By MERRIDITH O’LEARY
For the Gazette
Published: 3/30/2020 2:01:43 PM
With everyone understandably on high alert about coronavirus transmission, I’d like to explain in detail what happens when an individual tests positive for coronavirus disease COVID-19.
The state testing lab is required to report all positive tests to the local health department in the community where the individual resides through the statewide electronic notification program, Massachusetts Virtual Epidemiologic Network, referred to as MAVEN. MAVEN provides the local health department basic identifying information about the individual including name, age, gender, address and phone number.
At that point, local health departments are responsible for contacting the individual to give instructions to isolate, which means staying apart from others in the house — alone in a separate bedroom, using a separate bathroom if possible — and not leaving the house for a period of time. This phone call is also when we launch a public health strategy that has been much talked about during this pandemic: contact tracing. Simply put, we ask the person to list the people with whom they have been in close contact AFTER THE START OF THE SYMPTOMS.
That detail may be confusing for people because we’ve all heard a great deal about the fact that people may well carry the virus days before symptoms emerge. While that is true, according to the state Department of Public Health, chances of transmission of the virus are highest right as a person begins to feel sick, so contact tracing aims to focus on an individual’s close contacts during that most infectious period of time.
Close contact for tracing purposes means physical intimacy or spending time with a person at a distance closer than six feet for 10 minutes or longer. While transmission can occur at greater distances or in lesser times, contact tracing focuses on the events that pose the highest statistical likelihood of transmission.
People identified during contact tracing interviews must then be interviewed by the health department (from the town where they live, if possible) and are instructed to remain in quarantine for 14 days while they monitor for COVID-19 symptoms. Quarantine is when individuals separate themselves from other people because they have been exposed or possibly exposed to coronavirus. The 14-day period was established because scientists believe that is the maximum period of time it would take to develop symptoms of COVID-19.
I understand there is a great deal of fear about this illness because of how contagious it is as well as its relatively high fatality rate, but remember that if someone you know has been diagnosed with COVID-19, you are not considered a close contact (therefore at high risk of infection) unless you were around them while they were experiencing symptoms.
If patients have tested positive for COVID-19 during a period when they had frequent contact with the public while experiencing symptoms, health departments are required to take steps to notify people of this risk.
Here is an important point related to the number of recorded cases of COVID-19: The numbers don’t reflect the scope of transmission of this virus because we have a huge cohort of people across the country, as well as here in Hampshire County and Northampton, who are sick with COVID-19 but have not been tested. They haven’t been tested either because a positive test result would not change the course of treatment or because the test was not available.
The limitations of our data
Questions have been raised about why the city does not provide a running list of COVID-19 cases, including details such as how many police officers and firefighters have tested positive. I understand the community is interested in this data and these details. However, just as local health departments are responsible for tracking cases and monitoring the health of those who have become ill, we are also responsible for protecting their privacy. Within a city or town with small case numbers, releasing the numbers can be tantamount to identifying the people who are sick.
The Massachusetts Department of Public Health releases information about new positive COVID-19 cases and deaths only at the county level in its efforts to protect the privacy and confidentiality of individuals who test positive for COVID-19. Based on recent DPH guidance urging cities and towns to protect the privacy of patients, the City of Northampton’s Health Department is not releasing the numbers at the present time because our numbers are so low. The Health Department is in contact with the people who were potentially exposed to the positive cases as well as the owners of the businesses or places of employment where the potential exposures occurred to inform and counsel them on next steps.
Anyone who is looking for data can find it on the state’s Department of Public Health website, which offers total statewide numbers and a county breakdown that is updated daily. To see that information, visit mass.gov/doc/covid-19-cases-in-massachusetts-as-of-march-28-2020/download.
Investigating and monitoring COVID-19 cases takes an enormous amount of time. So far in this pandemic, Jenny Meyer, the city’s full-time public health nurse, and I are the only people available from the Northampton Health Department to educate the public about how to stay safe when a highly contagious virus is in our midst, respond to suspected COVID-19 cases, conduct the contact tracing for identified cases and set up other systems within a public health framework to respond to the needs of our community as the number of cases increase.
To that end, in an effort to more cohesively collect data about the occurrences of COVID-19 in our local communities, the Northampton Health Department has recently taken steps to create a new public health nurse program overseen by the city that we believe will more efficiently provide COVID-19 patient follow up, close contact tracing and surveillance as well as daily interviews with quarantined individuals for Whately, Goshen, Westhampton, Williamsburg, Middlefield, Chesterfield, Huntington, Plainfield, Worthington, Chester, Easthampton and East Longmeadow. For this time-consuming task, the Northampton Health Department has hired five nurses who will work with Meyer, who will oversee the program.
There are a few more points I’d like to make. For people with COVID-19 identified through testing or diagnosed based on symptoms, home isolation can be lifted when the following has occurred:
- They have had no fever for at least 72 hours; this means three full days of no fever without using medicine to reduce fevers, such as acetaminophen (Tylenol) and ibuprofen (Advil).
- Other symptoms (such as cough or shortness of breath) have improved.
- At least seven days have passed since symptoms first appeared.
These guidelines can be tricky and not always entirely clear, so if you are ill and have any questions regarding ending a period of isolation, reach out to your diagnosing provider or the public health official who has been assigned to your contact tracing.
The very best way to protect ourselves and our families from this illness is to follow the statewide advisory urging everyone to stay home except for essential tasks, which include essential jobs that can’t be done at home, urgent medical appointments, grocery shopping or visits to the pharmacy. When people are out among other people, it is crucial that they practice both social distancing and frequent, adequate hand washing. It is perfectly fine to go outside for exercise, as long as social distancing practices are maintained.
For more information about what to do if you are sick with COVID-19, visit the website for the Centers for Disease Control and Prevention (CDC) at cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html.
Merridith O’Leary is the public health director for the city of Northampton.
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