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Tracing COVID across Jo Daviess County: Schleicher, Stangl and Sanders work on identifying contacts during pandemic

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GALENA–Contact tracing and quarantining have been buzz words this year that are critical in the county’s fight against COVID-19.

Jo Daviess County Health Department Director of Clinical Services Lori Stangl and Samantha Sanders, emergency response coordinator, have spent most of their time recently contacting individuals who were in contact with someone who tested positive for COVID.

 

Contact tracing

The health department gets faxed, called or emailed about a positive result depending on where the test was administered. For example, a positive test at Midwest Medical Center is faxed to the health department office.

Sanders emphasized that those who have been tested should wait until they get their results before being in contact with others.

Stangl and Sanders then contact the positive case and interview the individual to gather a list of contacts from two days before symptoms or two days before the test.

“Some seem to want to contact individuals themselves and then we follow up with the contact to explain it and tell them what we are asking,” said public health administrator Sandra Schleicher.

“I do empower the person who has it to call the contacts themselves, because then the people have a heads up and they know who it is,” said Stangl. “We can’t identify who it is; we can only identify that they were a contact for someone who has tested positive for a COVID test and tell them the date of the contact.”

Schleicher said the health department will only contact those individuals identified to the department.

Stangl will then ask if the contact has any signs or symptoms of COVID, and in that process, Stangl has noticed many people don’t understand the symptoms of COVID.

After Stangl goes through the information, she then explains the quarantine process to the individual.

The health department utilizes the state’s contact tracing application, SalesForce. Information, including a phone number or email, is entered. Through these modes of contact, the contact completes a health evaluation every morning so that the symptoms and severity of COVID are monitored.

“Most people consent, but it is the best way that we can do any type of monitoring, especially now that we are dealing with schools that have several people on quarantine. It is not manageable,” said Stangl. “The system is much better than us calling every person, every day. At the end of their quarantine the system will generate a letter that will release them to either go back to work or to go back to school.”

Stangl said that the responses to certain questions trigger the case to be escalated, and Stangl and Sanders touch base with that person. Those who are a contact and form symptoms are contacted as well because of a change to their isolation protocol.

Those who do get notified as a contact do not have to be tested initially, but Stangl said there has been mixed messaging from different government agencies on that matter.

The Jo Daviess County Health Department is still advocating for individuals to be tested when testing is available.

“We need to make sure that people know that if you are in quarantine because you are a contact and you test negative, that does not mean that your quarantine is over,” said Stangl. “You still have to stay in quarantine because a negative is just a negative in that moment in time. You have to stay for those 14 days.”

Stangl said if a person had a good exposure to someone who is positive and it has been 5-7 days since that contact, testing is a good thing because then the individual will know, especially if asymptomatic.

“Even then, if you are quarantined, you shouldn’t be spreading it,” said Stangl.

 

Quarantining

Those who are contacted are asked to quarantine for 14 days.

“We ask that they do not go out in public for 14 days from their last known exposure to a person that is positive,” said Stangl.

Those under quarantine monitor their health and answer the daily health questions for the department.

Stangl said the only exception to the quarantine rule is when an individual who is quarantined works in a critical infrastructure job.

“The CDC has listed a certain amount of businesses that are critical infrastructure,” said Stangl. “The one that best comes to mind for this area are health care workers.”

There are 16 sectors that are listed under this category. They are chemical, commercial facilities, communications, critical manufacturing, dams, defense industrial base, emergency services, financial services, food and agriculture, government facilities, health care and public health, information technology, nuclear reactors, materials and waste, transportation systems and water and wastewater systems.

These sectors can be quarantined and still are allowed to go to work.

“The mindset is that most people in health care, their employers should already have a pretty good system and will be in proper personal protective equipment and if they do become symptomatic, they will minimize any chance for infection,” said Stangl.

Stangl said that even if individuals are allowed to go to work, which is under the directive of the critical infrastructure employer, they are still required to only go from home to work and back.

