A doctor in training who wasn’t feeling well went into work.
The attending physician who supervised the Eastern Virginia Medical School resident sent the new doctor home. A little later, the doctor started to feel better and went to a barbecue with about 25 people.
The next day, when that doctor returned to work, another supervisor noticed the resident wasn’t well and sent the employee home. But that didn’t stop the doctor from going to a wedding of about 75 guests.
When the doctor’s condition worsened, the resident finally reported to the health center and got tested for the coronavirus. The nasal swab sample came back positive, which triggered a series of contact-tracing interviews to determine who might have been exposed.
EVMS leaders say the incident, which happened in July during a surge in Hampton Roads, is an example of the cascading effect one person’s infection can have, and the daunting task public health officials, institutions and employers face in trying to contain the disease from spreading further.
It also highlights the risk health professionals face in transmitting COVID-19 in clinical settings. The school recently used the story to emphasize to its students, staff and faculty the importance of wearing masks and social distancing on and off campus.
“That one individual’s behavior had about five different points where a different decision could have been made,” said Donald Combs, vice president and dean of the School of Health Professions at EVMS.
The doctor-in-training was in touch with about 100 different people, 25 of whom met the criteria for close contact and had to be put in quarantine for two weeks. Combs put it another way: That’s the equivalent of one full-time physician missing a year of work, he said.
Health departments use case investigations and so-called “contact tracing” as tools to prevent the spread of contagious diseases. People who work as disease detectives interview sick people about their whereabouts and try to reach as many people as they can who could have been infected. Then, they give them tips on how to get tested and stop passing it on to others.
Virginia contact tracers were in touch with about 81% of cases within 24 hours of the diagnosis last week, according to Virginia Department of Health data, though the goal is to reach everyone. Close to 8,500 people are under public health monitoring based on those investigations.
Close contact is usually defined as being within 6 feet of a person with COVID-19 for at least 15 minutes or having exposure to the person’s coughs, sneezes or kisses while they were infectious. Research shows that a person’s contagious period could range from one to two days before a person noticed symptoms or tested positive to seven or eight days after. For mild cases of the coronavirus, the CDC is recommending that patients isolate for 10 days after their symptoms started.
For years, the state health department has conducted case investigations for other infectious diseases, like measles and tuberculosis. But the