Public health nurses are disease detectives.
Investigation of certain diseases and conditions is a routine practice for public health nurses. State and federal laws require health care professionals and laboratories to report cases of these “certain diseases and conditions” to their local public health department. Public health is then obligated to investigate each reported case to try to determine where the person may have picked it up and to try to stop its spread to others. This is true with COVID-19 as well.
Public health nurses at RiverStone Health start by interviewing the diagnosed patient to try to determine how, when and where they may have been infected. After that, they turn their attention to who the “close contacts” may have been during the time the patient would have been contagious to others. Then they can notify those people to let them know they may have been exposed and check to see if they are sick. They can also implement disease control measures. With COVID-19 some of the disease control measures are to isolate people who are sick from people who are well, and to quarantine people who are well but have been exposed and now have the potential to become ill from the recent exposure.
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This can be a big job for even one case. In the COVID-19 pandemic, contact investigations and monitoring of close contacts is an enormous task. For example: Among the first 10 people diagnosed with COVID-19 in the United States, 445 close contacts were identified, according to a March report from the federal Centers for Disease Control and Prevention (CDC). That included 19 people in the ill person’s household, 104 community members who spent at least 10 minutes in close contact with the ill person, 100 people who were exposed to the patient in a healthcare setting and 222 healthcare personnel, including paid staff and volunteers.
For COVID-19, public health nurses monitor the identified close contacts for 14 days after the person’s last exposure to the person who tested positive for the virus. Close contacts who do not have any symptoms are quarantined at home for 14 days. They are monitored to see if they develop any signs or symptoms, like fever, cough, shortness of breath and others. If they develop symptoms during the quarantine period, they will be referred for testing and then isolated.
Before COVID-19 was discovered and arrived in the United States, three staff members at RiverStone Health did the close contact tracing for all reportable communicable diseases in Yellowstone County. Now there are 14 people on the team to conduct the case interviews and close contact notification and monitoring for all of Yellowstone County cases.
Public health nurses and staff are working long hours, seven days a week, to investigate every case of COVID-19 along with continuing to do the case investigations and interventions of all of the other reportable diseases and conditions that normally occur. It’s always been the work of public health; COVID-19 has added a new disease to the extensive list. The workload has increased, but the process is the same and the goal is the same: to protect life, health and safety.
The Billings healthcare community and the Yellowstone County community at large have come together to prevent the spread of COVID-19. Our success will be in what the public doesn’t see: the illnesses and deaths that don’t happen because prevention worked.
