North Dakota has emerged as a top state for coronavirus contact tracing -- a key component in states' public health strategies to combat the pandemic.
NPR reported last week that North Dakota -- population 762,000 -- is the only state to meet an estimated need of 30 contact tracers per 100,000 people. North Dakota contact tracing administrator Vern Dosch said 352 people have been trained on the techniques of finding people who have been close to someone with COVID-19.
Of those, 77 contact tracers are active in North Dakota. As many as 500 total could be trained, including 100 North Dakota State University health professions and emergency management students in coming weeks.
"Robust contact tracing" is one of eight priorities of the governor's "ND Smart Restart" for rebuilding economic activity.
"It's better that we have the most contact tracers and not need them, than not have them and need them," said Gino Jose, regional field epidemiologist with the state Department of Health, which assigns cases for contact tracing.
Local public health nurses and public health and nursing students are doing tracing, aided by a new database to quicken the process.
"It can take several hours to get through everybody’s contacts if there are several of them," Bismarck-Burleigh Public Health Director Renae Moch said. Sometimes the work goes late into the night.
About 15-20 registered nurses and environmental health specialists have been involved with the health unit's contact tracing for Burleigh County and other communities when help is needed.
Custer Health in Mandan has six staff who are doing contact tracing and case investigations, Director of Nursing Jodie Fetsch said. They've recently been assisting Fargo and Grand Forks cases as Morton County's new cases have slowed.
Bismarck-Burleigh Public Health has been in touch with more than 100 people in the process, Moch said.
By phone, tracers interview people who have tested positive and then find their close contacts, or people who were within 6 feet of them for more than 10 minutes. Interviews can take 45-60 minutes as they walk through the onset of symptoms and their activities for the previous 14 days and provide guidance on isolation and quarantine, Moch said.
People reached by contact tracers can be surprised or scared or expecting the call, she said. Each person on average has two to five close contacts, who are told to monitor themselves for symptoms and contact a health care provider if any appear.
Interviewees have been mostly cooperative, Moch said. To aid their efforts, tracers have reached out to employers, family and friends of people who have tested positive, she said.
"Just trying to remember everywhere they've been, if they've been to the grocery store, work, child care, different things like that," Moch said.
More than 29,600 smartphone users have downloaded the Care19 app to log their presence at locations for 10 minutes or longer, which also will aid contact tracing. The voluntary, anonymous app has not yet been utilized for location data.
Dosch said the app's developer is working on "the functionality" to use location data, which could be implemented by Tuesday or Wednesday. North Dakota's Information Technology Department is working on an interface for the data to come into the new database.
In the meantime, people can still use the app to keep track of their whereabouts, Dosch said.
Users must consent to releasing their tracing data with a randomized ID. The app will be a time-saver for contact tracers' inquiries of people's whereabouts, Moch said.
Contact tracing "is very time-intensive," Bismarck-Burleigh Public Health community health nurse manager Theresa Schmidt said. People can make a difference by practicing social distancing and being aware of where they've been, she said.
Household members of people who have tested positive for COVID-19 must quarantine for 14 days or face a class B misdemeanor, which carries a fine of up to $1,500. Additionally, COVID-19-positive people "must cooperate with the efforts of state or local health authorities to contact other exposed people," by order of State Health Officer Mylynn Tufte.
North Dakota's priority on contact tracing has been so successful because of time dedicated to training and daily meetings with tracers and case managers, Jose said.
Contact tracers undergo five to six hours of training, including software programming, sign a nondisclosure agreement and must adhere to federal health privacy laws.
Good relationships among local public health units and health care facilities across the state also have helped boost contact tracing efforts, said Kelly Nagel, director of systems and performance at the state Department of Health and lead contingency planner for the state's Unified Command during the crisis.
People have wanted to help, she said, from local public health staff to volunteers of the Medical Reserve Corps, who raise their hand to assist in emergencies.
Lutheran Social Services is assisting health department officials with contact tracing efforts for people who speak English as a second language. Refugee resettlement staff with the nonprofit were trained last week to provide translation for workers during interviews with health officials, according to Shirley Dykshoorn, vice president for senior and humanitarian services for LSS.
Gov. Doug Burgum said a goal of contact tracing is speed, to call people who have tested positive within four hours. He called the NPR story a good piece of national reinforcement for North Dakota.
"We're managing for capacity, not headcount," the governor said.
Reach Jack Dura at 701-250-8225 or email@example.com.