key: cord-0802746-66h8zq17
authors: Matthias, James; Charboneau, Tracy; Schaffer, Cheri; Rusten, Jennifer; Whitmer, Sharon; de la Paz, Joseph; Dykstra, Janet; Pathmanathan, Ishani; Stowell, Daniel
title: Notes from the Field: COVID-19 Case Investigation and Contact Tracing Program — Spirit Lake Tribe, North Dakota, September–November 2020
date: 2021-04-09
journal: MMWR Morb Mortal Wkly Rep
DOI: 10.15585/mmwr.mm7014a4
sha: 801c382d1d9ecf38a6142de49ff82b42b7acb4b2
doc_id: 802746
cord_uid: 66h8zq17

nan

During September 29-November 20, data were retrieved by COVID-19 response team members from Spirit Lake Tribal Health's COVID-19 case and contact database, including patient demographics; links between COVID-19 patients and close contacts; test results; and symptom onset, isolation, and quarantine dates. Symptom data from Spirit Lake's TIM 2 monitoring system were analyzed to assess COVID-19 symptoms reported by close contacts of COVID-19 patients during October 22, (when TIM 2 use began for contact management) through November 30 (when the last close contact unit § enrolled by November 20 completed quarantine).

During September 29-November 20, a total of 317 persons with confirmed COVID-19 and 667 close contacts among the Spirit Lake Tribe were reported; 129 (19.3%) of these close contacts received a subsequent COVID-19 diagnosis (Table) . The average interval between specimen collection to receipt of a positive SARS-CoV-2 test result was 2.25 days (median = 3 days, range = 0-9 days). Overall, 254 (80.1%) of 317 patients with confirmed COVID-19 and 420 (78.1%) of 538 close contacts who did not receive a COVID-19 diagnosis were contacted by program staff members and instructed to isolate or quarantine within 24 hours of receipt of test results or identification of cases. ¶ The proportion of confirmed new COVID-19 cases arising from known contacts was 41% (weekly range = 24%-59%).

During October 22-November 30, a total of 44 close contact units were enrolled in TIM 2 , which logged 366 responses during 524 quarantine days (70% daily response rate). Among these 44 enrolled close contact units, 17 (39%) reported one or more persons with symptoms, 16 (94%) of whom were contacted within 24 hours and instructed to quarantine to prevent further transmission. A total of 20 persons from eight close contact units received a COVID-19 diagnosis. During the assessment period, the incidence of COVID-19 in the Spirit Lake Tribe plateaued at approximately 520-600 cases per 100,000 persons per week; during the same period, a 1.5-fold increase in incidence occurred in North Dakota, from 455 to 1,137 cases per 100,000 per week (1,4).

Implementation of a COVID-19 case investigation and contact tracing program for the Spirit Lake Tribe highlighted several important lessons. First, the program required daily, continuous staffing to effect timely COVID-19 mitigation. Second, obtaining information from and maintaining contact § Individual persons or family units sharing a phone number. ¶ Patients were instructed to isolate in accordance with CDC guidance at the time (https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation. html), and close contacts were instructed to quarantine in accordance with CDC guidance at the time, which was 14 days after last exposure to a COVID-19 patient. * These numbers might not include all patients or close contacts associated with the Spirit Lake Tribe because of limited sharing of health information among overlapping state, local, and tribal jurisdictions. † The date used for confirmed COVID-19 patients was the date of receipt of a positive SARS-CoV-2 test result; for close contacts the date used was the date of identification as a close contact by a confirmed COVID-19 patient. § Close contacts who received a COVID-19 diagnosis were included in the total number of patients with confirmed COVID-19 on the date that they received their positive test result. The percentage of cases among close contacts was calculated as the number of close contacts who received a COVID-19 diagnosis divided by the number of confirmed COVID-19 cases. ¶ Included close contacts who received a negative SARS-CoV-2 test result, those who did not receive testing after exposure, and SARS-CoV-2 infections not reported to Spirit Lake Tribal Health and Spirit Lake Health Center. ** This week only contains 4 days to align with the assessed period (September 29-November).

† † During this and all subsequent weeks, close contacts of confirmed COVID-19 patients were given the option to enroll in CDC's Text Illness Monitoring system (version TIM 2 ) for daily symptom monitoring.

with COVID-19 patients and their close contacts was challenging. Using Spirit Lake community members as investigators and contact tracers aided in outreach because of their knowledge of alternate methods to reach patients or contacts (in-home or family contacts) when locating information was incomplete. These community members also helped to improve response rates about COVID-19 exposures because they were trusted by the community and were able to provide culturally appropriate advice about the need to isolate or quarantine. Third, shared rooms and living spaces among multigenerational families or within whole households with cases or exposures in this community often hindered within-home quarantine and isolation and adherence to these measures. To address this challenge, program staff members distributed critical supplies (e.g., groceries, over-the-counter medications, thermometers, personal protective equipment, and cleaning supplies) and health literacy information (about daily temperature logs, isolation and quarantine procedures, and mask use) to each household. Finally, approximately 100 (10%) persons identified through the case investigation and contact tracing program experienced homelessness or unstable housing during this period, necessitating the provision of temporary shelter and meals at a motel for these persons during isolation and quarantine. Despite these challenges, this tribally managed COVID-19 case investigation and contact tracing program effectively reached Spirit Lake tribal members to provide isolation, quarantine, symptom monitoring, and support services and contributed to timely case and contact management. This program might help guide similar programs in other tribes and the public health community.

ND: North Dakota Department of Health

NDDoH takes action to prioritize faster results on COVID-19 tests, adjust contact tracing process

Atlanta, Georgia: US Department of Health and Human Services, CDC

Spirit Lake Tribal Health and Spirit Lake Health Center staff members, health care providers, contact tracers, and community health representatives; CDC COVID-19 Response Team; Center for State, Tribal, Local, and Territorial Support, CDC; Michael Kellie White, Seh Welch, CDC.Corresponding author: James Matthias, lnk1@cdc.gov. 1 CDC COVID-19 Response Team; 2 Spirit Lake Tribal Health, Spirit Lake Tribe, North Dakota; 3 Spirit Lake Health Center, Spirit Lake Tribe, North Dakota.All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.