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PLEASE NOTE: This section will be updated with additional Q & A as available. This is an ever-evolving situation and information is subject to update and change quickly.
What is contact tracing?
Contact tracing is the act of finding people who may have come into contact with a person infected with a disease (in this case, COVID-19), in order to notify those individuals so that they are aware they may have been exposed, can monitor themselves for symptoms, and know to stay at home to prevent the spread of the disease (quarantine). If you receive a positive COVID-19 test, you may get a call from the Department of Public Health asking about your symptoms and possible exposures.
Contact tracing is part of a process called case investigation. When the Department of Public Health (DPH) receives notification that an individual has tested positive for certain communicable diseases – called “notifiable diseases,” of which COVID-19 is one – a case investigation is initiated. This means that a local epidemiologist or communicable disease specialist calls the person who tested positive, provides them with education about what they need to do to prevent the spread of the disease, and conducts an extensive interview with the person. In the case of COVID-19, one of the important outcomes of the interview is identifying people who may have come into contact with a person who tested positive so that they can be notified and take recommended next steps.
Contact tracing is a normal function of Public Health, and our local epidemiology team routinely performs contact tracing for a variety of infectious diseases. Contact tracing for COVID-19 has been ongoing since the virus was first detected in Georgia.
How does case investigation and contact tracing for COVID-19 work locally?
When a person is tested for COVID-19, the healthcare provider that administered the test must report the results to the Department of Public Health (DPH). When the Northeast Health District – the local branch of the Department of Public Health – receives notification of a positive test result for COVID-19, a member of our Epidemiology team reaches out to the individual who tested positive to provide education on how the person can protect their health and the health of others, including isolation and quarantine (staying home to prevent the spread to others). They also interview the person who tested positive to determine the need for additional outreach and notification of people who were in close contact. This is referred to as case investigation. After the initial case investigation, our team notifies close contacts of the individual who tested positive, provides education to them, and enrolls them in a self-monitoring program to ensure they know what to do if they develop symptoms of COVID-19. This process is referred to as contact tracing.
Who is responsible for case investigation and contact tracing?
The Georgia Department of Public Health (DPH) has both the legal authority and the legal requirement to perform case investigation and contact tracing for communicable diseases, including COVID-19. Schools, universities, and employers may assist DPH with case investigation and contact tracing, but DPH is ultimately responsible for both.
What kind of questions are asked during a case investigation interview or during contact tracing?
Contact tracers ask for things like date of birth, email address, and other personally identifying information, but they will never ask for credit card or Social Security numbers.
Close contacts are identified during phone interviews with individuals who have tested positive for COVID-19. Patients being interviewed are asked to provide the name, phone number, and dates of exposure of close contacts. Someone is considered a close contact if they were within six feet of the person who tested positive for more than 15 minutes while the person who tested positive was infectious.
An individual is considered infectious for two days prior to symptom onset (or two days prior to when the individual was tested, if no symptoms) and for 10 days after (12 days total).
With this information, a contact tracer is able to call close contacts and provide notification that they have been exposed to COVID-19. Contact tracers may leave voicemails and send texts if the initial attempts go unanswered. Information about exposure is never given out until the exposed individual is reached by phone call.
Is contact tracing confidential?
Test results for COVID-19 are treated as protected health information (PHI), which means that they are only disclosed when necessary as a part of preventing or controlling the spread of the disease. HIPAA regulations generally allow disclosure if there is a serious and imminent threat to the safety of others, and the disclosure is to someone who is in a position to prevent or lessen the threat (45 CFR 164.512(j)).
Every effort is made to protect patient privacy during contact tracing, and only the minimum amount of information that is necessary for appropriate intervention to prevent or control the spread of COVID-19 is disclosed.
How many contact tracers are responding to COVID-19 locally? Do we have enough?
There are approximately 75 individuals assigned to our Epidemiology unit who handle case investigation and contact tracing related to COVID-19 for our 10-county area. Contact tracers and case investigators respond to reports of positive test results as they arrive. It is important to note that in many situations, a connection to a particular location or institution can only be determined by an interview with the person who tested positive.
Although the team we have now is very successfully managing the current case flow, we are expanding our staff to be ready for the possibility of future increases. We evaluate staffing needs on an ongoing basis and will continue to adjust levels as needed.
