Disease detectives

Tracking viral exposures across rural Montana
Deb Hill
News-Argus Managing Editor
Tuesday, May 12, 2020
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Public Health Nurse Julie Rooney works at her office, part of the Central Montana Health District, Monday afternoon. Rooney is tasked with finding people who may have had contact with someone testing positive for COVID-19 across six counties.
Photo by Matthew Strissel

Montana, and especially Central Montana, has been extremely fortunate to avoid the large number of COVID-19 cases seen elsewhere in the country. In part that is due to the dedicated work of local public health officials.
Behind each positive coronavirus test is a small army whose job it is to find out who else may have been exposed, a process called contact tracing.
In Fergus County – indeed, in a six-county area including Fergus County – that detective work is done by Public Health Nurse Julie Rooney, who explained how she goes about it. While the six-county Health District Rooney works for has had only a few cases of COVID-19 to trace, Rooney is not unfamiliar with the process, having done similar investigations for cases of pertussis (whooping cough).
“Pertussis is still alive and well,” Rooney said. “We see almost a case a month.”
Whether tracking pertussis, COVID-19 or any other reportable communicable disease, Rooney starts the process out with a phone call to the individual with the positive test.

“We do it over the phone, and our goal is to find out who they’ve had contact with,” Rooney explained. “We ask people to go back 16 days.”
While it might seem difficult for a person to recall everyone they’ve met up with for more than two weeks, Rooney said in reality people are able to be pretty precise.
“People here usually have not had a lot of contacts,” Rooney said. “With COVID-19, because of the way it is spread by droplets when people are close to each other, we are asking people who they have been within 3 feet of for more than 10 minutes. Amazingly we don’t have a lot of those contacts in our lives here.”
Rooney said the responses she’s had are overwhelmingly helpful, as no one wants anyone they know or work with to get ill.
“People tell me all the information they can think of,” she said. “They are absolutely wonderful.”
Once Rooney has a list of contacts, she’s back on the phone with each of them.
“I explain they may have been exposed, and ask if they are having symptoms. If they are, they need to get tested. If not, I ask them to self-quarantine for 14 days, because that’s how long it can take for COVID-19 symptoms to show up,” Rooney explained.
Luckily, the area covered by the Health District has only seen a few cases of COVID-19. Given the amount of time it takes to track down and communicate with everyone who potentially had contact with one of those cases, a bigger outbreak could be overwhelming. Rooney said reaching people can be very time consuming, so she has a plan in place in case there is a surge in the numbers.
While Rooney hopes there won’t be a surge, the additional testing now being done may result in new cases being discovered, including those that are asymptomatic, a strange and deadly aspect of  COVID-19.
“We are testing more people now that medical centers are doing elective surgeries again,” she said. “They are testing patients before they do procedures on them. We may also see some testing in skilled nursing facilities soon, and even sentinel testing that could pick up those who are asymptomatic for COVID-19.”
If the additional testing finds positive cases, Rooney will be on the job, tracking down those they had contact with. Because the novel coronavirus and COVID-19 are so new, Rooney said it can be hard to know what to expect.
“There’s so much we don’t know about it yet,” she said. “It’s like throwing a dart at a moving target.”

U.S. disease reporting process well established
What Rooney does is all part of a long-established plan, one that begins with local health departments and ends with the federal Centers for Disease Control. And it’s not just limited to COVID-19, as tracking of outbreaks has been a tactic in limiting the spread of communicable diseases since the early 1900s.
Which diseases are reported, and how they are reported, are standardized processes, according to Montana Public Health Lead Epidemiologist Stacey Anderson.
“All of the states have agreed voluntarily to do this reporting,” Anderson said. “We report to the Centers for Disease Control.”
Anderson said the process requires the state to use an individual’s residency status when mapping incidents of disease.
“If the person lives full time in Helena, for example, it is reported as a Helena case,” she explained. “This system gets more ‘gray’ when people are snowbirds or spend part of the year somewhere else. We look at where they spend most of their time.”
Anderson said the lack of healthcare options in rural parts of Montana means it is not uncommon for reportable illnesses to be diagnosed somewhere other than where the person lives.
“If you live in a small town in Montana you are probably going to a larger town for your healthcare,” Anderson said. “By attributing that case to where the person’s residency is, it allows us to focus our education efforts in the area where they are most needed.”
Anderson said the reporting system has benefits because it ensures the same case of a disease is not listed more than once.
“We have a process every year that lets us rectify the case counts with the CDC to ensure accurate reporting without duplication,” Anderson said.
But no matter where the case is located, it is up to the local public health officials to do the investigation and contact tracing that prevent it from going any farther.
Which is where Rooney and the other public health nurses across Montana come into the process.
“We take protecting the public health very seriously,” Rooney said.



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