Russell Explains Contact Tracing Of Virus, Board Discusses Masks-Brevard NC
Last updated 6/1/2020 at 3:59pm
As of this morning, Transylvania County had 14 residents confirmed to have contracted COVID-19. In each case, Transylvania Public Health initiated “contact tracing,” which helps to understand how the person may have been infected and, hopefully, curtail the virus’ spread, according to Elaine Russell, the county’s Public Health’s director.
Last week during the Board of Commissioners regular meeting, Russell explained the contact tracing process, which can only be as good as the information provided by the individual.
“Sometimes it can take a couple of interviews to get where we need to be,” Russell said.”
Sometimes people are “reluctant to share” some of the “deeper details” about their lives, she said, or they don’t want friends or family members to “be in trouble” or restricted in some way.
“We try and talk them through that,” Russell said.
So far, the county has had 446 negative tests, with 33 pending results.
Medical providers are required to contact Public Health after a test is ordered, and Public Health is notified of positive cases through the Division of Public Health’s N.C. Electronic Disease Surveillance System, which staff “religiously check every morning,” Russell said.
Once someone is confirmed to have the virus, a Public Health communicable disease nurse will call the person to start a communication process, and, generally, over a couple of days there will be several phone calls. Next steps for the patient include an extensive questionnaire review with the nurse: recalling activities over a previous two-week period, including any recent travel history to hotspots or “close contact” with a known COVID-19 case. Close contact is defined as less than 6 feet of distance from someone for more than 10 minutes, Russell said.
The goal, she said, is to identify the “exposure pathway” and to slow the risks to the larger community.
The nurse will then advise the person to isolate at home, limit visitors and close contacts, and wear a mask around others.
The isolation order lasts for seven days since symptoms first started and at least three days without fever, and with no fever reducing medication and other symptoms having improved.
The nurse will also routinely be on the phone with the person who tested positive.
As part of the contact tracing, the nurse will focus on those close contacts and “drill into” who they may have been in contact with and then provide advice. Contacts should self-quarantine for 14 days from last exposure to the exposed person, Russell said, and he or she would be advised to get tested.
Sometimes, she said, someone could have been at an event with a number of other people. The person may know the event’s date and time but not the number of people with whom they were in close contact, Russell said. On those occasions, health officials would publically cite a particular event, if there were no other way of getting information to those who may have been exposed.
As of now, because of the relatively few numbers in the county, one or two nurses with the necessary training are assigned to the contact tracing, but if the need arose, Public Health has 20 employees who could do the job, Russell said.
“This is a wonderful and loving and thoughtful community, and we have been very blessed overall that everyone has wanted to participate and share their information and do what is necessary to protect their friends and family and neighbors,” she said.
After Russell’s presentation, Commission Chairman Mike Hawkins noted the slight uptick in positive numbers in the past couple of weeks in the county.
At the meeting, the county had only 12 confirmed cases. Of those first seven cases, Russell said, the people are doing well.
For cases eight through 12, those people were going through the process, appeared stable and none were in hospital.
Of the 12 cases, two were pediatric cases, three were in the 20-to-40 age group and the other seven were 62 or older.
He asked what could be causing the increase, and he noticed the previous weekend that some local businesses were doing an “exceptional job,” with social distancing, glove and mask wearing, while “others who were not at all.”
Russell said more testing is being done, yielding mostly negative results but also some positives, and North Carolina is continuing to experience outbreaks at long-term care facilities, meat and poultry plants, and in some prisons and jails. With things opening up, people are also mixing more.
As of last week, Transylvania, with 12 cases, and Graham County, with two, had the two lowest numbers in the region.
Henderson and Buncombe counties have seen increases, particularly in long-term care.
Russell said she hopes there is a “learning curve” going on, and her staff will reach out to businesses to “promote good compliance.”
As of last week, roughly 430 tests had been conducted on county residents. Lemel asked if more needed to be done.
Russell said they were pursuing more testing, but among the concerns is that someone who gets a negative test may just think, “I am free and can do whatever.”
“That scares me for you and your family,” she said.
Her department is doing more targeted outreach, included with Hispanics, African Americans and first responders.
The “problem” with putting up a tent and beginning testing, she said, is that it will provide data but will it provide the data the community needs.
Guice noted that in Buncombe County stores are requiring customers to wear masks, while in Henderson County it is up to store owners to decide.
He said he’d like the board to have a conversation about “what is and isn’t appropriate.”
Hawkins said the board has never really talked about its method, or approach, to managing its decisions and actions in relation to COVID-19.
He asked: What is the board thinking about as it makes these decision? What are its goals? And how does it drive what it does and doesn’t do?
He believes “identifying the goal is easy.”
“We want Transylvania County citizens to be safe, to be healthy, to be able to keep their jobs, to be able to live their normal lives,” as best they can, he said, but identifying how to do it is harder.
Since the beginning of the virus’ outbreak, commissioners have heard from local citizens and others with a wide range of opinions, “often expressed very emotionally,” he said.
At one end of the spectrum, he said, are citizens who believe the “best approach is strict control, a lockdown kind of control, even above and beyond” what has been mandated by state and federal restrictions.