What does a normal day for a contact tracer look like?
Contact tracers work 100% remotely. The average day includes both notifying new contacts of an exposure, and following up with individuals who have already been notified and enrolling them in daily symptom monitoring.
The number of case investigation calls that a team member performs daily varies greatly depending on the responsiveness of cases to outreach efforts and the complexity of case circumstances. Case investigators would generally be expected to manage from 8-25 cases per day. The number of close contacts that can be handled varies even more widely, and individuals performing contact tracing may call anywhere between 30-50 contacts per day.
Contact tracers are responsible for calling all new contacts identified during case interviews and giving notification that they have been exposed and are at risk of getting sick. They also provide guidance for the exposed person to self-quarantine for 14 days from the date of exposure. (Note: Critical infrastructure workers may be permitted to continue to work following exposure to COVID-19 as long as they wear a mask, do not develop symptoms, and follow additional guidance.)
After answering any initial questions, contact tracers enroll the exposed individual into the symptom monitoring program, which sends a text each day to check in with the exposed person to ask about their symptoms. Patients may also choose to receive a daily call from a contact tracer to inquire about symptoms or call in themselves.
Once somebody is enrolled in symptom monitoring, they report their symptoms daily until the end of their monitoring period (14 days after their last exposure). If they respond that they are having symptoms, contact tracers can refer them to be tested and provide additional guidance for them and their families.
I would like to help with contact tracing – how can I do that?
The handling of protected health information requires authorization and access to systems dedicated to maintaining the security of that information, and individuals performing case investigation and contact tracing must receive specialized training on these systems. For these reasons, only employees of the Northeast Health District perform case investigation and contact tracing; these critical functions are not delegated to outside organizations.
Individuals interested in applying for a position with the Northeast Health District can review job descriptions and apply on the DPH website.
I tested positive for COVID-19, but I didn’t get a call from DPH. Why?
COVID-19 is a notifiable disease, which means that by law, any positive cases must be reported to DPH. In some instances, the reporting process may take several days in addition to the processing time for the test results. Due to the length of time a person is infectious, contact tracing is only useful within a specific window of time after a person is identified to have COVID-19 based on either symptom onset or the date of test. After that timeframe, the infectious period has passed and contact tracing would not assist in preventing possible spread of the disease. In order to be effective, contact tracing requires the timely reporting of test results.
How does contact tracing at the University of Georgia work?
The University of Georgia has implemented a COVID-19 reporting tool – DawgCheck – that can be accessed at https://dawgcheck.uga.edu or through a mobile app, to facilitate information sharing with the Georgia Department of Public Health (DPH)’s Northeast Health District. Any UGA student, employee, or other UGA-affiliate with a positive COVID-19 test is required to report the positive result through DawgCheck. Positive tests are reported through DawgCheck from any of the approximately 50,000 faculty, staff, and students connected with the University of Georgia, regardless of location.
DPH may first receive notification of a positive test result from either DawgCheck or the State Electronic Notifiable Disease Surveillance System (SENDSS). If received from SENDSS, DPH will initiate a case investigation. If received from DawgCheck, DPH will link the self-reported information from DawgCheck to the validated positive test result reported through SENDSS once it becomes available. Upon confirmation of a positive test result in SENDSS, a member of our epidemiology unit contacts the person who tested positive. If a DawgCheck report was submitted, the information is used to guide case investigation and contact tracing.
DawgCheck is a supplemental tool, and information provided through DawgCheck facilitates case investigation by DPH but does not replace it. Because DPH is legally required to perform contact tracing, it is important that schools and universities not duplicate the process, as multiple requests for the same information may make people who have tested positive or been exposed to COVID-19 less receptive to the contact tracing efforts DPH is required to perform. Schools, universities, and employers may assist DPH with case investigation and contact tracing, but DPH is ultimately responsible for both.
Are positive COVID-19 cases among UGA students counted in the case reports for Clarke County or are they reported for the county of the student’s permanent address?
Residence is defined as where a person lives most of the year. Although the initial report may list an individual’s permanent address, if case investigation determines the individual lives on or near campus, the case will be reported in the case numbers for Clarke County. Case counts on the DPH Daily Status Report are subject to change as result of these investigations and corrections.