After learning that a member of the school community had tested positive for COVID-19 in mid-October, the first call officials at the Lyme School made was to the New Hampshire Department of Health and Human Services.
After that, the school nurse and two physician parents got to work interviewing the affected family to determine whom they might have interacted with while they were infectious and then calling those people to determine if they met the definition of a close contact. If they did, the health providers asked the affected students and school staff to quarantine for 14 days after their last possible exposure.
The do-it-locally contact tracing is becoming increasingly common as New Hampshire COVID-19 caseload grows, creating a backlog among official state public health contact tracers.
“We are primarily the people who are doing that contact tracing,” Lyme School Principal Jeff Valence said in a Wednesday phone interview. “The state picks it up thereafter.”
As cases of COVID-19 tick upward across the region and the country, contact tracers have gotten busier identifying those who may have been exposed to the virus through interactions with people who have tested positive. Tracking down close contacts quickly is important so that they can begin quarantine, preventing further spread in case they are carrying the virus.
In North Dakota, beleaguered public health officials in October started asking people who test positive to notify people who they think they’ve had close contact with of their positive test and the need to quarantine. An Alaska health official told The New York Times that they have moved to a “bare-bones” form of contact tracing.
Public health officials haven’t gone that far in New Hampshire, but they do ask school nurses, long-term care providers and hospital staff to begin contact tracing when they know who infected people may have had close contact with, New Hampshire Department of Health and Human Services Commissioner Lori Shibinette said during an October news conference.
“Absolutely, we’re going to ask them. Please, if you know that this person has had close contacts, go ahead and ask them to quarantine until we finish our case investigation and get to that,” she said.
As rapid antigen testing has taken hold in New Hampshire, people may get their results immediately and share the news with school officials and others as few as 24 hours before state officials get it, Shibinette said. In addition, she said that the number of contacts in each case has increased when compared with the spring, from three in March and April to five or six now.
Contact tracing has become more complex as schools and businesses have reopened and the coronavirus has infected students and younger adults. The work was more straightforward at the outset of the pandemic, when people were staying closer to home and had fewer interactions with others.
“That is a big jump for us,” Shibinette said on Oct. 15. “So the case investigations are more complex, because schools are back in (session) and maybe they’re playing on a sports team, or they’re in a club, or something like that.”
Schools aren’t alone in being asked to participate in contact tracing. As of Saturday, diners in New Hampshire restaurants now are required to provide their names and phone numbers in order to improve the process should it later be determined that someone was in a restaurant during their infectious period, the Associated Press reported. That requirement was requested by the New Hampshire Restaurant Association and approved by Gov. Chris Sununu’s reopening task force on Thursday.
Case numbers in the Twin States have in recent weeks returned to levels not seen since the spring, with New Hampshire this week hitting a new high in the average number of daily new cases, which as of Wednesday was 113.3. Statewide, the level of transmission was considered “substantial” as of Friday. In the Upper Valley, Grafton County last week moved from a “minimal” to “moderate” level of transmission. Sullivan County remains in the “minimal” category.
To address the increased workload, New Hampshire has brought on more contact tracers, including at least 30 members of the National Guard, Shibinette said. As of this week, the department had a total of 120 contact tracers, in addition to the Manchester and Nashua health departments, which conduct their own contact tracing, DHHS spokesman Jake Leon said in an email. The state had about 90 tracers in the spring and has flexed up to have as many as 150 at times, he said.
All cases and close contacts are notified within a day of when the department identifies a case, Leon said. He didn’t say who makes that contact, but when cases involve schools, at least the first contact is often from a school employee.
Vermont has 37 active contact tracers, said Vermont Department of Health spokesman Ben Truman. Contact tracers in the Green Mountain State generally complete interviews with infected people within 24 hours of learning of the case.
As cases have increased, Truman said it’s taken longer for contact tracers to complete their work, which he primarily attributed to difficulty in getting people to pick up the phone.
