North Dakota is having people do their own COVID-19 contact tracing

Health officials have said timely contact tracing is a key component in preventing the spread of COVID-19.
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As COVID-19 cases surge in North Dakota, the state's Department of Health is asking people to do their own contact tracing. 

In a tweet Tuesday, the North Dakota Department of Health (NDDoH) said "if you have tested positive for COVID-19, please isolate and inform any close contacts you've had that they should get tested," citing a backlog of COVID-19 case investigations which is causing a delay in calls.

NDDoH further explained the situation in a news release, saying "a sharp increase in coronavirus cases in recent weeks has put increased pressure on contact tracing teams at the state and local level, leading to tracing delays and a backlog of positive cases that have yet to be assigned to a case investigator."

On Tuesday, state health officials announced a high of 1,036 new COVID-19 cases. The state has also reported the most COVID-19 cases per capita in the country over the past week.

Because of the surge in cases, people aren't finding out the results of their COVID-19 test until about 72 hours after the lab confirms the results (previously it was about 24 hours), the release notes.

In an effort to reduce this backlog, 50 North Dakota National Guard soldiers will switch from contacting close contacts of those who test positive to notifying people that they've tested positive. 

This should eliminate the backlog by Thursday, NDDoH says.

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“This temporary situation required an immediate and significant shift in resources to provide results in a timely manner to individuals who test positive to protect their health and slow the spread of COVID-19,” North Dakota Gov. Doug Burgum said in a statement.

As a result, public health officials will no longer contact a COVID-positive person's close contacts. Instead, people with coronavirus are asked to notify their close contacts on their own and tell them to visit the NDDoH website for information on what they should do next. (However, public health officials will still handle contact tracing for health care settings, K-12 schools and universities.)

Lack of compliance with contact tracers

Public health officials have stressed that contract tracing is a key strategy in preventing the spread of COVID-19 because identifying a COVID-positive person's close contacts and having them isolate for 14 days can break the chain of disease transmission (more on this below).

But NDDoH says "significant community spread" of the virus and lack of compliance with close contact investigations "have diminished the effectiveness of contact tracing" in the state. 

“Case investigation and contact tracing are just two of the tools used to combat COVID-19. Now, more than ever, we need to prioritize what’s most important and this includes quickly identifying positive cases, strengthening community mitigation efforts and taking personal responsibility,” Gov. Burgum said. “Wearing a face covering, social distancing, avoiding large gatherings and staying home when you’re sick all play a role in limiting spread and saving lives and livelihoods.”

According to the New York Times, Gov. Burgum, a Republican, has maintained that the best way to handle the virus is a "light touch of government" and North Dakota is one of fewer than 20 states that don't have a statewide mask mandate, with many counties resisting restrictions designed to limit the spread of the virus.

As part of its efforts to reduce the backlog of cases, NDDoH is building an automated process to notify people if they test positive, and then a case investigator will follow-up with them after the initial automated notification. Currently, the system is only set up to automatically notify people if they test negative.

“Speeding up the notification process and conducting thorough case investigations of positive patients will help us to better identify potential clusters and allow patients to more quickly seek treatment and notify other individuals who may have been exposed to the virus,” Interim State Health Officer Dirk Wilke said in a statement. “It’s critically important to understand that the quarantine recommendations for close contacts haven’t changed.”

According to the federal Centers of Disease Control and Prevention (CDC), having close contacts of COVID-positive people isolate as soon as possible is crucial to controlling the virus. The CDC says:

"Identifying contacts and ensuring they do not interact with others is critical to protect communities from further spread. If communities are unable to effectively isolate patients and ensure contacts can separate themselves from others, rapid community spread of COVID-19 is likely to increase to the point that strict mitigation strategies will again be needed to contain the virus."

A close contact is considered someone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the infected person tests positive or shows symptoms.

Close contacts should quarantine by staying home for 14 days from the last date of exposure, maintaining a social distancing from others in their household and self-monitoring their symptoms (here's a chart from the CDC that shows when you should start and end your quarantine).

The Minnesota Department of Health has said people who are showing symptoms of COVID-19 should isolate and get tested right away. 

Meanwhile, those who believe they were exposed should isolate and consider getting tested even if they don't show symptoms as not everyone with the virus exhibits symptoms, but they can still spread it to others.

In those instances, MDH recommends getting a COVID-19 test 5-7 days after you were exposed. And if you test negative, get tested again around the 12-day mark. This is because a COVID test is a point in time indicator, so if a person is tested too soon, their result may be negative even though they could be infected.

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