GREENFIELD — After a brief introduction explaining they’re with the Hancock County Health Department, their first phone call begins with, “We received a report that you tested positive for COVID-19.”
It’s often not the most welcomed start to a conversation, as public health nurses Margie Hoskins and Brittany Cecil will tell you.
When a Hancock County resident tests positive for the novel coronavirus, Cecil and Hoskins are the ones who reach out for an extensive interview and to find out with whom they’ve recently been in contact. That latter part often means making more phone calls with more difficult news and instructions to deliver.
Contact tracing is an imperative part of keeping the contagious disease in check as much as possible. And as plans start to materialize for loosening restrictions that have slammed much of society to a halt, tracking down people who have been exposed will continue to be vital to ensuring COVID-19 doesn’t rebound out of control.
The county health department finds out about local COVID-19 cases from the Indiana State Department of Health, Hoskins said. It’s also not uncommon for the department to get a heads-up from Hancock Regional Hospital when it gets a positive patient.
“Once we’re notified that they test positive, we immediately make contact in pretty much any way we can,” Cecil said.
Information from the state department of health doesn’t always come with a phone number. Often, Hancock County Sheriff’s Department detectives lend their skills and are able to provide contact information.
Crystal Baker, office administrator and preparedness coordinator for the county health department, said sometimes that first call from Cecil or Hoskins is the first time a patient learns they’ve tested positive for the COVID-19, the illness caused by the novel coronavirus.
When that happens, it incites a wide range of reactions, including sadness, anger and fear, Hoskins and Cecil said. Hoskins added it requires them to not only behave like nurses, but counselors and teachers.
That initial fear often subsides through education, Cecil said.
“We’ve built lots of relationships over the past six weeks,” she added.
They even give out their cellphone numbers to patients and contacts so they can reach them outside of the office if necessary.
“We talk to them enough and in-depth enough that they feel comfortable to call us,” Hoskins said. “…It’s been a rewarding experience.”
During the first phone call with a patient, Cecil and Hoskins conduct an interview and complete a COVID-19 case investigation form. The first three pages are filled with questions seeking information about the patient, symptoms, health history and whether they’ve been in close contact with anyone recently. The last two pages are reserved for listing all of those contacts and information about them.
Cecil and Hoskins start with whom the COVID-19-positive patient lives.
“Because we know for sure they’re going to have contact,” she added.
Guidance from the Centers for Disease Control and Prevention that the nurses follow defines contact as being closer than 6 feet to another person for 10 minutes or longer.
“So pretty much everyone in your household,” Cecil continued. “We start there, and then we go through anybody else outside your household.”
They ask the patient to take them back 48 hours from the time their symptoms started and recall everyone with whom they’ve had that CDC-defined contact.
The nurses said fortunately, from a disease-spreading standpoint, anyway, most of Hancock County’s COVID-19 patients have been sick enough that they’ve stayed home.
“They’ve not been at Kroger picking up prescriptions, or at the gas station, or wherever,” Cecil said. “They’ve been home. Once their symptoms started, they started quickly and they started hard and they were at home. So we’ve been very lucky on that. It’s mostly household contacts.”
On Thursday, April 23, however, Hoskins was preparing to follow up on a case that had exposure to 18 people. Another case likely has 23 they’ll have to track down, Cecil added.
They can tell contacts when they were exposed, but not who did the exposing. Contacts need to quarantine in their own home for 14 days after the date of the exposure.
Patients who have tested positive and don’t require hospitalization need to isolate in a room by themselves if they don’t live alone, and preferably a room with access to a bathroom that only they will use.
“We want them completely isolated so they’re not infecting everybody else in their house,” Cecil said.
Hoskins agreed.
“If they’re sick enough to where a family member has to come in, we recommend they wear a mask when they go into the room,” she said. “But, typically we want them to leave the tray outside the door and knock and walk away.”
Positive patients should remain isolated until 72 hours after symptoms resolve without the use of fever-reducing medication. Also, at least seven days need to have passed since their symptoms started.
There are different CDC guidelines for health care workers who have been exposed to the disease; they aren’t required to quarantine and can continue working until they are symptomatic.
Cecil and Hoskins also regularly check in with the county’s COVID-19 patients and contacts. They ask patients how they’re feeling and make sure their symptoms eventually start to improve. When they catch up with contacts, the nurses ask if they’ve developed any symptoms and what their temperature has been.
It’s not as daunting as it may seem to call that many people on a daily basis, Cecil said. Because many COVID-19 contacts live in the same household, nurses can check on all of them by speaking with one person in the residence.
“You can gather a lot of information from just casual conversation,” Cecil said.
If a contact develops COVID-19 symptoms like a cough, fever or shortness of breath, Cecil and Hoskins work to arrange for them to be tested somewhere. The nurses also go through the process of finding out with whom the contact has been in contact over the past 48 hours and reach out to them.
Baker said getting to that level — the “contacts of contacts” — is rare.
Cecil and Hoskins are also able to point patients and contacts toward services like grocery delivery and other resources if they live alone or no one in their residence is able to leave.
When a Greenfield Intermediate School teacher tested positive for COVID-19 in March, school nurses helped the health department with contact tracing. Outside of that, however, Cecil and Hoskins have been tackling it themselves.
Hoskins said when the health department receives word of a positive case, it often only comes with a name. Baker assists the nurses by looking up patients’ addresses to ensure they live in Hancock County.
Contact tracing currently takes up all of Cecil’s and Hoskins’ work time, and even extends into Saturdays and Sundays.
“You can’t just let people run around not in quarantine because it’s the weekend,” Cecil said. “We have to get to them as soon as we can.”
She views it as a calling.
“This is our job,” Cecil said. “This is what we’re made for.”
The patients’ and contacts’ appreciation for easing their fears also helps get her through the challenges, she continued.
“It’s just those little things,” she said. “Even though your ear is sore from being on the phone all day and you’re writing notes, when they repeatedly tell you, ‘I appreciate you so much,’ that’s what makes you keep going.”
Hoskins agreed.
“It makes you feel like you’ve done something to help that person, but you also feel like you’ve done something for the community, and that’s what public health is about,” she said.
Baker is confident their efforts have been effective.
“At least locally I think we’ve been fairly successful at helping slow things down,” she said. “I don’t know if you can necessarily pinpoint that directly to contact tracing or the quarantine or stay-at-home order, but all of those pieces of the puzzle come together and they add up to hopefully not overwhelming the health care system.”
Once the state reduces social distancing restrictions, positive cases occurring after that point will come with more contacts to trace, Hoskins said.
“Right now everybody’s fairly limited to home and maybe a grocery store trip,” she said. “…But once those bans are lifted, the contact tracing is going to be more involved. It’s going to be a bigger process.”
But she’s confident she and Cecil will be able to rise to the challenge.
“We have a strong enough drive for the community that we’ll take care of it,” she said. “We’ll handle it. It doesn’t matter how long it takes; we’re going to take care of the community.”