As Texas continues its effort to bolster contact tracing for COVID-19 patients, physicians have a critical role to play even without joining the state’s ranks of volunteer tracers.
In fact, Wendy Chung, MD, chief epidemiologist for the Dallas County Department of Health and Human Services, says physicians who diagnose patients with coronavirus should recognize that they already are conducting important elements of contact tracing when they counsel those patients on self-isolation and how their household members should self-quarantine.
“When you’re talking to your patient and asking, ‘Who else is in your household? And does anyone that you live with have high-risk medical conditions?,’ that’s part of contact tracing,” said Dr. Chung, who chairs the Texas Medical Association’s COVID-19 Task Force.
Contact tracing involves identifying people at higher risk of contracting COVID-19 because of their contact with an infected person; notifying those people of their exposure; and encouraging them to quarantine until 14 days since their last exposure while monitoring themselves for symptoms. It’s a key piece of Gov. Greg Abbott’s phased plan to reopen Texas and historically has helped eliminate a host of infectious and infamous diseases. For example, the World Health Organization says smallpox, declared extinct in 1979, was “totally eradicated by a lengthy and painstaking process, which identified all cases and their contacts and ensured that they were all vaccinated.”
State and local health departments have been drawing their official contact tracing forces from volunteers, from reassigned employees at the Texas Department of State Health Services (DSHS), and from outside vendors.
Dr. Chung says physicians provide immeasurable assistance to the effort when they collect and document histories for patients with a suspected COVID-19 diagnosis. That can include information about other people in the patient’s household, those contacts’ phone numbers, and information about their health. For example, if the patient has a child who has another health condition, such as diabetes. Dr. Chung says including that information into the patient’s electronic health record is extremely helpful for public health authorities.
“You have no idea – that helps us so much,” she said. “When that test comes back positive and physicians already have that [information collected], that’s great. Because time is of the essence, and maybe five days later, when the test result returns, that patient may be intubated [and] I can’t interview them anymore. But if this information is already in the medical record, that is extremely valuable to us. And [the physician has] already primed the patient to be thinking about who they’ve been around, and what precautions his own household members need to take immediately.
“Physicians naturally have these conversations in the course of seeing patients that they already know very well.”
Physicians testing patients for COVID-19 also have specific reporting obligations. Governor Abbott’s March 24 executive order requires all health care practitioners using an point-of-care test for COVID-19 approved by the Food and Drug Administration to submit daily reports of all test results to both DSHS and local health departments. That includes positive, negative, and indeterminate results.
Aside from testing, if you diagnose or suspect a probable case of COVID-19, you should report that case to your local health entity.
C. Junda Woo, MD, medical director for the City of San Antonio Metropolitan Health District, says physicians can stress to confirmed or suspected COVID-19 patients the importance of everyone in their household self-quarantining, if they and their housemates have a typical living situation. The American Medical Association’s (AMA’s) Code of Medical Ethics says physicians should educate patients about the benefits of quarantine and isolation, encourage voluntary adherence, and support mandatory quarantine and isolation if patients don’t adhere voluntarily.
Also, AMA says physicians “should notify their patients that information they provide about contacts will be shared with public health authorities for use in contact tracing to mitigate additional spread of the disease and treat those who have potentially been exposed.”
“If it’s … like a regular household, then everybody else needs to self-quarantine,” Dr. Woo said. “The last day of their exposure to you, that’s when the countdown clock starts on their self-quarantine.”
For more resources on contact tracing, visit the U.S. Centers for Disease Control and Prevention website, which includes federal guidance, information on the core principles of the effort, and more.