While for the most part contact tracing is going smoothly for schools around New Hampshire, it’s not without challenges, said Paula MacKinnon, president of the New Hampshire School Nurses’ Association.
“It’s very stressful for schools to now take on the role,” she said. “There are at times difficult parents to deal with who we need to try to get on the side of public health. It is very time-consuming.”
While school nurses were celebrated at the beginning of the school year for their role in helping to reopen schools, some of that shine has worn off now that they have to enforce all the various COVID-19 safety guidelines, according to MacKinnon.
It’s “not easy for a parent to hear that a child needs to be home (or) tested,” she said.
Michael Hinsley, town health officer in Hanover and Lyme who has been helping both towns and schools in those towns with their COVID-19 response, praised school staff for stepping up to do contact tracing, which he described as “critical work in a finite time frame.”
“Our communities locally have been exceptionally well-served and protected by the efforts of the school nurses,” he said.
As in Lyme, school officials in SAU 70 also took the step of notifying people who may have been exposed after positive cases were identified at the Ray School, Richmond Middle School and Hanover High School last month.
“While we have provided the Department of Health and Human Services with a list of those students who may have had ‘direct contact’ with the positive case, there are currently over 900 people statewide in the queue for contact tracing,” Richmond Middle School Principal Tim Boyle said in an Oct. 10 email to families after a case was identified there.
Due to that backlog, Boyle said the school would “shortly send another confidential email to families and teachers who are a part of the cohort.”
Similarly, SAU 70 officials also began contact tracing and worked with Dartmouth-Hitchcock Medical Center to arrange for testing following a positive case at Hanover High School.
“This will prevent individuals from having to wait before contact tracers from DHHS call,” Superintendent Jay Badams said in an Oct. 16 letter to families. “With the help of DHMC, we will directly contact all those students and staff shortly. Some of you may have been contacted already, but we want to make sure our community has the most up-to-date information in a timely manner.”
SAU 70, like the Lyme School, has the benefit of having physicians in the community. The SAU has a Physicians Advisory Group advising school officials on their COVID-19 response. It also has a school district physician, Dr. Steve Chapman, a DHMC pediatrician.
In an email, Chapman emphasized the importance of schools working in a coordinated way with DHHS in their response to a case of COVID-19.
“This involves close contact identification, notification of families and staff, and then testing and quarantining for those identified,” Chapman said. “What schools can do is keep accurate seating charts, use cohorting where possible, and continue to practice risk reduction strategies that work such as mask-wearing, hand sanitizing, physically distancing, and of course staying home if you are sick.”
He also noted that the cases in schools are coming from elsewhere, as the virus does not appear to be transmitted in schools.
“We’ve had over 100 tests of close contacts all coming back negative,” Chapman said of SAU 70. “Kids, teachers and administrators doing a great job of keeping schools safe.”
Thanks to the work of the school nurse and physician parents in Lyme, the school identified 56 close contacts whom they asked to quarantine, Valence said. Testing coordinated with DHMC revealed no additional cases. Because of those quarantines and the effect on staffing, grades 5 through 8 at the K-8 school moved to remote instruction from Oct. 20 until this past Friday.
While Valence said it would be nice if the state had sufficient resources to do the contact tracing itself in a timely manner, “We were very fortunate that we have a lot of individuals with a great deal of expertise.”
Even schools outside the immediate vicinity of the state’s only academic medical center are working on contact tracing. When Newport school officials learned of a case in a student at the high school on Tuesday, the high school nurse and principal conducted contact tracing to identify people who may have had close contact with the person who tested positive, Superintendent Brendan Minnihan said in an email to families.
School staff were the ones who notified those contacts. The high school moved to remote instruction on Wednesday to allow time for cleaning and contact tracing, but was able to reopen for in-person instruction on Thursday.
Valence acknowledged that not all schools have physicians in the community to assist when a COVID-19 case crops up, but he said that “schools are innately very innovative and we have to be to be able to respond to so many different things.”
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
