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Case investigations stalled by unanswered calls

During a recent one-week period, 34,000 people tested positive for the coronavirus in Pennsylvania, with case investigations beginning within two days for 30% of them.

But only a quarter of that 30% — 8,300 investigations — resulted in a patient contact, according to the state Department of Health’s director of testing and contact tracing.

“People don’t want to answer the phone,” said Michael Huff in a conference call with reporters Tuesday. “People don’t realize how important it is.”

Case investigations that are stymied by patients not answering calls is widespread in the U.S., and on Tuesday, the Centers for Disease Control and Prevention issued guidance on prioritizing calls, so investigators and the contact tracers who follow up with close contacts of people who are infected get the maximum benefit from their often-frustrating efforts.

The guidelines assign the highest priority to investigations in cases that are less than seven days old, then tracing those patients’ household contacts, along with other contacts who live, work or visit congregate living facilities, high-density workplaces and other high-risk settings — including potential superspreader events, according to the CDC.

The guidelines assign less priority to contacts “outside the household who are at increased risk for severe illness, part of a cluster or exposed within the past six days,” the CDC states on its website.

The guidelines assign even less priority to cases that are older than six days and their contacts.

But after 14 days, “investigation and contact tracing should generally not be pursued,” because the subjects would likely have recovered by then, according to the CDC and Huff.

Unfortunately, before those 14 days expire, too many people are going uncontacted and unadvised about isolation and quarantine, Huff said.

People aren’t answering the calls at least partly because they lack “public trust,” according to Huff.

They may be afraid to provide information to someone they don’t know, may fear information they provide won’t be kept confidential or they may be reluctant to “negatively impact” a restaurant or bar where they may have eaten or drunk, Huff said.

Many simply don’t answer the phone on principle, if they don’t recognize the caller, based on caller ID, he said.

He himself doesn’t answer when contacted by callers he doesn’t know, he said.

To remedy that problem, the department is trying to ensure that when any investigator or tracer calls, recipients’ caller IDs show the caller to be “a trusted source,” like the Department of Health or the appropriate county or municipal health department, Huff said.

Callers are trained to keep confidentiality and be “sensitive” about the questions they ask, Huff said.

The department has been shifting contact tracers to case investigations in hopes of boosting the percentage of successful first contacts, according to Huff.

The ideal is to establish contact within 24 hours when someone tests positive, to minimize the chance the patient will spread the infection, he said.

The department continues to promote the state’s free contact tracing app, COVID Alert PA, which notifies participants if they’ve been in close contact with another app user who subsequently tests positive.

The app has been downloaded about 560,000 times.

Mirror Staff Writer William Kibler is at 814-949-7038.

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