*Editor's note: This report reflects Polk County case numbers as of press time Friday afternoon.
In a shocking increase, Polk County’s confirmed positive COVID-19 cases doubled in a week, jumping from 16 on Thursday, July 2, to 31 by Thursday, July 9.
The county’s active cases tripled, up to 18 from five, as of press time Friday.
According to the Polk County Health Center, at least nine of the 16 new cases are direct contacts to a previously reported positive case.
PCHC community educator and public information officer Carol Bookhout said the sharp growth doesn’t come as a surprise.
“Multiple positives are always a possibility when you have several direct contacts to a positive case,” she said.
She said the health center’s contact tracing team “worked diligently” to immediately identify those contacts.
“This contact tracing and the resulting testing for those who have been a direct contact to a positive enables us to contain the spread of the virus,” Bookhout said.
While the sources for most of the county’s recent cases include contact with another positive case and a travel or work exposure, health center staff hasn’t been able to determine sources for two confirmed cases, per previous news releases.
According to the Centers for Disease Control and Prevention, “community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.”
However, Bookhout said in an email Thursday Polk County is not currently experiencing community spread.
The CDC says “each health department determines community spread differently based on local conditions.”
“The recent increase in positive case count can be alarming, but we want to encourage the public,” Bookhout said.
She said the health center appreciates “the efforts of many businesses, organizations and individuals who have made the choice to practice social distancing, good hand hygiene, wearing face coverings and staying home if they are sick.”
The strategies “have created a safer, healthier community for all of us,” she said.
Three pillars of the county’s recovery plan — including stability in the health care system, the availability of testing and the ability of public health staff to maintain and monitor active cases and contact isolation — remain stable, Bookhout said.
Gary Fulbright, CEO and executive director of Citizens Memorial Hospital and Citizens Memorial Health Care Foundation, said Friday the hospital is “functioning at normal capacity and has the resources currently to accommodate hospital admissions, including the patients who may need to use ventilators.”
As of press time Friday, he said CMH does not have any current inpatients with active COVID-19 symptoms. However, he said the hospital is “continuing to screen and test patients in our clinics, drive-thru testing site and emergency room for COVID-19.”
“We have an adequate supply of (personal protective equipment) to support patient care needs and additional PPE for COVID-19 related care,” Fulbright said.
He called CMH hospital staff members resilient, saying they “are doing an amazing job taking care of our patients and residents.”
“Things are going as well as can be expected considering the times we live in now and the precautions we all must take to keep our patients, residents, families and co-workers safe,” Fulbright said.
How does contact tracing work?
Thanks to the recent spike in cases, contact tracing and monitoring of quarantine isolation by the Polk County Health Center’s epidemiology team may be more important and more challenging than ever.
Contact tracing “involves identifying people who have an infectious disease and people who they came in contact with and working with them to interrupt disease spread,” according to the CDC.
In an interview Monday, June 29, Polk County Health Center Administrator Michelle Morris said it generally takes her team three to six hours to “work a case.”
It all starts, she said, when the center is notified of a positive COVID-19 case by the state or a local health care provider.
“Once that happens, we wait for confirmation on the lab report,” she said.
The next step is to contact the individual, Morris said. First, the team verifies the person’s identity and address.
“We have gotten some reports of individuals who had lived in our community in the past but had since moved,” Morris said. “So let’s say we’ve identified that they actually live in Greene County. We’ll go ahead and collect as much information as we can.”
She said her team then passes on the information to the correct county health department.
But, once the health center confirms a person is indeed a Polk County resident, “that’s where the investigation starts,” Morris said.
She said her staff will ask the person when symptoms started and start mapping out the individual’s activities from 48 hours before symptoms began until the current day.
“Where did you go? Who did you have contact with? Were you in any public places? Did you go to work? Who were your contacts at work?” Morris said. “We literally just walk with them through each day until we get to the day we’re at.”
Once the staff members complete that step, they start reaching out to people who’ve had direct contact with the positive case.
But, being a direct contact means more than just passing someone in a store, Morris said.
“It’s closer than 6 feet for more than 10 minutes,” she said. “You have to meet that criteria in order to be considered someone to contact.”
When the health center makes calls to close contacts, Morris said, they don’t reveal the positive case’s identity.
