A Day in the Life of a Disease Investigator

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You may be reading that title and wondering what a disease investigator is and why the topic is being discussed in a public health blog post, so let’s start there!

In the state of Washington (and all states), there are certain health conditions that are considered “notifiable,” which means that anytime they are diagnosed (or suspected) by a healthcare provider, the information is forwarded to the local health department so they can learn more about who has the condition and how they got it. This is where a disease investigator comes in!

Disease investigators usually work within the communicable disease division of health departments, and you may have even talked to one before! When a community member gets sick with something like salmonella, E. coli, or hepatitis C, we reach out to ensure the patient is aware of their test results, discuss treatment, if necessary, and work to ensure the disease doesn’t continue to spread further. A day in the life of a disease investigator can be very exciting stuff.

An example of a typical (but busy) day can look like:

  • A member of the public called to say they got sick with a stomach bug after eating at a birthday party.
  • We received a call from the Washington State Department of Health letting us know they need our assistance reaching out to a local nursing home to test residents for a possible multidrug-resistant organism exposure.
  • We received A new lab result in the state reporting system notifying us there is a new case of valley fever (coccidioidomycosis) to evaluate. It is important to call the patient to find out if they have recently traveled.
  • A local veterinarian called asking for advice about whether or not a dog they are treating should be tested for rabies since it came in contact with a live bat.
  • A fax from a hospital came in with a lab result for someone who tested positive for salmonella. Upon speaking with the patient, we discovered they ate at the same birthday party we received that call about earlier. Time to figure out if we have an outbreak on our hands!
  • A school nurse called to inform us that one of their students is being evaluated for chickenpox. Even though it isn’t notifiable, we still have guidance and a notification letter we share just in case.

The possibilities are endless! The next steps we take depend on the needs of the case we are investigating.

Next steps might look like:

  • Interviewing the patient to learn about their experience, including how they may have been exposed, their symptoms, and if they may have accidentally exposed others.
  • Conducting contact tracing to inform contacts they may have been exposed and possible guidance if they need to seek healthcare.
  • Consulting with healthcare providers to help them decide next steps for treatment.
  • Conducting a foodborne illness outbreak investigation with the help of our environmental health team.
  • Providing treatment if the person is unable to see a healthcare provider (for certain conditions, not all).
  • Packaging specimens and shipping them to the public health lab for further testing. This can include things like stool specimens, nasal swabs, and even animals.
  • Providing education on how to prevent the illness from spreading to others. Which usually always involves talking about good hand washing!

And at the end of the day, we take our on-call phone home with us in case of any urgent needs throughout the night. Though no day is the same, it usually contains a mix of these things, plus a few meetings. As disease investigators we often make interesting discoveries that make us feel like a detective. But no matter what the day brings, we’re here to help determine the cause of an outbreak, keep tabs on where and how disease spreads, connect people with the proper treatment when appropriate, and help prevent others from getting sick.

Moving Beyond the Statewide Mask Mandate

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On February 17th, Governor Inslee announced that the statewide indoor mask mandate will be lifted on March 21st, 2022. This mandate, which includes indoor locations such as restaurants, grocery stores, malls, and public-facing offices, has been in effect in some capacity since June 24, 2020. Beginning on March 21st, the mandate will also be lifted for K-12 schools and childcare locations throughout the state.

For many people, this is going to feel like a big change. After all, we’ve been required to wear a face covering for nearly two years now. If you have questions or concerns about this shift in direction—if you are feeling big emotions like frustration, anger, fear, or apprehension—please know that all these responses are valid.

Current Disease Summary

We are still experiencing a level of disease activity across the state that is considered high by the CDC, with case, hospitalization, and death rates still well above what we would have considered “acceptable” prior to the Omicron surge. So, you may ask, why end the mask mandate now?

The governor’s decision is based on science and our current statewide data. While rates are still high, we have been seeing a decrease in new COVID-19 cases and hospitalizations for several weeks now and, as a result, our hospitals are better able to care for patient loads. The date was selected based on our hospitalization trends and where the state predicts we will be in the next several weeks. It has been determined that by March 21st, Washington state will be at a safe level of disease activity, which will allow our hospitals to operate at a sustainable level.

We have also seen similar trends around the globe where Omicron surged before us. Many experts are predicting that the pandemic may be on the way to becoming endemic, meaning most cases will be less severe, and the disease’s impact on society will be more predictable and (in theory) less disruptive.

