School cases help fuel renewed COVID-19 contact tracing delays

The delta wave of the coronavirus has overwhelmed Nevada health districts charged with notifying the close contacts of people testing positive for COVID-19 that they may have been exposed to the disease.

“Over the last few weeks with the spike, we are, unfortunately, having a backlog again,” said Devin Raman, a senior disease investigator with the Southern Nevada Health District.

District disease investigators interview people who test positive to determine with whom they may have been in close contact when they were contagious. Contact tracers then inform these close contacts of their exposure, so that they can self-quarantine or take other steps to stop spread of the disease.

By adding staff, automating some functions and other measures, Clark County’s health district has less of a backlog than it did during the wave last summer.

“It’s not where we hoped we would be at this time, going on eight months after having the vaccine available,” Raman said.

Raman says the lag time in notifying close contacts can be several days or longer, depending on a variety of factors, including how quickly the person who has tested positive returns the health district’s calls.

New cases, though declining, averaged well over 600 per day in the county over the last week, forcing the district to prioritize which cases get handled first by its 250 contact tracers. With kids back in school, a top priority is cases involving school-age children.

School cases prioritized

With these cases, “Early notification allows parents and guardians to quickly intervene by making complex decisions for their families in proactive ways leading to less exposure in classrooms,” Stephanie Bethel, a health district representative, said in an email. “If a contact is made aware of an exposure, they are more likely to self-quarantine and/or monitor themselves for COVID symptoms and seek testing.

Bethen said people who test positive are notified via text message within 24 hours after test results are received, provided that their contact information is accurate.

“The notification advises close contacts who might be asymptomatic to stay home if they are unvaccinated or if they are experiencing symptoms to stay home as well.”

The Clark County School District, which works with the health district to trace possible COVID-19 exposures, declined to comment, instead directing a reporter to an FAQ on its website.

Report school COVID-19 positives at schooltips@reviewjournal.com

Despite the efforts to speed notification in school-related cases, some teachers have complained about notification delays.

At a Clark County School Board meeting on Aug. 26, educator Hannah Comroe called on the district to be more transparenent with COVID-19 case numbers per school and districtwide.

She also said there’s a need to be faster in contacting families so that COVID-19 doesn’t continue to spread throughout a school.

“Those in close contact to others who are confirmed positive are not getting notified until days later,” Comroe said. “This is unacceptable.”

Bethel said health district and school district staff are working side by side to conduct the tracing as quickly as possible.

“The teams work together to investigate case reports and contacts that may have been exposed on-campus or during school district-related events, and that are received directly by the school district,” Bethel said via email.

The health district “also works with the school district team to investigate cases that are beyond the scope of the school district team and are generated from the health district’s own community contact tracing and case investigation efforts.”

The health district has dedicated nine of its contact tracers to working directly with the school district.

“The health district does not provide the identity of the index patient or where the exposure occurs to protect the privacy of the individual,” Bethel said. “The Clark County School District notifies close contacts in addition to distributing mass notifications to advise individuals of an exposure on campus.”

The success of contact tracing relies on the cooperation of those involved. It’s very important that “parents and staff answer calls from contact tracers and disclose their affiliation to the school district during the contact tracing investigation,” Bethel said.

As of Monday, the school district’s online dashboard reported 2,295 cases of COVID-19 since July 1, including 393 this month.

‘Not very effective’

Contact tracing is nothing new, but it has gained public attention in connection with COVID-19, a disease that has defied efforts to stop its spread.

“Public health organizations have used contact tracing for decades to stop the spread of infectious diseases including HIV, measles, syphilis and tuberculosis as well as COVID-19,” Bethel said.

But Raman said that the high volume of COVID-19 cases is posing a unique challenge that limits the effectiveness of contact tracing.

“It’s not very effective, no,” she said. “Contact tracing is most effective for diseases that spread slowly by close contact. Because that’s when we have time to … reach the contacts and do that intervention quickly, before it has time to spread to multiple people.

“The problem with COVID is that it spreads really easily, really quickly and for a long period of time. And so it’s very challenging to stay on top of contact tracing, which is why we see just huge spikes and waves of it everywhere. Because it’s very, very difficult to interrupt the transmission of an airborne disease like COVID.”

Kevin Dick, district health officer in Washoe County, the most populous county in Northern Nevada, shares Raman’s concern.

“Our disease investigators are simply overwhelmed,” he said in a statement. “We have a dedicated staff working seven days a week who are reaching a breaking point under very difficult circumstances to reduce the spread of COVID-19. Contact tracing is not designed to be effective when COVID-19 is widespread in the community and with this many new cases coming in.”

Despite her qualms, Raman believes that contact tracing helps to curb COVID-19 cases in the community and in the schools.

“Hopefully, we’ll continue to get better and better at it as the school year goes on,” she said. “But it is definitely challenging, probably one of the most challenging things us as an agency has faced.”

Contact Mary Hynes at mhynes@reviewjournal.com or 702-383-0336. Follow @MaryHynes1 on Twitter. Review-Journal staff writer Julie Wootton-Greener contributed to this report.