Health District explores ways to ramp up contact tracing capacity

By Kelcie Grega

Saturday, May 16, 2020 | 2 a.m.

As the state moves forward with its multiphase reopening plan, the necessity to track where infected people have been will be just as important as more widespread testing, Las Vegas health experts say.

Since even before the first COVID-19 case in March, the Southern Nevada Health District had its staff monitor those traveling from where COVID-19 infections were more widespread.

Within six weeks of the first positive case, the Health District added an additional 57 staff — including some interns from UNLV — to bolster its contact tracing capacity, said Victoria Burris, the communicable disease supervisor.

With contact tracing, public health staff and volunteers can work with infected patients to identify everyone they’ve been in contact with, said Brian Labus, an epidemiology expert at the UNLV School of Public Health. The strategy has proven effective in countries like China, South Korea and Germany for handling the outbreak.

“In doing that, you can now intervene with all those people to try and stop the ongoing chain of transmission,” he said. “So you find all the people who were exposed and you have them quarantine and stop disease spread.”

But contact tracing in Nevada is only as effective as the state’s capacity to expand its public health workforce. The National Association of County and City Health Officials reported that there needs to be a minimum of 30 contact tracers per 100,000 people in order to effectively track the virus within a population. An association survey of state public health departments indicates that Nevada currently only has 2.5 contact tracers per 100,000 people.

“We fully understand that what we currently have for contact tracing is nowhere near enough,” Gov. Steve Sisolak said before entering Nevada into initial phase of its gradual reopening.

Burris said that staff at the Health District receives 100 to 150 coronavirus reports per day. While current staffing levels are able to manage these cases, the numbers will likely increase as testing becomes more widely available. Statewide, about 2,500 people a day are being tested, officials said. Of those, 9% are positive cases, Sisolak said Friday.

“Right now we’re meeting capacity but with changes in case counts and the additional testing in the community, we started planning early on how to meet the demands.” Burris said.

Southern Nevada’s capacity to expand its contact tracing workforce over the next several weeks will be crucial in better positioning it for reopening in the long run, Labus said.

“If you think about disease spreading through a population, these are the people looking at the links between people and breaking those links,” he said.

The Health District is working with its IT department to develop an automated notification system to help gather information from infected Las Vegas-area patients.

“As soon as we receive a report from a provider on a positive case, we would run that report through our automatic notification and be able to send a message out to that person after we verify their identity to make sure they’re notified of their results and give them an opportunity to respond through our online portal any information on contact,” she said.

Burris said they've considered using some members of the Nevada National Guard for contact tracing. They are also looking for volunteers — although the role isn’t for everyone, Burris said.

“We’re looking for people with some level of comfort talking about medical information and about a positive result,” she said. “There are some difficult situations our investigators have run into. You may be talking to someone who has lost a family member recently or is having trouble financially.”

Labus, who helped facilitate UNLV’s involvement, said there’s a great deal of training involved before becoming an effective investigator. Contact tracers also need to know what questions they should even be asking.

“You have to be willing to call someone out of the blue, telling them they are positive and then being a health educator,” he said. “Sometimes you’re interviewing someone and you come across something that’s a little weird. Your instinct should be to follow up on that.”

With COVID-19 having a 14-day incubation period, contact tracers only have a limited amount of time to notify the right people before it’s too late, Labus said.

“Simply passing someone in the grocery store is obviously not going to be the same risk as living with someone or working in an office with them,” he said. “We know which ones are high risk for transmission and go after those first.”

Casey Barber — one of the contact tracers from UNLV — said much of her job involves building trust with people as she tries to gather as much information as she can while also ensuring the person on the other line is comfortable disclosing that information.

"Sometimes it's just listening a little bit of where they may have gone and asking about that in an approachable way to try and get more information," she said. "I think every time we make a call, we learn how to do it better."

Language barriers have also proven a challenge for the Health District. While some contract tracers are bilingual, the district still needs to rely on translators to conduct contact tracing on certain populations, said Dr. Fermin Leguen, acting chief health officer at the Health District. This method is not ideal because when you use a translation service, you lose part of the rapport that you establish with the patient, he said.

“But that’s unfortunately the only option when we’re unable to match the volume of cases with the ability of speaking Spanish in the group, and the same happens if it’s, let’s say, Filipino or Chinese,” Leguen said.