'So many asymptomatic': Here's how DeKalb County health officials conduct contact tracing in a COVID-19 surge

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Editor's note: This is Part 1 of a three-part series talking with local public health officials about contact tracing, Region 1 mitigation enforcement, staffing, messaging and public health concerns as it relates to the current surge in COVID-19 cases in DeKalb County.

Lisa Gonzalez, director of the DeKalb County Health Department, uttered more than once during a nearly hour-long interview that she knows "she sounds like a broken record."

Gonzalez, who's leading the department's efforts to combat the COVID-19 pandemic in DeKalb County, and amid record-breaking numbers of cases locally and public push back from regional mitigations imposed by the state, spoke Tuesday about the virus' divisive hold on the county.

"We definitely know that a lot of this is political," Gonzalez said about the online and public defiance locally stemming from a prohibition on indoor dining at bars and restaurants which began Oct. 3.

"It’s politicized, but what I would say to that is if you were to tell me that after the election next week, all of this would go away and get better, God I hope so," she said. "But I don’t think that’s the case. I think we will continue to see an uptick in cases. I don’t think we’ve seen the worst of it. I think with the holidays approaching, it's only probably going to get worse. And so yes, we’re dealing with the politics of this every single day. However, if you go back to the core public health concerns here, they are not going to go away, we have a lot still to do."

Gonzalez said community spread of the virus is widespread throughout the county, which on Tuesday reported 33 more cases to bring the total past 2,509 to date. That's 439 new cases in the past 11 days.

"At the beginning, we saw cases primarily in DeKalb and Sycamore, where there's the most population," she said. "But in the last month or so, it really is across the county in every ZIP code. You've seen our ZIP code data totally change in the last month. Because community spread is real and its widespread. And we’re also finding so many asymptomatic positives, there’s so many. That’s what makes this so difficult, is because there’s so many people who are walking around, right now, without symptoms."

Daily Chronicle editor Kelsey Rettke and sports editor/reporter Eddie Carifio spoke with Gonzalez and Greg Maurice, director of health prevention, for the following Q&A about contact tracing, how it happens and what it tells us.

The health department beginning in July was awarded a $2.8 million COVID-19 grant from the Illinois Department of Public Health to hire on additional staff for contact tracing. They hired 10 additional contact tracers to conduct case investigations and track community spread and a public health educator to assist their 40-person staff in continued pandemic mitigation efforts, Gonzalez said.

Q: Tell us about your staff and the additional contact tracers.
Lisa Gonzalez
: We're hiring as we speak, week by week as quickly as we can get people on boarded. We’re doing that because this resurgence of the cases has really pushed us to our limits as far as the contact tracing goes. So we have an overarching goal with that funding to try and reach people within 24 hours. With the number of cases that are coming in recently, it's really challenging to do that.

Q: Walk us through testing. A person has a test done, gets their results, is called by the lab who did their swab test (whether Physicians Immediate Care, IDPH, a private provider) to report their results, and either told to quarantine and await a call from a local health department contact tracer or told they're negative. What does that look like?
Once that person is tested, right now it's probably within 24 to 48 hours they get a test results. So if you’re tested, within 48 hours you know results. There is a little bit longer lag before we actually get our results through our system which initiates contact tracing and case investigation.

So once we receive that positive test through the statewide lab reporting system, we then begin our work reaching out to that positive case. We do a thorough case investigation which takes about 50 minutes per person, and also determine who are their close contacts, and it's also our responsibility to follow up and contact the close contacts.

You should quarantine until you get your test results, too.

Q: During a 50-minute contact tracing interview, what questions are asked?
LG: It's everything you suspect we would ask: when did you first start exhibiting symptoms, so that we know when to start our count? We’re asking them who those close contacts were, where have you frequented in the past period of time so we can see who others were exposed. We still use that cumulative within 6 feet for a cumulative 15 minutes in a 24-hour period.

Q: Then you reach out to their close contacts and ask them the same questions?
Yes. In cases where it’s a positive case in a congregate setting, you can imagine we have to act very quickly, because they already have potentially exposed others because of where they live essentially and trying to act very quickly to make sure we’re doing what we need to on that side as well, isolating the patient or the person.

I mentioned that one case investigation takes 50 minutes, and then each close contact who we have to contact takes additional time, so it is a process. So when we look at, let’s say, 140 cases over a weekend, if you multiply that out, you can imagine that sort of influx that we’re seeing right now.

Q: What if someone's not honest with a contact tracer about where they've been?
: That’s happening. It’s happening more and more I think, and we can only take information we get. What we find, though, is that if the positive or the contact to the positive is not honest, we can take the information we’re provided. However, sometimes through contact investigation, we find out additional information that maybe wasn’t disclosed at first. That’s why it’s called investigation, because we’re doing a lot of fact finding and reading through the lines.

Q: Are you getting push back when you reach out to close contacts of a positive person and ask them to quarantine? Those who've been exposed?
Usually the positives are expecting we’re going to contact them, they’re sort of waiting for our call, right? But the contacts to that positive may not know they’ve been exposed, and we don’t necessarily disclose who they’ve been been exposed to. So we do see more push back as it relates to our contact with the contacts because, first of all, they’re usually not happy we’re going to quarantine them for 14 days. And they’re maybe not expecting the call, because the person who tested positive had not shared that with them. So we do work with our staff to look at ways in which we communicate those who are maybe not so happy to hear.

Q: For those who've been exposed but not tested, are you encouraging them to then get tested?
If they’re asymptomatic, then they should not test right away. Like, if I’m exposed to you today, it would do me no good to go get tested today. So what the guidelines say is between day 5 and 7 from last known exposure, you may want to get a test. Now if that contact is already symptomatic, then yes, we would recommend they get a test.

Q: What if you tested negative? Does that mean you're in the clear?
There is so much of that asymptomatic infection happening right now, so I think at this point they're [drive-thru testing sites] not going into a whole lot of details. But educating people to make sure that you are quarantining after you test because it doesn’t do us much good if you’re going to go test, and then run to every store in town and go see a group of friends when you test positive.

It really is case by case because if you are close contact to somebody who’s positive, you’d have to quarantine regardless of whether or not you tested negative. We say over and over again, you cannot test your way out of quarantine. If a public health official has told you you need to quarantine for 14 days, it doesn’t matter if you test negative on day seven. We would still require you to stay throughout that 14 days in quarantine.

I think the justification behind that is that you could pop up positive any time in those 14 days. So once you’ve been exposed, it could be day 13 and you could develop symptoms or you could be asymptomatic and be shedding the virus.

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