With the launch of the Penn Cares program late last year, weekly saliva-based testing for COVID-19 has become a key component of Penn’s spring semester campus reopening. Since the start of 2021, more than 109,000 tests have been conducted.
But testing is just one part of an effective public health strategy. At Penn this strategy includes contact tracing, the use of quarantine and isolation facilities, and health and well-being monitoring platforms, measures that work in concert with testing to help mitigate the spread of COVID-19.
Contact tracing remains a ‘critical tool’ against COVID-19
“Contact tracing has been a critical tool in infectious disease epidemiology for many years and is really showing its value during COVID,” says Jennifer Pinto-Martin, executive director of Penn’s Center for Public Health Initiatives (CPHI). “Screening testing will identify positive cases, but, if someone misses a screening or is tested too early for the virus to be detected, then you might have people at risk for COVID going undetected. However, if you do a good job at contact tracing, then that person could be identified as someone in the same orbit as a positive case and you have another chance to catch them.”
“You can test everybody, but, if you’re not identifying people that they’ve come in contact with, it’s very difficult to contain any viral spread,” says Kierstyn Claycomb, one of the contact-tracing team leads. “We complement testing in a way that helps to remove potentially infectious people from circulating around the community, which will help contain the spread of COVID.”
For all new COVID-19 cases identified through Penn Cares testing, contact tracers reach out to members of the Penn Community and track information using an integrated system managed through PennOpen Pass. There are separate teams of contact tracers for Penn students as well as a team led by Claycomb that does contact tracing for faculty, staff, postdocs, vendors, and contractors.
The process of contact tracing involves conducting case interviews with anyone who tests positive for COVID-19. Contact tracers try to determine how a person contracted COVID-19, talk through their activities and interactions during their infectious period, and provide guidance on how to reduce exposure within their households. Then, contact tracers will determine who among a person’s contacts is a potential close contact that should quarantine to prevent the possibility of spreading the disease further.
“Through investigating we’ve identified activities or areas that we were able to modify,” says Claycomb. By looking at “clusters,” defined as two cases in the same location within five days, the team can take a closer look at workplace-related cases to see if there is a specific area or behavior that can be remedied. Some examples cited by Claycomb include additional spacing and plexiglass barriers to make breakrooms safer for eating, and changing the ways that hourly employees punch in and out to avoid congregating around time clocks.
Safe spaces for students during quarantine
Another part of Penn’s public health strategy includes having a dedicated facility for isolation. As part of the COVID Response Plan and on the recommendation of the Philadelphia Department of Public Health, Penn identified isolation spaces for students to mitigate risk to the rest of the community. COVID educators are on call for students who are household members of COVID-positive individuals with one-on-one educational sessions provided on quarantining safely at home.
Having a dedicated facility for isolation and specific guidance on how to quarantine safely at home are key components of reducing further transmission in the campus community, says Pinto-Martin. “If someone has tested positive, even with masking and social distancing, there is still the possibility of transmission, so these facilities are an important measure to reduce the possibility of further transmission” she says. “We are lucky to have a large facility, one still with lots of capacity, and I think that has helped keep our positivity rate low both now and in the fall semester.”
New text-based platforms to support students
For students who receive a “red pass” from either testing positive, being a close contact, or developing new symptoms for COVID-19, there are also new programs to provide support for their health and overall well-being during isolation and quarantine. One new platform is COVID Navigator, an automated text messaging program launched in early February that assesses how students who are in isolation or quarantine are feeling and if they need additional support.
Developed in partnership with Penn’s Center for Health Care Innovation, COVID Navigator was modeled on COVID Watch, the system developed and used by Penn Medicine to communicate with COVID patients at home. COVID Navigator directly interfaces with PennOpen Pass and provides another way for Wellness at Penn providers to connect with students who are in quarantine or self-isolating. “The goal is to be able to better connect with students with a text-based system, which may seem less intrusive,” says Vanessa Stoloff, Student Health Service medical director. “It’s a way to figure out what their needs are and gives us a way to prioritize student health calls.”
After students with red passes are initially contacted with information on how to quarantine or self-isolate, they are automatically enrolled in COVID Navigator and receive a follow-up text that asks how they are feeling compared to the previous day. If a student reports feeling worse, or sends a message directly to the platform, a follow-up message asks what type of help they need and provides relevant contact information. A follow-up “nudge” is sent if no response is received; students can opt out of the program at any time.
Using COVID Navigator, students can request medical support from the Student Health Service, mental or emotional health services through Counseling & Psychological Services, ask Campus Health questions about their quarantine or isolation period, or discuss other needs, such as food or academic support. The latter option is supported by the new Social Needs Response Team (SNRT), a program developed by CPHI, Penn’s Center for Health Equity Advancement, and the Hospital of the University of Pennsylvania’s Department of Case Management and Social Work, originally designed to assist people with safety, distress, or social needs and concerns.
Heather Klusaritz, director of community engagement for CPHI, says that SNRT’s infrastructure was incorporated into COVID Navigator as a way to help students address their concerns and access available resources. “If they indicate they have social needs, we reach out and talk to them and do a brief screening to identify any unmet needs,” Klusaritz says. “We address whatever needs they prioritize in the moment but also talk about how they are managing isolation or quarantine and discuss strategies to manage stress or loneliness.”
And beyond the current public health crisis, COVID Navigator’s capabilities could be used to bolster other areas of student support in the future. “There are really interesting ways to think about how a system like this could allow students to feel more anonymous or protected about how they reach out for help in a way that wasn’t available before,” says Klusaritz.
Take-home messages for a safe spring semester
As the midpoint of the spring semester approaches, Claycomb encourages members of the Penn community to be vigilant about monitoring their symptoms on PennOpen Pass and to be open and transparent if they do get a call from the contact tracing team. “When we call, it’s not for punitive reasons. We genuinely want to understand the places you’ve been and the people that you may have been in contact with so that we can notify them and make sure that they have appropriate guidance and support to keep themselves, their families, housemates, or workplaces safe,” she says.
And with COVID Navigator now in its third week of use across campus, the platform represents “one more piece of the puzzle” for both connecting with and providing support for students during the pandemic, says Stoloff. “There are so many ways to connect in 2021, with preferences that vary from student to student. COVID Navigator is a text-based version to provide students another way to connect with Wellness,” she says. “The goal is not to replace a human being but to help prioritize the students who do need our help.”
Pinto-Martin emphasizes the continued “critical importance” of public health measures like masking and social distancing, even as the vaccine rollout gains momentum, to help keep campus safe. “They might seem like basic or boring measures, but they have enormous impact in reducing the spread of COVID,” she says. “We know these public health measures work, and we encourage people to recognize that there is a light at the end. We need to just buckle down until then.”