ITHACA, N.Y. –– To slow the spread of COVID-19 Tompkins County Community Health Nurses have turned their focus towards contact tracing –– identifying people and places where positive cases may have come in contact in order to try and stop the virus in its tracks.

Community Health Nurses investigate all reportable diseases, like tuberculosis or pertussis year-round to identify contacts and to educate individuals regarding disease transmission and prevention. However, as the pandemic has grown and New York State begins to reopen, Community Health Nurses have shifted their focus solely to coronavirus, and have been joined by nurses from the department of Children with Special Needs and Environmental Health staff in order to meet the county’s demands.

“We have a just in time training program to address any new cases that come up,” Public Health Director Frank Kruppa said in a public forum in May.

Rachel Buckwalter is a Community Health Nurse in Tompkins County who has had her caseload dedicated to coronavirus since March. Before she was working with MOMS (Medicaid Obstetric Maternal Services)  which provides health insurance, early prenatal care and education to income-eligible pregnant women. She was also working with sexually transmitted infections in the county, where contact tracing was a large part of her work –– pulling lab reports off the state database, following up to make sure those people have been treated appropriately and that their partners got treatment also. 

Rachel Buckwalter at work

“My work prior to COVID, especially the sexually transmitted infection work, is communicable disease, and so I had some of the skills already from that kind of work, so when things started to increase and we started seeing people getting tested and getting calls, my supervisor reassigned my caseload to be on the communicable disease team full time,” Buckwalter said.

In March, Buckwalter trained with another nurse to do the coronavirus contact investigations, which included using state materials and internal training documents at the health department. Since then, her day has followed the same pattern –– getting her temperature checked before joining her colleagues for a morning debriefing, then getting assignments for the day. 

The morning briefing consists of talking about any community-wide things that might affect the work such as if the COVID testing site at the mall is open, if there is a change in hours, if the county is testing nursing homes and when they expect results. 

The contact assignments consist of checking in with positive cases and asking them interview questions to track who and where the person has interacted, and how they might re-enter the world after recovery.

“The first thing we ask is how are you feeling, go through symptoms, then try to pinpoint the date of symptom onset,” Buckwalter said. “And then based on that date the guidance from the State Department of Health and the CDC is to go two days prior to that and start talking with them about what they did every day.”

Nurses ask patients to maybe pull out their smartphone or calendar or sit and talk with them for a while about a day by day what their activities were.

“It’s really variable about how sick that person is, if they have a really mild case or don’t feel that ill they might have a lot of activities, and might be out doing stuff,” Buckwalter said. “If it’s someone that’s very cautious and has mostly been staying home, maybe their only contact has been family members in their own home.”

When patients have tested negative twice, at least 24 hours apart they can then be released from home isolation.

Buckwalter said nurses sometimes have to work with employers if a positive case worked several shifts during the time they may have been infectious as was seen in cases both at GreenStar and Wegmans.

“We contact their employer and verify what shifts they worked and who they worked with and reach out to those contacts too.”

Contact tracers don’t release the name of the case to those they may be infected or come in close contact with the positive cases, but Buckwalter said often people have an idea where they may have gotten infected. 

“Sometimes it’s related to travel out of the county…early on we saw a connection with travel to New York City, but there’s very little travel now. And sometimes people say they have no idea and it’s just community spread.”

Also, every few days, a traveler list through the regional health office out of Syracuse and notifies nurses of travelers whose final destination is Tompkins County, who are advised to be put in a precautionary quarantine.

Community Health Nurses have stressed that spread is likely when people are within 6 feet for more than 10 minutes, even if people have masks on because most people aren’t wearing the super protective N95 masks that healthcare professionals wear. Buckwalter wants to remind people that the virus can enter through your eyes or on your hands and then touching your own face.

However, she also said they haven’t seen the source of new positive cases coming from running essential errands.

“Usually grocery shopping is not a significant risk –– it’s close contact with other people. Usually, people are able to get in and out of the store and take the right precautions so we really have not seen cases connected.”

Now that new positives cases have somewhat slowed in Tompkins County, Buckwalter said the other areas of Community Health work have started to come back.

“When things were really ramping up here in March and April we completely shut down our other programs and put everything else on hold and now we’ve had stretches of say five days with no new cases, so my supervisors have said, “hey contact people on your caseload…reach out and say things are opening up a little bit and resume services but do it remotely.”

She said the health department has put on hold their immunization clinic for people who don’t have insurance, but that that could resume sometime in the future.

Buckwalter said her supervisors have started a resumption plan for getting Community Health nurses back to their regular beats.

Anna Lamb

Anna Lamb is a reporter for the Ithaca Voice. Questions? Story tips? Contact her at alamb@ithacavoice.com