[MUSIC PLAYING] SPEAKER: So as a contact tracer, you're going to investigate cases and identify contacts. Sometimes you'll encounter some more risky situations for transmission and you'll have to handle them in a bit of a different way. So now let's talk about what some of those situations might be and how you can identify them. So as you know, when someone who's infectious has more and closer contacts with more people, that can be a really risky scenario for transmission. So there are a couple of important terms to keep in mind here. One is congregate housing settings. And this is any kind of shared living environment where an individual or a family has private living quarters, but shares common dining, recreational, or other facilities with others. These can be risky places for transmission. Also think about high-risk sub populations. And this is a segment of the population that may have characteristics that increase their risk for infection or increase their risk for severe disease. We already know what some of these groups are. Older adults, for example, are at much higher risk for severe disease. So when you are investigating cases and investigating contacts, talking to them, it's important to be on the lookout for anyone who is a member of one of these special populations that are at increased risk. So if you're talking to a case, for example, and they mention that they are in a very dense contact environment where they live closely with other people or have many shared spaces, then this is something you'll want to take note of because you may need to report it to your supervisor. You may need a different approach for contacting the people that they've had contact with. There are other situations where it may be difficult to contact trace and identify exposures. We'll go through some examples of this, as well. But in some cases, people may not even know who they've had contact with, so you may need an institutional approach to identify who their contacts are. Let's say, for example, they were in a movie theater. You may need to work with the movie theater to see who else was in that theater. The case themselves may not know. Let's think of another population, people who may find it difficult to isolate themselves or quarantine themselves within their living environment. We're going to talk about some examples of that, as well. And then finally, there are groups of people who are at higher risk for severe disease or death. And they may need some additional special considerations. So now let's define these four groups and unpack them a little bit more so you understand what you're looking for and when you might need to report to your supervisor that there may be a high-risk event. So the first scenario are dense contact environments. This is where there are large crowds of people. So if a case has recently been at a conference and had many contacts with others, you're going to want to note that and take some special action. If the case frequently has close contact or interactions with others, including physical contact or being within six feet for prolonged periods of time-- these kinds of contacts can lead to what we call a super-spreading event. And that means an unusually high reproductive number. So on average, you know that someone who is infectious who has COVID-19 could infect two to three other people. But if they have contact with dozens of people while they're infectious, then it's possible that they can infect many, many more than two to three people. And so again, this is a risky situation that you'd need to identify because you may need to take more than just the usual contact tracing steps to address this kind of exposure. Some examples of what those dense contact environments might include conferences, as I mentioned, people who've spent a lot of time on mass transit. So maybe they took a flight or they were on a train together for a long time. Religious services or demonstrations are another place where people often have close contact with many other people. The workplace environment could be another example, bars, gyms. Schools with people sitting together in a classroom for a long period of time is another dense contact environment, sporting events and concerts or other places where people are often in very close contact with each other. So anytime you identify a case who's had one of these exposures during their infectious period, you're going to need to report to your supervisor. There may be more than you need to do than the typical contact tracing. So let's talk about the next group, those where it's complex or hard to contact trace and identify exposures. So these are examples where the close contacts may be unknown to the case. So let's say you were at a concert. You may have had very close contact with someone next to you, but you may not know them. You may not know how to contact them. Another example is where the recall of close contacts may not be reliable. So let's say that you're talking to the case and they just may not remember who they've had contact with for various reasons. Another example is where there may be so many contacts that they had, it's difficult to determine who's really at risk and who the possible contacts are that you need to find. So some examples of where tracing contacts can be difficult are in a homeless shelter, for example. So the case themselves may not recall all of their contacts. They may have had contact with multiple people and they can't remember who they were. The contacts may be spread out through multiple jurisdictions. So let's say, for example, the person was in two different shelters in two different counties during their infectious period. So that would make the contact tracing much more complex. You may also have difficulty locating or testing contacts who were exposed to this person. So that's another added layer of difficulty in this kind of setting. In some places, it may just be very difficult for cases to isolate themselves from others or for contacts to quarantine themselves from other people. They may just be unable to distance themselves from others because of either the design of the house or the facility or maybe because they have developmental disabilities and aren't able to distance themselves from others. They need someone for their everyday care. It also may be that where they live, there aren't enough resources like masks, gloves, or staff so that you can adequately keep people separated from each other. So let's say one person is caring for two people. You don't have enough staff so that those people can be cared for independently. There could also be social pressures where they live, which makes it very difficult for them to keep a distance from others. Sometimes people may also be unwilling to cooperate. And that's another difficulty that you would want to notify your supervisor about. So one example of where it may be difficult to isolate or quarantine could be an intermediate care facility. And these are homes with people who have special needs. So the residents may be unable to cooperate or isolate or quarantine themselves because they may not understand basic concepts of hygiene and social distancing, so they may not be able to carry out the instructions themselves and it may be difficult to remove them from other people who are infected within the home because they all need care and there's nowhere else for them to go. It's also harder to maintain resources for effective prevention in those scenarios because they may not be used to using masks and gowns and they just may not have them on hand. So this would be another example of where you'd need to talk to your supervisor right away. So we've talked about the three examples where risk of transmission may be higher. But remember there's a fourth group as well, where the risk of transmission may be higher, but there's also a higher risk of severe disease or death. These are people who are more likely to get infected because they have many frequent close contexts similar to some of these other scenarios. But they also may have underlying medical conditions that put them at risk for severe disease. And they may get exposed to the virus multiple times because of others who they're having contact with. One example of this kind of scenario is an assisted living facility. So it's a congregate living situation where people may have their own rooms, but they share resources like kitchens or other social spaces, so they're at high risk for infection. Most residents in assisted living are over 60 years of age. So they're at higher risk for severe disease and death, as well. And these facilities may have multiple levels of care, including skilled nursing facilities which care for individuals with illness or injury. So they may have some of the same limitations on isolating themselves or quarantining themselves from others. So this is going to be an especially risky situation where people are at high risk for infection, but also severe disease or death. So again, as a contact tracer, you're going to have to help identify these high-risk situations when you're talking to cases or to contacts. It'll be really important for you to collect the necessary information to accurately assess this risk. So this will include making sure you know where people live and where they are, the type of interactions they have every day. If they're in one of these settings or have been in settings where they could have had contact with many people, you'll need the contact information for the venue. You'll need the name of that venue, where is it located. You'll need details. You'll need the names of their close contacts as best they can remember, but perhaps even details about contacts that they're not able to remember. You'll need specifics about where they've been, so if they were on a flight or a train. If they went to a movie theater, which movie did they see and what time was it? If they were at a conference, what's the name? If they were in a class, who's the teacher and where's the school? You'll need facility names. And this will all help you with helping to control transmission in this scenario. Your identification of this high-risk situation may also depend on noticing a pattern between multiple calls. So maybe, let's say for example, you talk to a few cases in a day and they all may work in the same facility. Well, then that could be a clue to you that there is transmission going on at that facility. And you'll need to escalate this issue. You'll need to report it to your supervisor immediately because it could be some indication that there is a high risk of transmission at that facility. When you're speaking with someone who may be in this high-risk scenario, you'll need to note for them that there may be additional follow-up required. And again, you should immediately escalate and report any kind of high-risk case or contact to your supervisor. Typically, these high-risk scenarios are going to be handled by specific teams that are trained to work with facilities, to work with organizations, to work with these cases and contacts to come up with a comprehensive plan on how to address risk and how to provide the services required to really stop transmission in these scenarios. So it's important, again, to immediately contact your supervisor if you identify high-risk cases or contacts. [MUSIC PLAYING]
