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 magnitude of this pandemic forced the agency to beef up its staff from a few hundred to nearly 2,000 to do this work.
Fortunately, Combs said, none of the people asked to quarantine because of the EVMS resident ended up getting sick.
The school has used a phased approach to bringing back medical students and residents. Today, it is fully back open, but the school has implemented new policies to try to keep staff and patients from getting sick. Combs, chairman of EVMS’ ramp-up task force, said their strategy includes universal masking, a daily symptom-monitoring protocol and drive-through nasal swab testing for any staff with new symptoms.
The new norm has also meant trying to deprogram people from falling into old habits that are counterproductive, like working while sick.
“As health professionals, we tend to take a very serious view of our commitment to show up for work every day,” Combs said. “Culturally, we sort of work through it, but that’s not necessarily a good thing.”
Medical schools and hospitals throughout the country are struggling with the same issues.
Dr. Carol Epling, director of employee occupational health at Duke University Medical Center, said it has been a challenge to get people comfortable with the idea of staying home if they have even a minor new symptom. Duke has a policy of keeping anyone who has to stay home because of a symptom on a paid status.
Duke also has urged safety for employees while they eat their meals, one of the riskiest times of the day because it’s when people remove their masks. Health care workers are reminded to keep their distance, try to face in the same direction if they’re in a dining area and go outside if possible, Epling said.
The health system also mailed masks and hand sanitizer to each employee’s home to underscore the need to continue making safe choices after leaving the premises.
“So much of it is about personal responsibility for all of us,” she said. “If we have a potential close contact and exposure, then we need to take steps to make sure we’re keeping both ourselves safe and people close around us.”
EVMS human resources staff said they revised their short-term disability plan at the start of the pandemic. If employees were required to isolate because they were sick or if they had to quarantine, they could receive pay for up to 14 days. Some employees are allowed to work from home, depending on their health and work duties.
School leaders say that as the pandemic has worn on, public health experts have gained a sharper understanding of what constitutes an exposure risk. As more is learned about how the disease spreads, fewer people are being asked to quarantine.
The school has tested 373 people through it’s drive-thru screening program, most of whom were employees and students, though 17 were patients. There have been 43 positive employees and students thus far, 17 of whom got their nasal swab tests on campus. The drive-thru clinic’s rate of infection is 4.6%, slightly lower than the state’s average of 4.8%.
Dr. Margaret Baumgarten, an EVMS professor who is leading its clinical response to COVID-19, said staff are reinforcing the message that wearing masks works. They’re doing that through virtual town hall meetings and providing masks for all employees, students and researchers.
And they’re setting the expectation that medical staff and students should be models for the community. That means correcting common misconceptions.
“People often feel, ‘You and I work in the same setting,’ or, ‘You and I are friends, we don’t need to do social distancing,’” Baumgarten said. “I think that’s sort of an awareness we’re starting to build. The risks don’t stop at work.”
Elisha Sauers, [email protected], 757-222-3864
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