What is Contact Tracing?  

There has been much talk of contact tracing as an important tool of COVID-19 risk assessment, but many people don’t understand what it is, how it works, what some challenges are and who’s been doing it well.   

What is contact tracing?  

According to the CDC contact tracing is: “The process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission. When systematically applied, contact tracing will break the chains of transmission of COVID-19 and is an essential public health tool for controlling the virus.” 

This involves identifying people who may have been exposed and then following up with them from the point of exposure. This may sound simple but figuring out everyone a person has been in close contact with is very challenging. And the larger the numbers of people who have been exposed or contracted the virus, the more monumental the task.

Dr. Hugonnet from the World Health Organization explains “You need a system to identify cases, a functioning laboratory, a system to feedback data, people to identify and follow-up with contacts, provide support if they need quarantine, and treat them properly. This amounts – at a minimum — to three days of work per COVID-19 patient.  It all adds up.”   

Why is contact tracing important in the workplace?  

So, why is contact tracing important for the workplace? It is an effective strategy to interrupt disease transmission within the workplace. It accomplishes this by separating people who have, or may have, COVID-19 from people who do not. As many people who have COVID-19 may not experience symptoms or may be shedding the virus before experiencing symptoms; this is vital.  

These measures have been used by health departments of different levels all around the world for years to slow or stop the spread of infectious diseases. Most recently contact tracing has been used to stop the spread of SARS, MERS and Swine Flu, among others.  

What is the contact tracing workflow?  

Contact tracing involves identifying close contacts of those with confirmed positive tests or probable COVID-19 patients. Close contacts are defined as any individual within six feet of an infected person for 15 minutes or more.  

These are the steps involved in contact tracing:  

• COVID-19 patient interviewed  
• Patient identifies contacts  
• Contacts triaged for assignment  
• Contact assigned  
• Contact notified then if testing available and
  • Contact tests positive, then they are instructed to self-isolate, are referred to a medical provider if necessary, and referred to support services.  
  • Contact tests negative, then contact is followed up with as contact quarantines for up to 14 days from exposure if deemed a close contact. 

Problems with contact tracing  

Unfortunately, as important as contact tracing is, it quickly becomes complicated and time-consuming. It also becomes increasingly difficult to muster the appropriate resources as cases rise. If it isn’t done within 24 to 48 hours of a positive case, it becomes almost impossible and is also no longer as effective.

We’ve seen this happen all across the world, especially in the west where COVID-19 has spread the most. In England, one in eight people who have tested positive have not been reached, 18% of those who are reached provide no details for close contacts. In the US, more than half of those with positive test results provide no details when asked. And this was not during the first wave in the spring but in November as case numbers quickly were rising.  

There are many reasons for these failures. Old technology and underfunded health-care systems have not been able to provide the functions needed. Even wealthy nations have had problems hiring enough contact tracers, organizing them effectively or make sure that people are self-isolating.   

There also has been distrust of both health authorities and technologies used in effort to control the pandemic. Without the data, researchers find it hard to draw lessons and suggest best courses of action. Countries with no restrictions on movement will end up needing to trace more contacts than a country with some form of restrictions or lockdown.  

In December 2020 Nature Magazine explained: “In reality, failures occur at every stage of this test–trace–isolate sequence. People get COVID-19 and don’t know it, or delay getting tested. Positive results can take days to be confirmed. Not everyone who tests positive isolates when requested. People can’t always be reached for an interview or don’t provide details of their close contacts. And not all contacts are reached, or are willing to comply with quarantine orders.”   

As we have learned more about the virus and technology has made getting test results faster, governments have been able to improve their virus response.

Successful use of contact tracing and learnings for occupational settings 

Many of the countries who have been successful in controlling the spread of COVID-19 have been able to do so due to their previous experience with other infectious disease outbreaks like SARS and Swine Flu. This includes such countries as Taiwan, South Korea, New Zealand and Japan. Most of these countries cracked down on the disease early and were able to utilize personal data such as mobile-phone signal tracking to ensure compliance and the tracking of purchases and/or CCTV footage to help recreate patients’ movements and identify possible contacts. But these actions bring up concerns about legality and privacy.  

With the COVID-19 pandemic, the December 2020 Nature Magazine has noted “A handful of places stand out as exemplars of successful contact-tracing — including South Korea, Vietnam, Japan and Taiwan.” with resultant significantly lower infection rates. 

It has also been more common among these countries to have people quarantine at designated quarantine facilities. But most countries do not have this option and many people’s living circumstances make it difficult to isolate. In the United States it is estimated that as much as one in five households lack the space needed for an effective quarantine.  

It’s also important to consider culture. Many Asian countries are used to masking when ill or in case of the spread of an infectious disease. There is also a culture of understanding the necessity of such measures, trust in the system in place and less misinformation is circulated.  

Even as vaccines begin to roll out around the world, contact tracing is going to remain an important tool to get control of and eventually eliminate the danger of the spread of COVID-19. At Integra we will continue to stay up to date on best practices and communicate best options to all our employees, partners and clients.  

Case investigation and contact tracing is a specialized skill. To be done effectively, the CDC guidelines state it requires people with training and medical supervision.  

