Delays in Reporting COVID Positive Cases To Framingham Slowing Down Contact Tracing Efforts

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FRAMINGHAM – On Thursday, September 3, a Framingham High student was administered a coronavirus test at a private Framingham clinic and was told that day she was positive for COVID-19. As of today, September 15, no one has contacted her family about contact tracing, a key tool used by health officials to stop the spread of the disease.

The responsible family, however, had everyone in the house tested, A week later, mom was notified she was positive on September 10, and dad was notified on September 12 he was positive.

As of today, none of the three Framingham family members have been contacted by the City of Framingham for contact tracing.

“No one has reached out to us for any information, so how are they tracing anything? This is all so frustrating,” said the mother. (Due to privacy reasons SOURCE has chosen not publish the family’s names).

All three were tested at different private facilities in the Framingham or MetroWest.

That family is not alone.

in the past couple of weeks, several Framingham residents have contacted SOURCE to say they tested positive at Carewell, Partners, MetroWest Medical Center, and other testing sites, and were still waiting to hear from a contact tracer more than 72 hours after the positive test result, and some waiting more than a week. (Editor’s Note: They are quoted below but none of their names are being published for privacy reasons.)

Contact tracing is one of the key tools the Commonwealth of Massachusetts and the City of Framingham are using to slow the spread of the coronavirus.

Contact tracers call positive patients to offer services and support. A tracer;s job is to quickly locate and talk with the patients, assist in arranging for patients to isolate themselves, and work with patients to identify people with whom the patients have been in close contact so the contact tracer can locate those individuals and have them tested and quarantined until the test results.

In late August, Framingham was named one of the high-risk communities for the virus in the state.

The Governor said Framingham is one of six communities in the Commonwealth with a dangerously high rate of infection.

Last week Framingham’s rate was 4.89% and the state’s rate was 0.9%.

The Massachusetts Department of Public Health said “most new cases of COVID-19 and contacts are called within 24 hours of their entry into the Department of Public Health’s MAVEN system,” by the state’s first-in-the-nation state contact tracing program.

Governor Charlie Baker announced the partnership with Partners in Health to run the tracing program earlier this spring. MAVEN is the state’s system with all the coronavirus data.

“As soon as a lab result is reported into MAVEN, the local health department in the city/town of residence has access to that information. The only time that DPH has data that is not immediately visible to the local health department, is if the patient’s address has not been reported by the health care provider or laboratory. At that point, the Department of Public Health conducts a manual process to determine the patient’s address, enter it into MAVEN, and then the result is automatically and immediately visible to the local health department,” said a Department of Public Health spokesperson to SOURCE on Monday,

Framingham is not a part of the state’s contact tracing program. The City of Framingham opted out of it.

Health experts said positive COVID test results should be reported as soon as possible into MAVEN & the state.

“In practice, the average time between when a person gets tested and when the result gets reported into MAVEN is 2-3 days,’ said the Massachusetts Public Health spokesperson to SOURCE yesterday, September 10.

So how does the process work?

First, a patient makes an appointment with doctor or at a testing site. A swab is taken from the patient, and that is sent to the laboratory. The laboratory runs the test and then notifies the doctor or testing site. Doctor or testing site then informs the patient. Then, the “test result is recorded in DPH’s MAVEN and immediately visible to local public health department,” said the state spokesperson.

Framingham has been offering free COVID-19 drive-thru and walk-up testing, thanks to the Commonwealth of Massachusetts, in three locations. Typically the turnaround for those test has been 24-48 hours. Many private testing sites can provide either immediate test results or results in no more than 72 hours.

Residents who test positive in Framingham will not hear from members of the Commonwealth’s contact tracing program (CTC) as the City of Framingham opted out of the state’s program.

“We did try the CTC with a few cases in April and we stopped using them when we encountered the problems highlighted in the Boston Globe article.  The CTC is undergoing some changes and we are monitoring that.  When they are able to address the issues that many local health departments observed, we will definitely participate.  We still have enough local capacity to manage our current caseload at this point,” said Framingham Health Director sam Wong to SOURCE last week.

In July, the Boston Globe reported “Local health departments also conduct contact tracing, and the state effort was meant to help with that effort. But the state collaboration with Partners in Health was plagued by problems from its start in early April, according to several local health department leaders. They said widespread computer glitches, gaps in training, and communication struggles led to significant delays in contacting infected residents. Public health experts say ideally it should take no longer than three days to connect with and test those who may have been in close contact with an infected person. But some local health leaders said it often took longer than that for Partners just to connect with the initial infected person, delaying efforts to identify and isolate others.”

The City of Framingham runs its own contact tracing program, but now it is experiencing delays between a positive test result by a resident and when a contact tracer starts their job.