By the end of March, statewide COVID-19 hospital admissions are projected to fall to levels that no longer overwhelm hospital systems.

Another big factor? More than 73 percent of Washingtonians are now at least partially vaccinated against COVID-19 and over 2 million boosters have been administered. The large number of people who were infected during the Omicron surge will also likely result in some additional community immunity, at least for the short term. However, because we don’t know yet how long this immunity lasts or have a way to test for it in individuals, vaccination is recommended for everyone, even those who have been previously infected.

Change Will Be A Gradual Process

It is important to remember that change will be gradual. The governor began the process last Friday by lifting the outdoor mask mandate, which included large outdoor gathering and events with more than 500 attendees. Now, folks are free to attend outdoor concerts, street fairs, and farmers markets sans mask—something that many of us wouldn’t have considered doing back in the thick of 2020 or 2021.

The lifting of the indoor mask mandate on March 21st will also not include certain indoor settings considered to be high-risk for disease spread, like healthcare settings, long-term care, and correctional facilities.

Also still in effect is the federal mask mandate that requires masking on all forms of public transportation, including buses, trains, and airplanes, and in transportation hubs. This mandate is still in place, though the White House is reviewing data and may announce changes in the near future.

And though the mandate will be lifted for K-12 schools on March 21st, schools will still be required to report COVID cases and outbreaks and work with local public health departments to monitor disease activity. Routine testing, isolation, and quarantine protocols will also remain in place per the CDC’s guidance.

Feel Empowered to Mask Up

For those who are weary about taking off their mask, please know that Washingtonians can make their own decisions about when it may be appropriate to wear a mask, even after the mask mandate ends. This goes for businesses, as well, which still retain the right to choose stricter requirements.

Those who want or need to wear a mask in public can continue to do so. If you are at greater risk because of factors such as your age or underlying health conditions, you are encouraged to continue to take more precautions. There also may be certain settings where wearing a mask makes sense, like when caring for someone who is high-risk, if you are sick, if you’re in a location where social distancing isn’t possible, or if you are not fully vaccinated.

And if you are choosing to wear a mask in certain settings, you may wonder what mask you should wear. The answer is simple: Wear the mask that you will use consistently—and correctly.

For additional information on Governor Inslee’s announcement, please read the full press release or call the State COVID-19 Information Hotline at 1-800-525-0127. For local questions related to COVID-19, you may contact Skagit County Public Health at (360) 416-1500.

Changes to our weekly COVID-19 updates and what you should expect

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You might have noticed that Skagit County Public Health is using a new graphic to show local weekly COVID-19 data. If you are actively monitoring our data using the state’s Data Dashboard, you might be wondering why the data we’re putting out doesn’t seem to be matching up with what you’re seeing on your screen. For some background information and some answers to questions you might have, we’ve put together the following Q&A.

What’s going on with the state data dashboard? Why are the numbers not lining up?

There are a few things happening right now that are causing our local numbers and those appearing on the state’s Data Dashboard to not line up exactly. Firstly, it is important to remember that the state Dashboard typically updates Monday, Wednesday, and Friday, meaning numbers on the Dashboard today are actually representative of the data several days ago. Since the Omicron surge, the state systems have experienced a substantial slowdown in processing new cases and as they are caught up, the data on the Dashboard will be updated as well.

Another cause for the discrepancy is that sometimes data on the Data Dashboard contains duplicate information and it takes several days for corrections to be made. That’s why looking at the Epidemiologic Curves tab is the best place to view the level of COVID-19 activity, since these numbers have been verified both by the state and by local health jurisdictions like ours.

We are working with the state to correct the Cumulative Data on the Dashboard, but please expect to see some differences until these corrections can be made. In the meantime, our local epidemiologist is crunching our numbers to ensure that we can provide Skagitonians with the most accurate data possible.

Is the data really reflecting what’s going on when more and more people are using at-home test kits and maybe not reporting positive test results?

Now that at-home test kits are more widely available and are being used in greater numbers by the public, it is safe to assume that some positive test results are not being reported. That said, we know that many people continue to call either the state COVID hotline (1-800-525-0127) or Skagit County Public Health (360-416-1500) to report their positive results.

As we enter this new phase of the pandemic, and as our testing practices evolve, we can still look to key data indicators to determine whether we are trending upward, or downward.

One of the best indicators is our 7-day hospitalization rate. We can look to how our hospitalization rates are trending to determine the severity of a surge or wave. With Omicron, we experienced more new cases per week than at any other time during the pandemic, and as a result, we saw the greatest number of hospitalizations. While the majority of folks experienced milder COVID-19 during the Omicron surge, the number of hospitalizations increased proportional to the new cases.