“We literally just say, ‘Your name has been given to us, and we are contacting you to let you know you are a contact for a positive of COVID-19, and because of that, here are some instructions for you,’” she said.
Morris said the team asks about the contacts’ symptoms and health and then asks each person to quarantine — which means staying home, avoiding public places and avoiding seeing others — for 14 days.
“Then we offer testing to them,” she said. “We want to test each person that’s a contact to a positive five to seven days after they last had contact with that positive.”
She said her team works with the Greene County Health Center to offer testing at no cost, “so there’s no barrier to them receiving the test.”
Morris said some people decline testing.
“In reality, it doesn’t change the fact that they’re going to stay in quarantine,” she said. “Just because they get a negative test, it just means they’re exposure wasn’t great enough they developed symptoms, but we still need them to stay in quarantine for the 14 days.”
She said the health center staff “calls every person every day,” including the positive cases and each contact, during their quarantine periods.
They instruct the contacts to take their temperatures twice a day, once in the morning and once at night, and monitor for symptoms.
“We touch base with them every day,” she said. “We ask, ‘Hey, how are you feeling? What was your temperature? Have you developed any symptoms?’ We walk through that process with them.”
Each contact also receives Morris’ cell phone number, so they can reach someone after normal hours at the health center and on weekends.
“That way if something comes up and they have a question or they start having symptoms, they can call us at any time and let us know that’s the case,” she said.
At the end of the quarantine period, Morris said the health department gives each person a letter saying they are released from quarantine for employers.
Morris said, at the same time, the team works through potential exposures, sharing that information with the public.
“We take the time to make a phone call to those public places,” she said. “Just to have a conversation with them to say, ‘We want you to know, a public exposure occurred in your facility. This is the date and the time. Just be aware, we are going to release that in a news release.’”
Morris said education about sanitizing and social distancing at local businesses at the beginning of the COVID-19 crisis has been key to working through public exposures now.
“The great thing about it is that our businesses were very proactive and they had implemented those procedures, and so I think that helped the process,” she said. “All cases where we called and said, ‘Your business is involved,’ they already had the disinfecting and cleaning practices and procedures in place.”
‘Part of what we do’
While, as Bookhout simply said, “It’s hard to do contact tracing,” it’s not something new for the health center.
“There’re 97 reportable diseases in Missouri, and if any one of those diseases is reported in our county, then it’s our responsibility to do the investigation and do contact tracing related to that.” Morris said. “That’s part of what we do.”
Morris said contact tracing has been around as long as public health.
“It’s just part of our role and responsibility at the public health department,” she said.
Ultimately, Morris said the health center wants to help.
“We genuinely get to know the people we’re working with and want to know how they are,” she said. “How is their family? What questions do they have? How can we help them?”
She said her staff simply wants to meet needs in the community, whether that’s dropping off cleaning supplies or food for someone in quarantine or taking a few extra minutes to chat with someone who’s feeling especially isolated.
“We really do care,” Morris said. “We learn about them and their families. It does become personal.”
Bookhout said that care is something the team members carry with them constantly.
“You’re never away from it,” she said. “It’s always on your mind. … There is an emotional and mental toll that is taken on the staff.”
But that toll hasn’t stopped the health center staff, which Bookhout likens to a family, from pushing ahead.
Morris said that dedication is evident every day.
“We’ve learned so much from where we were four months ago to where we are today,” Morris said. “That’s another thing about our staff — their ability, their knowledge. These people get it done. They get in there, they learn it, they do it. It’s pretty amazing.”
She said health center staff has been in a “constant learning phase” for the past four months.
“It moves at the speed of light, whether it’s the information we’re getting, how we are to contact trace,” she said. “There are some times I feel like I’m in last place in a marathon every single day. It moves fast. Information changes fast.”
Both Morris and Bookhout said the staff’s support of each other and support from the community have helped the health center get through the past few months.
“When push comes to shove, we’ve got each other’s backs, and we’re not going to let anybody fall,” Bookhout said. “We’ve got a great crew here.”
“We want to help our community,” Morris added. “We want to protect our community. We are very fortunate in our community to have the great partners we get to do that with. I can’t sing their praises enough for the amount of help and support we’ve gotten from our community partnerships.”