Contact Tracing In Illinois: Piecing Together The Coronavirus Puzzle

Apr 24, 2020

Heather Kadyk’s job is like trying to solve a big puzzle. She's an infectious disease nurse with the Sangamon County Department of Public Health, piecing together the spread of COVID-19, in an effort to slow it down.

“Sometimes I wake up in the middle of the night and I’ll be like – that wasn’t the source case after all,” she said. “Because you start putting the dates and times in, and start thinking about who had which symptoms when. And sometimes the person you thought was the original positive, probably wasn’t.”

She and her colleagues work to find out where a person with a confirmed case may have caught it, and who they may have spread it to.

Kadyk spends her days on the phone talking with people with the virus and their close family and friends – trying to make sure they don’t leave their houses and give it to more people.

Kadyk said the contacts she talks to sometimes have different ideas about what quarantine means.

“It seems like half of the people I talked to this week had Easter dinner with their family – like with grandma and grandpa, and cousins,” she said. “They don’t understand that (quarantine) means no, you don’t see family. As bad as it is, and hard as it is and sad, you need to FaceTime them.”

So, Kadyk explains again. Still, for the most part, she said people are open to listening and following the rules. 

As policymakers argue over when to start easing stay-at-home orders and other restrictions, the work of contact tracers is a crucial part of that discussion. But there are a few challenges to a robust tracing system in Illinois - lack of healthcare workers trained to do the work, and limited and slow testing.

Box-It-In Approach

Illinois has been able to avoid the worst case scenarios of projected infections and deaths due to the coronavirus thanks to social distancing measures, according to models released by Gov. J.B. Pritzker and his administration. But the worry is that as those measures are removed, the state could see a spike.

“There's a risk of resurgence of the disease pretty much anywhere. We may see cycles or waves of infection,” said Josh Michaud, an infectious disease epidemiologist and associate director for global health policy at the Kaiser Family Foundation.

“If you have contact tracing and testing in place, then you can prevent major hills in the epidemic curve by keeping a lid on community transmission before it gets out of hand,” he said.

This is the “Box It In” approach , as named by Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention. The four elements are widespread testing, isolating those who test positive, tracing their contacts, and having them quarantine.

Effective tracing, Michaud said, goes hand-in-hand with widespread testing, which is not yet happening in Illinois.

“If you've not identified a good portion of the actual cases that are out there, you're only going to make a small dent in that epidemic curve,” Michaud said.

Widespread testing would include people with mild symptoms or no symptoms at all.

But Illinois still has limited swabs and lab capacity, and tests have been prioritized for people who are hospitalized or in nursing homes and other congregate settings, those with underlying health conditions, and healthcare or other frontline workers.

Still, there is some progress - new testing sites , including those with rapid testing machines , have opened recently around the state. And, according to an announcement Friday from the Illinois Department of Public Health, anyone with symptoms can now be tested.

Another challenge is having the trained workers to do the contact tracing. About 2,200 workers are doing contact tracing across the country now, according to the Association of State and Territorial Health Departments .

“So that is a quite limited number when you match it up against the scale of efforts that need to be done,” Michaud said.

An estimate by the association and the Johns Hopkins Center for Health Security suggests the U.S. needs 100,000 contact investigators, with Illinois needing around 3,860.

Pritzker has said tracing will be key to a strategy to easing restrictions, and suggested Illinois could follow the lead of Massachusetts, which is hiring a thousand workers.

The Illinois Department of Public Health did not respond to NPR Illinois’ questions about how many tracers are employed now, how many more it would need, and what the plan is to scale up.

However, in an announcement about extending the stay-at-home order, Pritzker said: “We are making progress building out testing and launching our contact tracing initiative, so that as soon as the time does come for our new normal, we can be ready. We’ll be sharing more on that in the days and weeks ahead.”

Social Distancing “Making A Dent”

Sangamon County has five staff working on tracing, after it hired back retired nurses and moved season workers to full time.

Gayla Havener, chief of infectious diseases with the county, said despite limited testing, they’re doing what they can.

“We are putting our resources into the cases that we know,” she said.

The county is working on 25 active cases, according to a spokesman.

And there is some good news. Havener said before the stay-at-home order, nurses would have to call 15 people connected to one positive case. Now, that number is down to four or five.

“So the distancing has made a huge dent,” Havener said.

Fewer contacts mean less chance for the disease to spread.

Kadyk, another nurse with the county, agreed they’ve seen a drop. Still, she said telling people they need to quarantine and shouldn't be going out is sometimes difficult.

“I think people think it’s an invasion of their rights, and I struggle with it,” she said. “Because from the public health side, we know how infectious this is.”