COVID lessons learned: In 7 months, state makes strides in testing, preparing

Gov. John Carney discusses pandemic strategy with officials at the State Health Operations Center in Smyrna on March 16, just days after the state’s first positive case was recorded and before social distancing requirements began. Dr. Karyl Rattay, Division of Public Health director, listens at right. Special to the Delaware State News/Ariane Mueller

DOVER — There’s been a laundry list of developments since the first confirmed case of COVID-19 in Delaware on March 11, seven months ago today.

Since then, the state has seen outbreaks in poultry plants, long-term care centers and the beach community. Numbers rose in the spring and early summer, before dropping to their lowest point in August. However, in October, those numbers are climbing again.

The way the state is fighting COVID-19 is constantly evolving. There’s typically close to 30 testing sites throughout the state per week, a team of contact tracers, social media campaigns and even an app.

Delaware Division of Public Health Chief Physician Dr. Rick Pescatore said a lot has changed since March 11.

“It certainly has been a dynamic environment,” Dr. Pescatore said. “Early on, we found out about the risk of asymptomatic spread, which is very significant. Knowing that has driven our testing and prevention strategy.”

“I think we’ve done a lot of good things,” he added. “We’ve had a lot of success in target areas of high risk. We’ve seen a lot of success in our measures to prevent spread, especially non-pharmaceutical methods, like mask wearing, hand washing and social distancing. All those things are really important to infection prevention.”

As of Friday at 6 p.m., there have been a total of 21,998 positive COVID-19 cases in Delaware. The state has recorded 653 COVID-19-related deaths.

There are currently 103 individuals hospitalized in Delaware for COVID-19. Nowhere near the high of 337, set April 27, but also more than triple the state’s low of 29, set Aug. 16.

Getting tested

Gov. John Carney has developed a routine of closing his weekly COVID-19 press briefings by repeating the same phrase three times.

“Get tested, get tested, get tested,” Gov. Carney says.

There’s plenty of opportunities for Delawareans to receive a COVID-19 test. A full list of options, sortable by ZIP code, can be found at de.gov/gettested.

Originally, only those showing symptoms or those considered to be a member of the most at-risk populations were encouraged to get tested. Now, the state wants anyone and everyone to take a test to know their status.

Bayhealth staff members look at a computer monitor during a drive-up COVID-19 testing event at Dover International Speedway on March 18. Delaware State News/Marc Clery

“Our job is to try to make sure (tests are) convenient, effective and they are where and when people need them,” said Delaware Emergency Management Director A.J. Schall at a recent COVID-19 press briefing. “We have the capacity, so we want to make sure testing is something people are taking advantage of.”

The state has partnered with Walgreens and Curative as part of its testing approach.

There are 19 fixed testing sites throughout the state, at Walgreens stores, Delaware Division of Public Health clinics and Curative-run State Service Centers. Curative also hosts about eight-to-10 pop-up drive-thru sites a week and just rolled out a mobile trailer, which will respond to outbreaks in communities throughout Delaware.

COVID-19 tests also can be done at hospitals or primary care physicians’ offices.

The state recently started an at-home testing option, as well. These tests are mailed to an individual’s residence, administered over Zoom with a medical professional for instruction and mailed to a lab with results expected in 48 to 72 hours. More information on the at-home tests, including how to request one, can be found at de.gov/hometest.

“We’ve seen phenomenal growth in our testing,” Dr. Pescatore said. “We have a great diversity in terms of our testing portfolio and a understanding that you have the ability to pull on many different strings to bring testing everywhere and to everyone. The partnership with Walgreens has allowed us to grow our footprint, Curative has been a great partner, and now, the home testing is very significant to the elderly or those who are geographically disadvantaged.”

Tracing the cases

As the state’s testing program has grown, so has its contact tracing efforts.

When the initiative first began, the DPH used 105 Delaware National Guard staff to do telephone-based contact tracing and 11 DPH staff to do field contact tracing.

But over the summer, Delaware entered into a partnership with the National Opinion Research Center at the University of Chicago for a new team of contact tracers. Through NORC, the DPH hired 150 telephone-based contact tracers and 13 field contact tracers to make in-person connections with individuals in the community for whom the DPH does not have a phone number.