Occupational contact tracing will review in-depth clinical aspects in a timely manner (under 48 hours), regarding potential workplace close contact. The level of detail reviewed with regards to particular workplace issues such as: shared tools, common workplaces, use of masking or personal protective equipment or protracted close quarters labour; is highly likely to be above and beyond what current stretched public health resources are capable of, resulting in reduced workplace transmission tracking of COVID-19 virus. 

Contact Integra at covid@integraconnects.com for more information on Occupational Contact Tracing. 

Medical Case Management

Medical Case Management (MCM) is a process of coordinating comprehensive healthcare services following illness or injury, to achieve focused, individualized quality care delivered in a cost-effective manner, with a view to returning the individual to a functionally improved state.  

The process, ideally implemented by a team of regulated healthcare professionals including but not limited to an Occupational Health Physician, Occupational Health Nurse, Physiotherapist or Occupational Therapist, integrates assessment, planning, implementation, monitoring and evaluation components into medical case management to achieve an optimal outcome for all stakeholders.

Medical Case Management includes the development of preventive systems and the mobilization of appropriate resources for care over the course of the health event.  Care is delivered with the goal of returning the employee to pre-illness or pre-injury function or to the highest level of functioning achievable while considering critical factors such as confidentiality, cost effectiveness, the hierarchy of vocational rehabilitation and workplace culture. These services can be delivered through a variety of models, i.e., in person on-site, via telephone or secure video link, in person off-site, or a combination thereof.  

The health care professional coordinates the proactive efforts of the individualized health care team to facilitate an employee’s health care services from the onset of injury or illness to reach maximum medical recovery and facilitate a safe, durable return to work (RTW) or an optimal alternative. 

A quality medical case management approach involvesAssessment, Planning, Implementation, Monitoring and Evaluation.

Key points to consider with each phase are as follows:

Assessment

A thorough assessment is undertaken with a view to understanding the total ill/injured individual’s physical, emotional, psychosocial, occupational and spiritual needs that are preventing a return to work. This includes: assessment of the employee’s social support network; available community resources; workplace and vendor resources; assessment of essential functions of the job (physical and cognitive demands); identification of functional gaps; and, evaluation of workplace policies on return to work (RTW) and accommodation.

Planning

This stage involves understanding the employee and employer goals; preparing and analyzing all information to formulate a plan; coordinating service providers; collaborating with community providers, healthcare practitioners and workplace stakeholders to set expectations of treatment plan and coordinating creative solutions to meet the needs of the employee and employer.

Implementation

During implementation, the Medical Case Manager coordinates all treatment providers involved and liaises with all stakeholders on plan implementation and progress of the employee to ensure goals of the treatment plan are on track.

Monitoring

Monitoring involves reviewing progress of the treatment plan, allowing for adjustments to the plan based on the employee’s progress and the planned return to work timeframe.  It also includes collaborating with the employer to ensure all stakeholders are working in synchronicity towards the same goal.

Evaluation

The Medical Case Manager evaluates quality and outcome of treatment, response of the employee’s recovery, and levels of employee function as it relates to return-to-work expectations. Ongoing evaluation ensures the treatment plan is cost effective and collaborative, addresses that the workplace is integrating the employee as expected, and ensures transfer of care to community and facility based professionals once medical case management has ended to safeguard that the continuum of care remains.

Quality medical case management provides the following, all while considering the overarching needs of the workplace and employee, which includes job duties, work environment, workplace culture, safety sensitive specifics and occupational health and safety considerations:

• Early intervention;
• Collaborative, prompt service and focused cost-effective outcomes;
• Individualized health care to employees;
• Transitional work opportunities/accommodation;
• Safe, durable and timely return to work;
• Knowledge and compliance with relevant legislation, and;
• Focused, cost effective outcomes.

Quality medical case management:

• Applies the balance of advocacy for all stakeholders and remains objective;
• Is conducted by regulated health professionals who can apply critical analysis and critical decision making to obtain an optimal outcome;
• Assures confidentiality is at the forefront in all phases of medical case management; and,
• Complies with professional code of ethics and legal or regulatory requirements.

Ideally delivered by a regulated healthcare professional who has:

• Understanding and knowledge and ability to unravel the complexity of disability inclusive of chronic diseases, illnesses or injuries;
• Understanding how complex medical conditions influence the employee’s perspective in how they relate to and function in society, and;
• A thorough understanding of return-to-work practices, hierarchy of vocational rehabilitation, relevant legislation such as human rights, Canada labour code, Employment Standards Act, Freedom of Information Act, occupational health and safety legislation, workplace culture, environment and job demands.

Managing any level of medical absences (occupational or non-occupational) of employees can be a complicated task. Relying and obtaining the services of a third party who has a team of highly qualified, regulated health professionals who do the right thing at the right time is key to get the right outcome for all stakeholders.

Some sobering statistics follow.

The Center for Addiction and Mental Health (CAMH) outlines:

• Mental illness is the leading cause of disability in Canada;
• The economic burden of mental illness in Canada is estimated at $51 billion per year; This includes health care costs, lost productivity, and reductions in health-related quality of life; and,
• In any given year, 1 in 5 Canadians experience a mental illness or addiction problem.

