By JAN LARSON McLAUGHLIN
BG Independent News
A shift in COVID strategy is replacing much of contact tracing with personal accountability.
For nearly two years, health departments have been scrambling to track contact tracing of new COVID cases. But the practice is no longer effective and health services are urged to focus instead on outbreaks and more targeted case investigations involving vulnerable populations.
“As the pandemic has evolved, we want to direct resources to the best uses,” Wood County Health Commissioner Ben Robison said Monday afternoon. “We want to focus public health strategies on the most effective policies.”
Due to the shorter incubation period of the Omicron variant, only a very small portion of the total number of cases and close contacts are reached by public health contact tracers in time to prevent onward transmission.
Nationally, public health is being urged to shift gears. Proof of this locally is the “COVID Self-Help Resources” box people can click on the Wood County Health Department website: https://sites.google.com/view/wchdohio- coronavirus.
The self-help resources are intended to help people navigate the virus without direct contact with the health service. The resource box information is expected to be expanded in the future.
“We built this to answer questions in a very simple way,” Robison said. “We want to empower people to make decisions that will protect them. We want to empower people to make good decisions.
The self-help advice is the same as that given by contact tracers – on isolating others, who should be told about possible exposure, the best types of masks to wear, vaccinations and reminders, and on COVID testing and therapeutics.
“We knew that was something to come in this pandemic response,” Robison said. “The pandemic is still with us. We need people to take these steps individually.
Most local school districts have already announced that contact tracing efforts have been halted.
Contact tracing through the health service will still be done on a limited basis in the event of an outbreak or if the cases involve vulnerable populations, such as in a nursing home.
“Something where early intervention will help down the road,” Robison explained.
Wood County’s latest COVID case numbers show a steep decline.
The total number of new cases reported in the last seven days in the county was 908. This compares to 2,713 reported for the week leading up to January 20.
“Our cases are dropping very quickly,” Robison said Monday afternoon. “Things are definitely going in the right direction.”
But the downward trajectory has already been seen – to be followed by an increase.
“That doesn’t mean we won’t see a blip up,” he said. “As we turn the corner, we expect to see another surge in the next two weeks.”
Changing the statistics format
For nearly two years, the Wood County Health Department has been reporting updates on local COVID cases, deaths and hospitalizations every Monday and Thursday.
Recently, the health department changed its statistical reports to align with those of the state. Instead of reporting new numbers every three or four days, the numbers will spread out over two weeks, with a few daily updates. There will be some lag.
Statistics show that six COVID deaths were reported in the past week (although that doesn’t mean they happened in the past week.) The average age of those who died was 64.
Between Jan. 6 and Jan. 20, Wood County had 71 COVID hospitalizations, with the average age being 62. The age range of people hospitalized with COVID was 10 to 96 years old.
The new statistics which can be found at https://sites.google.com/view/wchdohio-coronavirus, also show specificities for age groups. For example, the number of COVID cases among those 19 and under is higher than in the past. Cases among people aged 20 to 39 accounted for a much higher percentage of these age groups than other ages. This coincides with lower vaccination rates among those ages, Robison said.
Importance of reminders
The more detailed statistics on local COVID cases underscore the value of tracking the first two hits with recall, Robison said.
“If you don’t have your booster, you miss the protection,” he said. “The benefit is greatest for those who have completed their vaccines.”
People who received the booster may be inconvenienced by COVID, but they are much less likely to experience severe symptoms.
“It lessens the impact of the disease if you get sick,” Robison said.
“We’re going to focus on increasing boosters,” he said.
National change in contact tracing
Here is the published information for national public health agencies on contact tracing:
Although universal case investigation and contact tracing was implemented in the spring of 2020 to slow the transmission of COVID-19, much has changed over the past year, which has required a revised public health approach. This includes the wide availability of vaccines, a better understanding of the epidemiology of the virus, and the emergence of the more infectious variant of Omicron.
While universal case investigation and contact tracing during the initial phase of the pandemic was warranted in the attempt to contain the pandemic, most public health experts agree that this is no longer optimal.
Many states and localities have already reduced or stopped universal case investigation and contact tracing for COVID-19. A number of scientific and other factors reduce the usefulness and feasibility of universal case investigation and contact tracing for every case of COVID-19.
These factors include:
- The large number of asymptomatic and less severe cases. This is due to changes in the virus and widespread vaccination in the United States
- Many infections are never identified by public health agencies because people with asymptomatic or mild cases may not be tested, as well as the increasing use of “over-the-counter” home tests, which usually go unreported. to public health agencies.
- The highest risk of transmission to others occurs before the onset of symptoms and during the first days of symptomatic illness (or immediately after the first positive test for those who remain asymptomatic).
- The shorter incubation period of the Omicron variant.
Therefore, only a very small portion of the total number of cases and close contacts are reached by public health contact tracers in time to prevent onward transmission.
Therefore, public health agencies should shift their resources to more effective strategies to mitigate the impact of COVID-19 by focusing surveillance and prevention efforts on the most serious consequences of COVID-19: hospitalizations and deaths. .
Moving forward, key public health strategies should include:
- Increase the number of people who are up to date on their COVID-19 vaccinations, including booster doses, especially for those at higher risk of serious outcomes.
- Strong message about the importance of effective mask wearing, especially in these times of increased community transmission.
- Target prevention strategies to the most vulnerable individuals, populations and settings, including testing, distribution of better quality masks and early access to antiviral treatments and monoclonal antibodies.
- Availability of testing to support treatment, as a risk mitigation strategy in congregate residential settings, and individual use to identify their risk of transmission and self-isolate appropriately.
- Conduct outbreak investigations and targeted case investigations, as needed, to prevent or understand disease transmission in high-risk settings, or among people with more severe illness or showing unusual symptoms.
- Introduce and improve environmental measures to reduce the transmission of pathogens by indoor aerosols (for example, improve indoor air quality through ventilation, filtration and/or other technologies; and recommend more formal indoor air quality standards).
It’s time to empower the public when they suspect a COVID-19 infection. If a person suspects COVID-19 infection, they should get tested, stay home to avoid transmission to others, promptly notify close contacts of their exposure, and seek health care to facilitate access to medical treatment if it is at higher risk of serious outcomes.
This information may be provided by methods that may be more likely to reach the public than standard public health contact tracing, including information provided at the time of testing (for example, educational inserts provided with test kits home) and leveraging automated SMS/call systems (such as exposure notification systems) that can reach people to alert them of their status and provide general advice. It remains essential to provide access to resources if necessary so that the public can safely isolate themselves from others.
Although it is no longer optimal for public health to universally investigate and monitor individual cases of COVID-19 and their contacts, contact tracing remains a necessary public health tool to interrupt the continued transmission of COVID. -19 and prevent disease in the most vulnerable populations, particularly in certain higher-risk congregate residential settings (shelters, correctional facilities, and retirement homes) or in other specific situations, such as outbreak investigations or if warranted due to concerning changes in the clinical or epidemiological characteristics of the virus.
Individual jurisdictions may also consider pursuing contact tracing in other settings, including schools and daycares, depending on local context, priorities and available resources. Public Health will continue to evaluate optimal COVID control strategies as the response evolves and will make strategic changes to prevent or reduce transmission.