“At the other end of the spectrum are some citizens who believe the best approach is to just provide information and then let each individual decide for himself or herself what is best for them individually,” Hawkins said.
In-between the two ends are a wide range of opinions and possible options, which have been given to the board, he said.
“I think both of the two ends are fundamentally flawed,” Hawkins said. “We are dealing with a highly transmissive, potentially deadly pandemic for which there is no immunity. Strict, severe lockdown measures are effective in theoretical simulations but don’t consider real world implications.”
Many lockdown measures are antithetical to a free society, he said, while others are simply impossible as a practical matter.
“Reliance on individual decision making is also attractive in a theoretical fashion, but it, too, runs into real-world problems,” he said. “The fact is that some will make decisions that inadvertently could be catastrophic to public health.”
Commissioners have had to think about these things.
“We’ve definitely taken some restrictive action, and we do reserve the right to do more if the facts warrant it,” Hawkins said. “But the list of restrictive actions we’ve been asked to do is much longer than the list of actions we’ve actually done. More generally we’ve come down on the side of encouraging individual responsibility and facilitating ways in which we, as a community of people, can take care of one another.”
Hawkins went on to highlight the recent collaborative efforts to help essential workers, the general public and the business community.
“All these initiatives have relied on one common theme – Transylvania County citizens are extraordinary and we will take care of one another in ways that sometimes can’t hardly even be imagined,” he said.
Whether those efforts have worked, Hawkins said, no one can know for sure but pointed to Transylvania County having the 5th-lowest per-capita case count of North Carolina’s 100 counties, according to N.C Department of Health and Human Services.
“The story of the past three months is how our citizens have banded together to help each other. That will continue to be needed in the upcoming weeks and months,” he said.
“That’s what leadership is – leadership is figuring out ways to help people be the best versions of themselves.
“And that sounds like a self-help manual thing – but it’s true. It’s the essence of leadership at any level. It’s what football coaches do. It’s what business leaders do. It’s what faith leaders do. It’s what military leaders do. And it’s what political leaders should do… That is our approach. That’s what you can expect from us as we move forward. We will constantly be trying to find ways to help us all be the best people that we can be. Sometimes that’s going to involve regulation; sometimes it’s not. But all of it will be designed to achieve that goal that we talked about… We want Transylvania County citizens to be safe, to be healthy, we want them to be able to keep their jobs, we want them to live normal lives, and to do all those things in ways least personal disruptions.”
Hawkins asked Russell whether she believed wearing a mask in a retail setting helps to deter COVID-19’s transmission.
Russell said, “Yes.”
“It is a courtesy that you will extend to anyone you love, or care about, and we all care about this community,” she said.
She said it may not be necessary in some places but it should be worn when around other people in public.
“A decision to wear a mask just says that I care enough about the people around me to curtail my germs, so I don’t put other people at risk,” she said.
Lemel said that what Russell just said, would make “good messaging.”
Hawkins said his family business, the Pisgah Fish Camp, made a sign promoting social distancing and wearing masks as a deterrent to the virus and a show of consideration for others. Hawkins asked whether Public Health could make a similar sign and send it to the Chamber of Commerce and businesses. He stressed that it would be voluntary.
Commissioner David Guice said that “you would hope folks would comply” because he didn’t believe those actions could be enforced. Guice said he didn’t want the county “to look back after another outbreak in three months.” He asked the board to discuss the matter more but wasn’t sure an easy decision could be made.
“You are not going to make everyone happy,” he said.
Hawkins asked what was the county’s goal. He said he would not go into any business without a mask on, particularly to protect the employees. He didn’t believe enforcing masks was practical.
Guice said he was “interested in getting back to church” and would be wearing a mask.
“I want to do the right thing and that I am not the cause of someone getting sick,” he said.
Commissioner Jason Chappell said he wouldn’t support mandating masks and believes it is a person’s choice. He also said someone should be careful if they say, if you wear a mask you care about other people, and if you don’t wear a mask, then, you don’t.
“There are valid reasons for not wearing a mask,” he said.
Lemel supported en-couraging the pubic to wear masks but not mandating it.
She also backed the N.C. Department of Health and Humans Service’s three Ws. If you leave home,
•Wear a cloth face covering if you will be with other people.
•Wait 6 feet apart. Avoid close contact.
•Wash your hands often with soap and water for at least 20 seconds or use hand sanitizer.
Commissioners Jake Dalton said there are “people who have respiratory problems who can’t wear a mask.” –
“By saying that I’m not concerned about the community because I don’t wear a mask is kind of derogatory,” he said.
He said there are “vaccines for everything,” but that smallpox is the only disease to have been eradicated. He asked whether people would have to wear masks for the rest of their lives.
“There has to be some balance and understanding there, too,” he said.
He was against mandating masks, believing “businesses are smart.”
“They are going to do what’s best for them because their livelihood depends upon it,” he said.
Hawkins said COVID-19 is a virus that little is known about and no one knows how this will end.
He asked the board members to think more about whether they want to make a policy decision.
Guice agreed that the board should discuss it more at another meeting. He said he knows people who have died because of the virus and he has parents in their late 80s. As someone who has been in public life for more than 30 years, he is “concerned and never seen anything like this.”
He said society can learn valuable lessons from the past but COVID-19 is “new.”