“They aren’t allowed to go to Walmart or anything like that. The only time that they can leave is for that critical infrastructure job,” said Stangl.

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Stangl said some employers in the area have mandated that those in quarantine go to work because they consider their work as critical infrastructure work.

“That makes it a little bit more challenging for us, but we don’t see that as much,” said Stangl.

The health department is concerned about many people that might not be abiding by quarantine guidelines and may try to get off of quarantine before those 14 days are over.

“If you are on quarantine, please stay on quarantine,” said Stangl. “I know everybody, and people will tell me about people that they see. Of course I can’t speak to that, but there is only so much that the three of us can do. We can’t police everybody.”

Schleicher said she would prefer to not go the legal route and hopes that people will abide by their guidance.

“I know there are people that think that certain people should be on quarantine, but they don’t know the whole situation,” said Stangl. “In fact, if someone actually has it, their isolation is less than someone that is in quarantine.”

Stangl said she hasn’t seen much push back from those who are contacted and told to quarantine.

Families can be a challenge.

“If you have someone in the household that has the disease and they are on isolation and they can’t totally isolate themselves from the family, that family has to stay quarantined for possibly up to 24 days, because they have to start their 14-day quarantine after their last day of exposure to the infected person,” said Stangl.

Stangl said the first thing that the health department asks is if the individual is able to isolate themselves and not expose their family moving forward.

“If they can, then we use that date as the quarantine date for the family from that day forward,” said Stangl. “If they can’t, then their quarantine day starts on day 10, after that person is out of their isolation. That is when people are caught off guard.”

Another challenge for the health department is the mixed messaging across state lines.

“We have been trying to communicate with Midwest Medical Center and Medical Associates because there is a lot of difference with Iowa and we are running into that,” said Schleicher. “They are releasing a lot of different dates and our guidance is 14 days. This is what we are telling people, so we are communicating with them to tell their patients the same thing.”

 

Schools

As schools return to in-person learning, the health department has increased the number of contacts that they are to monitor in the county. Stangl and Sanders typically receive a call every day from a school in the county.

“School nurses and superintendents have been very helpful,” said Schleicher. “They gather all of the names together and get them to us. They typically provide the initial communication and then we will add them to the system to follow up.”

Schleicher said that the people who have to quarantine or are contacted depends on the contact.

“It is just the contact typically, we don’t do contacts of contacts,” said Schleicher. “Unless that person would develop symptoms, then we would go farther. If a kid gets sent home from school, they have to take all of their siblings with them until we know what the diagnosis is. There may be a short time that everyone is quarantined, but for the most part, it is just the contacts.”

Stangl said the schools being in session has increased the workload.

“It makes it challenging,” said Stangl. “Right now, our main job is managing COVID-19, whether it’s contact tracing or the COVID-19 vaccination plan that we need to work on and have in order.”

The number of contacts has increased as more and more people are out and about and especially since school began.

In the beginning, when Schleicher was the lone contact tracer, there would be one to three contacts per case.

Schleicher said that now it isn’t a surprise if someone has upwards of 40 contacts.

“You are out and about that much more and you are going to expose that many more people,” said Schleicher. “It definitely adds to the workload.”

The health department does not enforce schools’ direction on going virtual, but talks to district officials to consult them on the matter.

“It is still up to the school to decide,” said Schleicher.

According to Schleicher, the state is working on more metrics that focus on schools.

“It changes so much because if there is an outbreak in one place, that will make our numbers go crazy, but that might not have an impact on the school,” said Schleicher. “They have to look at what is actually going on before they make that decision.”

Schleicher said the department still has regular correspondence with all of the schools.

“I am super impressed with all of the schools,” said Stangl. “The efforts that they are taking in the communication with us and the communication with the parents, they are all doing a phenomenal job and they are doing their best to have the kids in school. I give kudos to them for everything they are doing.”

Stangl feels people in all health care fields across the county are doing all they can to help mitigate the spread and to keep people safe.

“I think everybody for the most part is doing the best that we can do,” said Stangl.

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