The North Dakota Department of Health is asking people who test positive for COVID-19 to notify close contacts that they need to quarantine due to a backlog of case investigations.

The state health department posted the announcement to its social media pages on Tuesday, Oct. 20, but in Grand Forks, local public health workers had proactively been asking people to reach out to their close contacts.

That's a recently adopted practice in the local health unit, though Grand Forks Public Health Director Debbie Swanson said it is not a formally adopted policy, and there had been no official guidance from the state. However, it has become necessary as the workload has outpaced the number of contact tracers, said Michael Dulitz, the Grand Forks County's COVID-19 data and analytics leader.

With a growing number of people who need to be contacted by public health workers and the amount of time it takes to conduct contact tracing, he said delays between the time that someone tests positive and the time that a public health worker can reach out and request isolation has become significant.

Record-breaking case numbers in Grand Forks County Tuesday will only exacerbate the situation, according to Swanson.

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"This is really going to tax our capabilities to make sure that we reach everybody and their contacts," she said.

The North Dakota Department of Health reported 192 cases of COVID-19 in Grand Forks County on Tuesday, Oct. 20. It's the highest single-day number of new cases in Grand Forks County since the start of the pandemic.

Tuesday's new cases put the total active confirmed cases in Grand Forks County at 632, surpassing the previous pandemic-high of 532 on Aug. 28. In the past week, active cases in the county have more than doubled. NDDOH also reported Tuesday that 36 people have recovered in Grand Forks County.

The change has moved Grand Forks from the orange "high risk" category to the red "severe risk" category on the Grand Forks Health Officer Risk Score. It's the first time Grand Forks has been in the "severe risk" category.

The Grand Forks Health Officer Risk Score is calculated using data compiled by Grand Forks County Health Officer Dr. Joel Walz. The score is intended to be used as a decision-making tool for Grand Forks residents and policy makers.

Dulitz said that, with COVID-19 cases rising among all age groups, it's difficult to tell whether the increase is because of concentrated outbreaks or an overall increase in infections throughout the community.

"I think maybe the bigger cause for concern would be looking at the trend line that we're seeing as well as the percent positivity as well," Dulitz said. "We're up over that 10% positivity rate, and for today, we had almost 20% positivity, so it was only about 1,000 tests and almost 200 positives. That indicates that there's probably more COVID out there than what we're even finding with the testing."

The NDDOH reported that Grand Forks County's overall positivity rate on Tuesday was 18.99%, with a 14-day rolling average of 9.3%.

Statewide, 1,036 new cases were reported Tuesday. There are 6,032 active cases of COVID-19 in North Dakota, with a daily positivity rate of 19.68%. Elsewhere around the state on Tuesday, 219 new cases were reported in Burleigh County, 161 new cases were reported in Cass County and 81 new cases were reported in Ward County.

"I think the biggest takeaway is that this is cause for concern," Dulitz said. "This is a good time to kind of double down on doing those preventative efforts."

According to a Monday, Oct. 19, comment from the Grand Forks Public Health Facebook page, people are being asked to notify their close contacts that they need to quarantine in order to allow contact tracers to prioritize reaching out to people who have already tested positive for the virus.

Grand Forks Public Health employs nine full-time and 11 part-time contact tracers. They also receive help from contact tracing teams at UND, and Swanson said her department is in the process of examining its budget in order to hire additional part-time contact tracers.

Statewide, there are about 400 employees from the health department, public universities, the National Guard and the private sector who directly contribute to contract tracing efforts, though many work only part time, North Dakota disease control chief Kirby Kruger said last week. He noted that the public health employees in Cass and Grand Forks counties, who are not included in his count, do most of the case investigation for their respective areas.

Kruger said that, until recently, the state had been able to keep up with its goal of reaching 85% of newly diagnosed residents within 24 hours, but rising case counts had proved a challenge.

According to a report published earlier this week by NPR, North Dakota is one of 43 states that cannot currently meet the need for contact tracers in the state. That report is based on data from the Contact Tracing Workforce Estimator developed by George Washington University's Fitzhugh Mullan Institute.

The Contact Tracing Workforce Estimator estimates that about 3,972 contact tracers are needed in North Dakota, or about 522 per 100,000 people, based on the average number of new daily cases. In Grand Forks County, it estimates that about 332 contact tracers are needed.

Grand Forks County COVID-19 Case Investigations Program Coordinator Ashlee Nelson said that, despite challenges, she continues to be confident in the Grand Forks Public Health team's ability to manage its caseload.

"As cases continue to surge, it will be more important for residents of our community to recognize the seriousness of COVID-19 and help us relay accurate information and education to their close contacts quickly," she told the Herald in an email. "We do our very best to reach out to identified close contacts within 24 hours, but there are some challenges depending on the volume of cases and cooperation of clients."

A NDDOH spokesperson was unavailable to comment Tuesday, citing a busy schedule.

COVID-19 guidelines

If identified as a close contact of someone who has tested positive for COVID-19, isolate in your home for 14 days to monitor for symptoms. During this time, do not spend time in congregate settings or attend gatherings and practice social distancing.

During this time, monitor yourself for symptoms, and check and record your temperature twice a day in the mornings and evenings. If you become ill during this time, unless it is an emergency, do not go to a hospital or clinic without first calling ahead.

Household contacts of someone identified as a close contact do not need to quarantine unless they, too, are identified as a close contact. While the close contact isolates, they and their household contacts should avoid sharing drinks and utensils and should avoid sharing a bathroom, if possible.

If you have a fever of 104 degrees or higher, cough, shortness of breath or other symptoms, including loss of taste or smell, sore throat, body aches, headache, diarrhea or nausea, you should be tested for COVID-19.

Forum News Service reporter Jeremy Turley contributed to this report.