Polytech field hockey head coach Torrie Huk takes the temperature of one of her players before the start of practice at Polytech last week. Delaware State News/Marc Clery

“Contact tracing goes hand in hand with testing,” said Dr. Rick Hong, the DPH’s medical director. “It’s great to know your status. When you do that and contact trace, you reduce the chance of disease in the community city.”

When receiving a call from a contact tracer, the caller ID should come up as “DE Public Health” or 446-4262. Contact tracers call not only individuals with positive cases, but people who could have been in close contact with the person testing positive.

Thanks to its contact tracing program, the DPH is posting a new dataset on its My Healthy Community dashboard that shows the types of venues visited by individuals who tested positive for COVID-19 in the two weeks prior to their symptom onset (or if no symptoms, date of their test).

According to the DPH, this is “meant to offer insight into the types of activities individuals reported participating in prior to their diagnosis. While these data suggest potential exposure during these visits, it does not indicate whether virus transmission actually occurred at those locations.”

The venue dashboard can be found in the “Cases” section at de.gov/healthycommunity.

In another effort to determine possible transmission of the virus, the Delaware Department of Health and Social Services and the Delaware Department of Technology and Information launched an app called “COVID Alert DE” last month.

The app is free and available in the App Store or Google Play. It is available to anyone 18 or older who lives, works or attends college in Delaware.

Gov. John Carney elbow bumps Capitol Police officer Michael Purnell after a COVID-19 press conference at the Carvel State Office Building in Wilmington on March 11, prior to social distancing guidelines and facial coverings. Special to the Delaware State News/Butch Comegys

The app runs in the background and can “securely and anonymously alert users who have been in close contact with someone who tested positive for COVID-19.”

The app is interoperable with similar apps in three surrounding states — Pennsylvania, New York and New Jersey. Gov. Carney said a week ago that more than 33,000 Delawareans have downloaded COVID Alert DE.

Looking back, and forward

With COVID-19 numbers on the rise again, the state recently was presented with a report from the Pandemic Resurgence Advisory Committee on how Delaware can manage a potential second wave of the virus this fall.

The committee, made up of 46 people and three subcommittees (health, equity and business), first looked at areas that were hit hardest by the virus during the first wave in the spring.

First was long-term care centers. At the height of the pandemic, “64% of COVID-19-related fatalities were in LTC facilities, above the national average of 42 percent, but roughly in line with most states in the Northeast and Mid-Atlantic,” according to the report.

As of Friday at 6 p.m., 385 of the state’s 653 COVID-19-related deaths have been residents of long-term care centers (58.9%).
The committee reported four factors for why there were so many outbreaks in long-term care centers at first:

• It was difficult adjusting to technical guidance as understanding of the virus evolved, specifically regarding resident separation.

• Testing protocols were applied unevenly — for example, staff were required to be tested regularly, while drivers who transported residents to dialysis were not.

• Staff worked across multiple facilities to financially support themselves, which risked spreading the virus between facilities.

• Limited personal protection equipment availability led to inconsistent use among staff and residents.

Since then, the state has worked to make more PPE available to long-term care centers and the DPH has changed its testing policy, requiring weekly testing at long-term care centers again, after shifting to biweekly testing over the summer.

Workers at the Milford Perdue Chicken plant stand in line during a Coronavirus testing on April 23. Delaware State News/Marc Clery

The other specific group hit hardest by COVID-19 were poultry workers in downstate Delaware, one of the early virus hot spots since the first poultry worker case was identified in Milford on March 28.

The PRAC states a total of 1,032 positive cases and seven COVID-19-related deaths came from poultry workers, as of August.

The PRAC goes on to say, “In Delaware’s six poultry plants, case rates rose dramatically in late spring as some employers experienced challenges implementing social distancing and COVID-19 disinfection guidelines, with one Delaware poultry plant experiencing a positive case rate of thirty percent.”

The state began universal testing for poultry workers, and there was not a single positive case of the virus in July and August, according to the report. The committee said, “Targeted employee communication, testing, and outreach (with the support of employers, if possible) will continue to be necessary.”

Communication to the entire state, said Dr. Pescatore, is one of the most important things the DPH is working on improving — to keep getting the word out about the importance of hand washing, mask wearing, social distancing and getting tested to know one’s status.

“I think we’ve been extremely fortunate in Delaware to have partnerships with community leaders and stakeholders to make improvements where it’s needed,” Dr. Pescatore said. “I think that’s something we can always do more with though. Whether it’s through the press, radio or social media, to get real and important information to the people.”


Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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