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The fight to slow global SARSCoV-2 (COVID-19) pandemic has created the need for the rapid creation, transmission, and interpretation of data within the field of public health unlike ever before. The ability for local public health to perform case investigations of infected persons, contract tracing, and health education depends on our collective ability, across state and local stakeholders, to manage and use these data as efficiently as possible. Combined with this, creating compelling indicators from the local epidemiological data is an essential component to build public support for public health recommendations, such as social distancing, and voluntary compliance to regulatory directed health measures can prove challenging.
East Central District Health Department (ECDHD) located in Columbus, Nebraska had employed a host of different strategies and associated technologies to aid in the case investigation and contact tracing workflow.
Case investigation and contact tracing begin with the positive test result. Depending on the test type (molecular or antigen), these tests are communicated in different ways. For example, with rapid tests, results available within one hour or less. These tests are often transmitted electronically to state health departments but could be FAXed if the electronic infrastructure is not in place at the testing facility. This process is similar for PCR testing, which takes up to a week for these labs to result.
In Nebraska, most PCR tests are performed through the Test Nebraska project, which is a public-private consortium powered by the State of Nebraska, DOMO, QualtricsXM, CoDiagnostics Inc., NomiHealth, RPH Engineering, SafeLane Health, and dozens of Nebraska clinics, hospitals, and hospital systems. This project expands testing across the State as a no-charge testing option that delivers results directly to the patient. Local health departments are also notified, usually within a few hours.
Regardless of the source of the test, all results ultimately populate the State data queue and accessible by local health departments through the National Electronic Disease Surveillance System (NEDSS). NEDSS also serves as the platform for submitting case investigation details to Nebraska Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC).
Depending on the speed of the test and the source (rapid test, reference lab, Test Nebraska), it can take several days for local health departments to be notified of the result. When speed is of the essence, this delay can slow down case investigations and contact tracing, potentially making it more difficult to slow the spread of the virus.
Because of these potential delays, the traditional call center became an essential of ECDHD’s Emergency Operations Center and serves as the axis for the health district’s epidemiological case investigations and contact tracing. Combined with strong partnerships with our medical community directing patients to self-report to their local health department, patient self-disclosure and automated Test Nebraska project result have done much toward reducing the time required to contact those that test positive that require isolation and subsequent close contacts for those that require quarantine.
Additionally, ECDHD uses other technology solutions to address the pandemic. Contact tracers contracted with Nebraska DHHS assist local health departments using REDCap to begin investigations and contact tracing, and then push the patient information NEDSS. Further, platforms like ArcMap GIS and Tableau are used to create easy-to-view data dashboards to share vital indicators with the broader public. Together, these technologies come together to quickly and efficiently address the COVID-19 pandemic within the health district.