What is causing that delay is still unclear.

“MetroWest Medical Center called me on Friday to tell me I was positive. I was told to quarantine. I was told to make a list of those I had been in contact with in the last 3 days. I was told someone would call me to discuss those contacts, maybe not over the weekend, but Monday. Today is Friday. It has been a week and I have not heard from anyone,” said a Framingham resident to SOURCE on Septemebr 4. (The news outlet chose not to use the Framingham resident’s name).

SOURCE asked the City’s health director if there is a delay in getting names and contact info of positive cases.

“We do not know if the testing provider (the healthcare entity that collects the specimens) gets the result sooner than we do.  We rely on the testing lab to upload the test results onto the state’s virtual epidemiological network (MAVEN), which in turn notifies us when there is a new case in Framingham,” said Framingham Health Director Wong.

“We rely on MAVEN since day 1 to notify us on any new case in Framingham,” said Wong.

When asked how many days on average from when one tests positive for COVID to when City is notified, Wong responded “Not sure we know the answer. We do know when the specimen was collected.  Lately, test results are provided to us via MAVEN within 48 hours of the test date (specimen collection date.”

Wong said the state via Maven sends the City notification when it learns of a positive case in Framingham.

One possible cause in the delay may be the private testing sites themselves.

“We had to fight with urgent care for our initial tests on because they said to just assume we are all positive. Frustrating because, while it doesn’t impact our quarantine timeline, it does directly impact who we need to inform of potential exposure,” said a Framingham mom, who has since tested positive for the virus, and 5 days later has not heard from anyone about contact tracing.

Framingham’s Health Director agreed that delays in reporting positive cases to the City does increase the probability for more infections.

Wong said once the City of Framingham is notified of a positive case, a city nurse calls the individual “within 24 hours, but sooner in most cases.”

The City’s contact tracing program currently has “one full-time and 10 part-time nurses doing case investigation and contact tracing for us, and 5 of which are school nurses,” said Wong.

“Back in May, we had 22 full and part-time nurses working on this.  Some of the school nurses have gone back to their regular school work, including Framingham State University nurses,’ said Wong to SOURCE on September 10.

The City of Framingham when contact tracing considers the “infectious period, which is the time frame that we identify close contacts as a part of the contact tracing process, is 48 hours prior to the onset of symptoms.”

Massachusetts Department of Public Health “developed a standard workflow questionnaire for case investigation and contact tracing within the MAVEN system.  Framingham uses that system, said Wong.

“It is very lengthy and comprehensive, including clinical questions (symptoms, underlying medical issues, etc.), demographic questions, employment questions, and exposure questions,” explained Wong.

“Asymptomatic people who tested positive, they need to be isolated for at least 10 days and stay asymptomatic the entire time,” said Wong.

And how does someone know if they have recovered from COVID-19 while in isolation, SOURCE asked Wong.

“Anyone in isolation can be release from isolation after they have meet the criteria from CDC and informed by one of our public health nurses.  Once they are released from isolation, they are considered ‘recovered’ per MDPH guidance,” said Framingham’s Health Director.

“I’ve been isolation in my apartment for days,” said one Framingham resident to Source on September 9. “My wife is working. One of us needs to work. She went to the free testing site and was negative. I’ve been home for 5 days and no one has called us. This is frustrating. I have no symptoms, but someone at work was positive, so they told me to get tested and now I am positive. I need to work to pay the bills. I’m fine. I need to know when I can go back to work. If I don’t hear from someone I plan to go back Monday.”

“My doctor’s office called me on Friday to say I was positive. It was the long holiday weekend, so I was not hopeful to hear from anyone in regards to contact tracing, but now it is Friday again, and nothing. How can the city stop the spread if they don’t even know that I am positive and who I have been in touch with?” said a Framingham woman to SOURCE on September 11.

Wong said if someone tests positive, they should contact the City of Framingham’s Health Department and not wait for the someone to call them.

But that is not the message the private healthcare providers are telling patients. It is not what the private testing sites or the free testing sites are telling individuals either. All have been consistent with their message. If you are positive, a nurse will contact use about contact tracing.

When SOURCE told Wong about some of the calls the news media received on individuals waiting on contact tracing, his response was “please ask them to call us.”

Wong said “we rely on MAVEN to provide us with the information on any new cases, including contact information.  Occasionally, there are cases that the contact information provided by MAVEN is incorrect.  Every efforts are being made to contact someone who tested positive, including Google search on white pages, previous infectious disease records, and engaging other healthcare partners such as the Kennedy Community Health Center.  Our public health nurses do this work 7 days a week.  We are developing messaging to residents to contact us when they receive a positive test result.”

editor

email: editor@FraminghamSource.com call or text at 508-315-7176

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