FARGO ― Amanda Johnson is preparing to call people who have been exposed to someone who has tested positive for the highly contagious coronavirus.
Johnson, a student in the master of public health and pharmacy programs at North Dakota State University, is part of an army of up to 1,400 contact tracers health officials seek to mobilize in an effort to try to contain the pandemic.
“As bad as it sounds, this is a once-in-a-lifetime opportunity to help with something on such a large scale,” Johnson said. “We just want to help the community.”
She will join epidemiologists and others working with the North Dakota Department of Health as well as public health agencies around the state, who could be overwhelmed as the spread of the coronavirus accelerates.
The ambitious effort, announced in late March by Gov. Doug Burgum, has a goal of multiplying by 10-fold the 123 public workers he said were available for contact tracing, 25 with the North Dakota Department of Health and 98 with local public health agencies.
“We’re in a logistical battle right now,” the governor said.
Increasing the scope of the contact tracing program will be important as the infection spreads, said Michelle Detholff, an epidemiologist who runs the North Dakota Department of Health’s epidemiology and laboratory capacity program.
“We want to have increased capacity to do this as long as we can,” she said.
NDSU will play a large role in ramping up the number of volunteers who are trained to perform contact tracing ― talking to those who have been exposed to find out who else might have been exposed to the virus, so they can be isolated to contain the spread.
Pamela Jo Johnson, who directs the master’s of public health program and is spearheading the effort at NDSU, expects 40 students could participate, with another 100 health professions students at the ready.
“We are mobilizing students,” she said. NDSU is recruiting volunteers from its master’s of public health, nursing, pharmacy and emergency management programs. “I have had over 250 students express interest in helping, and we are working with NDSU Volunteer Services to find other opportunities for them to help.”
The University of North Dakota School of Medicine and Health Science also is participating in the effort, and will initially contribute about 20 students, possibly expanding to about 40, said Ashley Evenson, who oversees the university’s master of public health program.
“We’re excited to be a part of it,” she said. “We’re starting with public health students, then we’ll branch out as necessary. As the need grows we can cast the net wider,” including recruiting nursing students and students from outside North Dakota who are enrolled in distance education programs.
“This work can be done remotely,” Evenson said. Also, she added, "We have yet to finalize, but are hoping to also create a few student research opportunities from the experience."
Johnson has met via video conference with colleagues at NDSU and elsewhere to coordinate the sprawling effort, which will include training videos and other materials for the contract tracers.
“They’ll be given really good guidance,” including case investigation forms, she said.
Contact tracing begins when health officials receive a report that a person has tested positive for the coronavirus, which causes the respiratory disease COVID-19. Many tests are conducted by the state health laboratory in Bismarck, but results from health providers are reported immediately via an established system for tracking communicable diseases
Any person who tests positive for the coronavirus ― a “case” in the parlance of epidemiologists ― is interviewed to identify others the person was in close contact with. In turn, those people are interviewed and their close contacts identified, as investigators work their way down the chain of contacts to determine who should be isolated to contain the spread of the contagious illness.
Aggressive contact tracing is essential to halt community spread, Johnson said. “That’s the only way we can really stop the continued spread,” she said.
Contact tracing zeroes in on those a person who tested positive for the virus was in close contact with ― that’s considered anyone who the person was within six feet of the person for at least 15 minutes, Dethloff said.
“We’re trying to get at people who were in close contact with that confined case,” she said. To determine that, contact tracers ask a host of questions to jog the person’s memory, asking who they’ve been with, whether and how they’ve traveled, what errands they’ve run, etc.
So, if someone took a 15-minute coffee break with someone who has the virus, “That is a close contact,” Dethloff said.
Contact tracing has limits. If someone went to a shopping center, for instance, it isn’t possible to identify all those who could have come in brief contact with the person, she said. Also, she added, brief encounters aren’t considered close contacts.
“Right now there’s a lot of social distancing, so we’re not identifying a lot of close contacts,” Dethloff said. “We’re not identifying people that have large, large numbers of contacts,” she said. “That social distancing is working.”
Those who have tested positive ― and thus launch a new contact tracing investigation ― are cooperative, said Brenton Nesemeier, a state field epidemiologist in Fargo.
“They’re more than happy to talk with us,” he said. “They have questions, they have concerns.”
During the interviews, which generally last 45 minutes to an hour for each person who has tested positive, health officials educate them on how to quarantine themselves for 14 days, plus at least 72 hours free of symptoms.
Health officials check in with the infected person during the quarantine. If the person is hospitalized, health officials check with a family member, Nesemeier said.
Although the coronavirus is highly contagious ― health experts believe each person with the virus passes it along to two or three others ― merely coming into brief contact does not mean a person will become infected, Dethloff said.
“It doesn’t mean they’re going to get COVID-19,” Dethloff said. “But they are at risk” and should be tested. “We’re trying to identify their close network so we can stop transmission.”
The ramp up in contact tracing in North Dakota is unprecedented in scope within memory, with the coronavirus pandemic the nation’s largest infectious disease outbreak since the Spanish influenza pandemic of 1918-19.
“Obviously none of us have experienced anything like this in our lifetime,” Johnson said.
All of the contact tracing work is by phone ― in student Amanda Johnson’s case, from an apartment on the NDSU campus, where she will be using her cell phone and laptop computer.
“They’re not going to come into contact with any people in person,” Pamela Jo Johnson said.
The master of public health students, some of whom have concentrations in infectious disease control, already have been taught contact tracing in their coursework and will be playing an important role, she said.
“These are the students who are ultimately on the front lines of this public health emergency response,” Johnson said.