Workers’ compensation boards (WCB) and commissions across Canada collect information about accepted time-loss injuries. In 2019, there were approximately 259,149 lost time claims in Canada. http://www.wsibstatistics.ca

It is evident by the above numbers that occupational and non-occupational illnesses and injuries have significant impact in the workplace. To help mitigate the losses in the workplace, it may be in your best interest to retain a third-party provider to manage this impact with a regulated health professionals team known to practice with a level of excellence. When choosing a third party you want to ensure they have a team of highly skilled and qualified health professionals who are interconnected with other providers and who share the same values and principles with a focus on sustainable, cost-effective outcomes.

Integra’s innate ability to navigate the complexities and nuances of occupational health means we can advise and guide your Human Resources strategic business partner, connecting you with the right experts in the process to reduce the impact mental health and injuries on the workplace and on the organization’s medical case management costs.

Embarking upon a journey with Integra to provide medical case management for your employees will ensure you get the most favourable outcome for all stakeholders.

With the economic burden of mental illness in Canada estimated at $51 billion per year and 259,149 lost time claims in Canada in 2019, the question to you is can you afford not to invest in quality medical case management?

Our guest writer Tracey Martindale is a Certified Occupational Health Nurse who has practiced in a variety of clinic, industrial and business settings during her career. As an outside the box thinker, she strives to achieve an optimal outcome for all stakeholders in their challenges. Tracey is a life long learner who seeks out opportunities that align with her values and principles. In her down time she stays grounded by hiking in nature with her pack, cycling, gardening and playing board games.

How to “Ergonomize” and Work From Home

Due to the current circumstances, many office workers are now working from home. This may seem ideal considering physical distancing measures in place, however, working in less than ideal physical infrastructure can have long-term consequences on your musculoskeletal health.

The difference between an office workstation and a home workstation is the lack of an appropriately set-up ergonomic workstation. Factors such as lack of proper support can lead to negative effects (i.e. low back pain and/or tightness in the neck and shoulders).

What does Ergonomics Mean?

Ergonomics are used to ensure the in which humans interact with objects around them is optimally designed. In an office environment, the objects of interaction include: desk; chair; computer monitor; keyboard; mouse. A good ergonomic set-up can ensure that office workers are interacting with these objects in a way that minimizes strain and injury to their bodies.

How to setup your workstation at home:

Three potential workstations will be discussed but the same general rules apply to any:

• At-home office
• On the Couch
• Standing at a table or kitchen counter.

At-Home Office Workstation

Desk and seat height: The seat should be adjusted to a height where the elbows are at 90 degrees when using the keyboard. Thighs should not be hitting the bottom of the desk. Ideally, feet should be flat on the floor and at a 90-degree angle. In some cases, adjusting the seat to accommodate for desk height can cause difficulty with placing the feet flat on the ground. In this case, use an object such as a yoga block, ream of paper or large hard surfaced book to place upon which to place the feet.

Back support: Sit all the way back in your seat. For comfort, place a small pillow or rolled up towel in the natural curve of your low back to help provide some back support.

Computer screen: If using a desktop computer, be sure to adjust the monitor in a way that it is directly at eye level to avoid looking downward or upward. You may want to place your monitor on a hard-surfaced book or a yoga block to elevate the surface if the monitor height is not adjustable. If you are using a laptop, consider purchasing a separate mouse and keyboard as well as a laptop holder to bring the monitor to eye level, to mimic a desktop set-up.

Couch Workstation

Back support and surface elevation: The secret to achieving the best position while sitting on the couch is by using pillows. They can be used to provide back support as well as to elevate the laptop. This will prevent the wrists from bending as you type. You can also place pillows under the elbows to help prop you up but be sure to avoid any position where the shoulders are shrugged upwards.

Foot positioning: Similar to the last scenario, if you are unable to place your feet flat on the floor, you can use an object such as a yoga block to achieve the 90-degree rule.

Standing Workstation

If a sit-stand work desk is not available, a standing workstation can be improvised with a few tools. Potential areas could be the kitchen counter, table or an office desk. In this case, books or boxes can be used to elevate the surface your laptop. In this position, keep in mind there should be a 90-degree angle at the elbows, and the wrists should always be positioned below the elbows. As with a laptop scenario on a home office workstation, a separate keyboard and mouse are useful.

Additional tips:

Posture and taking breaks: Whether sitting or standing, it is important to have good posture to prevent pain and tightness in the neck and shoulders. Try rolling the shoulders back and tucking your chin back every time you notice slouching. Also, it is important to take breaks at least every hour while working. During these breaks get up to move around or do some stretches at your desk. There are a multitude of online resources available for stretching at your desk.

Keep in mind the 90 Rule: Maintain 90 degree angles at the ankles, knees, hips and elbows when seated, and 90 degree angles at the ankles and elbows when standing.

Blue light: Consider getting a pair of blue light glasses to filter out the blue light from your computer screen, or adjusting the settings on your monitor. Blue light is known to interfere with melatonin, a naturally occurring substance that helps regulate our sleep patterns.