each person who came into direct contact with someone infected, it will be incumbent upon the actual person to notify anyone they may have infected. Contact tracing will still be done with people exposed in a “sensitive” setting, such as health care workers, first responders, or the homeless.
Otherwise, “we will be starting to ask the actual cases to talk to their close contacts and forward information about quarantine” as it’s quickly going to become “impossible for us to monitor hundreds of people in quarantine,” Humbaugh said.
The change to the practice, known as contact tracing, came Tuesday when the county saw its number of confirmed COVID-19 cases double overnight to 28, which included an 82-year-old woman who had underlying health issues and died after contracting the respiratory disease. So far in Kentucky, 163 people are known to have been infected with the virus.
Lexington public officials continue to echo directives from Gov. Andy Beshear to severely limit all social interactions, even those with fewer than 10 people.
In a press release Tuesday afternoon, public health department spokesman Kevin Hall said “recent cases of COVID-19 confirmed in Lexington came from a small party in which a person without symptoms unknowingly spread it to others. This is why it is important for everyone – whether they’re sick, symptomatic or seemingly fine – to follow the public health guidelines by staying home.”
The public health shift in contact tracing is part of a broader department shift from a “containment” phase to a “mitigation” phase, Humbaugh said. “We need to switch our strategy somewhat from trying to contain, to trying to slow the spread.”
Previously, if public health officials discerned, for example, 10 people had direct contact with someone positively diagnosed with COVID-19, each of those 10 would sign a written electronic agreement with the Lexington-Fayette County health department to self-quarantine at home for 14 days. Part of that included acknowledging, too, that, “I am a possible source of infection of a communicable disease,” according to a copy of the agreement.
Those actually infected who aren’t sick enough to be hospitalized sign a separate agreement, agreeing to self-isolate at home, acknowledging that they are a carrier who will cause spread of the disease. Leaving their home, “would create a serious risk and injury to the health of those individuals with whom I come into contact with, as well as the public at large,” according to a copy of that agreement.
Neither the infected nor exposed are allowed to leave Lexington while they’re being monitored, and they’re not allowed to ride in an ambulance or public transportation without public health staff permission.
Going forward, those who’ve had direct contact with an infected person are still required to self-quarantine with monitoring by public health staff, but since initiation of that process won’t fall to trained epidemiologists diligently tracking people down through contact tracing, but to the infected person, there are bound to be oversights.
In the early stages of infectious disease spread, contact tracing can be a crucial mitigation tactic. Exhaustive contact tracing, which takes tremendous amounts of time and resources, can theoretically lead epidemiologists back to a first carrier of a disease, sometimes referred to as patient zero.
Local epidemiologists in recent weeks have been tracking down dozens of people who may have brushed shoulders with someone infected, both to notify them of possible transmission, and to better determine who may have spread the virus.
Last week when Fayette County only had seven confirmed cases, the Herald-Leader asked readers to picture the process as a spider web, with an infected person at the center. Each strand of the web represents a different person someone infected had contact with, and others those people had contact with, and so on. For each of the seven patients diagnosed, epidemiologists contacted between 10 and 20 people about possible exposure.
In connection with the 28 cases confirmed so far in the county, the public health department has issued between 75 and 100 self-quarantine orders to people who were in direct contact with those infected, Humbaugh said.
Public health officials are still currently monitoring all of them, including those infected, who all still have symptoms, he said. That’s not unexpected, since it takes typically around 14 days for the virus to run its course, and Kentucky’s first case was announced just over two weeks ago.
Both the infected and the potentially infected are required to check in daily by phone with health department staff, and those infected must “self-report” their temperature and any symptoms. If someone’s symptoms are getting worse and they need medical attention, they must tell public health first, according to each form.
Violation of the daily check-in triggers the health department’s “right to enter the premises and verify the foregoing symptomatic information,” according to both forms.
One is considered in the clear if no symptoms flare up within 14 days, or once an infected person stops running a fever and showing symptoms for 72 hours, Humbaugh said.
This story was originally published March 24, 2020 at 5:39 PM.
