The Hamilton County Health Department will no longer notify the close contacts of those positive with COVID-19 and asked residents to self-police their quarantine periods, signaling the outbreak is overwhelming Chattanooga's established public health practices.
The department announced Friday it will continue contacting people who test positive but will stop contacting those who may have been exposed through each new infection until the current surge declines to more manageable levels.
Becky Barnes, health department administrator, said the change was due to increased testing, delays in getting results and a strain on computer systems.
"This is a temporary measure allowing us to focus on assuring positive cases are notified and isolated," Barnes said. "We have had a very robust contact tracing program but as infections surge we must, at least temporarily, focus on trying to reach the positive cases. Asking people to notify their own contacts means more people get tested and quarantined."
The department is also no longer sending letters notifying people when they can stop quarantining. Employers sometimes required such letters for people to return to work. According to the health department's announcement, people should make a plan with their employers about the new change.
Melissa McPheeters, a health policy research professor at Vanderbilt University Medical Center, said via email that she sympathizes with the health department.
"It sounds as though they are overwhelmed by cases and have determined that the contact tracing they can accommodate would not be effective given numbers and timing of test results. That should be a message to all of us that community spread is rapid and growing, and we should do our part to stop it," McPheeters said.
Contact tracing has been a key part in understanding and slowing the spread of coronavirus since the pandemic began. When a COVID-19 case is confirmed, case investigators determine the infected person's whereabouts and help notify their close contacts — anyone within 6 feet or less for 15 minutes or more — that they, too, could now be infected and should be tested.
In June, the health department began experiencing barriers in its tracing efforts as residents had more close contacts and increasingly refused to participate with the department. In the months since, local leaders have urged residents to continue following precautions despite increasing levels of COVID-19 fatigue and holidays such as Thanksgiving.
The health department has only been able to link a third of new cases to a previously known infection in the past 10 days, according to data from the department.
In order to work as intended, contact tracing requires skill and time, McPheeters said.
"In a situation where there are far too few resources and cases spreading widely, it is extraordinarily difficult," she said. "Furthermore, it needs to be done quickly after a test is conducted in order to have the anticipated effect of identifying sources of transmission chains and breaking those chains."
If community spread reaches a level at which contact tracing proves too difficult, McPheeters said, then it is appropriate to ask individuals to conduct "self-contact tracing" by notifying their contacts so that health departments can use their limited resources most effectively.
The past month has been the worst for the virus in Hamilton County to date. November was the deadliest month for the virus, killing 44 residents. Record numbers of hospitalizations, active cases and new infections have been reported in the past week, along with 15 deaths in the first three days of December.
Local hospital systems have been stressed with the influx of new patients and long-term care facilities reported a spike in cases in the past month. Earlier this week, Hamilton County Mayor Jim Coppinger asked former health care workers to return to work to ease the strain.
Barnes said she is optimistic residents can handle the responsibility of calling their own close contacts.
"Contact tracing has always been led by the information given to us by the cases we are calling, so we are confident that the cases will be able to identify their own contacts and will notify them as soon as possible," she said.
Along with changes to its contract tracing, the health department announced Friday it will adopt new guidance from the U.S. Centers for Disease Control and Prevention that allows for a reduced quarantine period for people who were exposed to COVID-19 from 14 days to 10 or seven days under certain circumstances.
Previously, the health department advised people who were exposed to COVID-19 to stay home for 14 days — the maximum time it's believed that the disease could take to manifest, often called the "incubation period." In its announcement on Friday, the health department said 14 days "remains the safest approach to reduce the spread of COVID-19."
However, the CDC now allows for quarantine to end after day 10 without testing and if no symptoms emerge. If a person gets tested on day five of quarantine and that test is negative, quarantine can end after day seven, as long as no symptoms occur during daily monitoring, according to the new guidelines.
People should continue to monitor for symptoms for 14 days and strictly adhere to safety measures — such as always wearing a face mask, distancing from others and practicing vigilant hand hygiene. Anyone who develops symptoms or tests positive should immediately self-isolate, according to the health department.
Quarantine periods will extend longer for those who are unable to distance themselves from infected people, such as if household members share common spaces.
Because there's no widespread vaccine for COVID-19 and the disease spreads rapidly from person to person, quarantining exposed individuals has been central to the public health strategy to combat the pandemic. It became even more important once scientists discovered that somewhere between 20% and 40% of people with the coronavirus never show symptoms but can still transmit the virus, according to the CDC website.
The change in guidelines is the CDC's attempt to bring needed relief to an overworked public health system and increase people's willingness to comply. Because COVID-19 is a new disease, guidelines can change as researchers learn more about the disease and how it spreads.
Quarantine protocols are distinct from isolation protocols for sick people, who should always isolate from others — including those who are quarantining — until they are well, which is typically about 10 days for COVID-19.
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