Another helpful indicator is to look at other parts of the globe that are further along in the Omicron surge. We can look to other countries to see how their waves have played out. While not an exact science, this can help us predict our own timeline here in Washington.

What about the new changes to contact tracing and investigation? Could this impact the data?

Beginning on February 14, the state has changed its system for case investigation and contact tracing (CICT). Instead of reaching out to every person who tests positive for COVID-19, the state will now focus CICT efforts on four key areas:

  • Outbreak Investigation
  • Case investigations in high-risk settings
  • Targeted case investigations among those at risk of more severe illness
  • Targeted case investigations among those with unusual illness presentation

The state will continue to receive reports of all electronically received lab results and will upload these positive results into the state reporting system, and encourages those using at-home tests to report positive results using WA Notify.

The fundamental difference now is that individuals who tests positive for COVID-19 will be solely responsible for reaching out to friends, family members, and colleagues who may have been exposed, and to encourage others to get tested and quarantine to reduce further spread. For this reason, there is a likelihood that some positive cases will go unreported and thus, wouldn’t appear in the state’s data reporting.

Where is the best place to go to see daily case information?

As previously stated, the best place to go for accurate data is to look under the Epidemiologic Curve tab on the Data Dashboard. Here, you can see both verified case count data, but you can also view our 7-day and 14-day trends.

At this point in the pandemic, looking at trends is going to be the best way to gauge current risk, and to see where we are heading. After all, looking at trends—instead of daily case counts—helps to tell the full story, whereas daily case counts do not show you how are numbers compare week to week, or month to month.

In an effort to help folks better understand our local data and to highlight key indicators that best represent our current risk status, we are changing the way that we provide our data updates each week. You will notice that we have a new graphic (updated each Wednesday) that highlights the following indicators:

  • 14-day case rate
  • 7-day hospitalization rate
  • Total number of deaths
  • Vaccination rates
  • CDC Level of Disease Activity

It is our hope that you will find these updates helpful. Of course, if you have questions, you can reach out to Public Health by calling (360) 416-1500 or emailing me directly at danicas@co.skagit.wa.us.

Include Preparations for Diseases in Your Emergency Planning

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Guest post by Skagit County Emergency Management

Emergencies come in all shapes and sizes, and sometimes they become stacked on top of each other — like dealing with flood or wildfire season during a pandemic. Skagit County Department of Emergency Management recommends that you take the time to revise your family emergency plans to consider how you will keep your family safe in the event of an emergency during a disease outbreak. These plans will be critical not only during COVID-19, but in the case of possible future outbreaks of other diseases.

The most important thing you can do in preparation for emergencies during a pandemic or disease outbreak is to learn about and practice effective infection control. Illnesses are usually spread through the air (when someone coughs or sneezes) or through contact (you touch something contaminated, then touch your face). The easiest and most effective way to limit disease spread is to frequently wash your hands, use good cough and sneeze hygiene, and avoid close contact with ill people.

So how can you work those preventions into your family emergency plans? (You do have a plan, don’t you?) Focus on being able to keep your hands and face clean, to clean surfaces if needed, and to maintain space.

Some examples of things you should consider:

  • Keep a supply of face masks, hand sanitizer, and tissues in your go bag for every person in your house. Wear a face mask whenever you are around other people.
  • Practice good cough and sneeze hygiene:
    • Cover your mouth and nose with a tissue when you cough or sneeze.
    • Throw away used tissues in a lined trash can.
    • Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.
    • For answers from the Centers for Disease Control and Prevention (CDC) to frequently asked questions about handwashing, just click here.
  • Stock supplies to disinfect surfaces, whether in your home or at an evacuation location.
  • Consider how social distancing will work if you have to evacuate — maintain enough space from others with only a small amount of time spent close to people outside of your household. Plan on having enough supplies so you don’t have to borrow from anyone you don’t live with, and maintain enough space between you and other households to limit contact. Be aware that you may need to travel farther away from home to find shelter; in order to maintain social distancing, local evacuation centers may not be able to serve as many people as normal.
  • Be sure water sources are safe and surfaces are effectively cleaned during and after an event. Standing water and open sewage are places of contamination and disease spread.
  • Know where to get verified information, not only for evacuations and weather, but also regarding disease information. The Washington State Department of Health and Skagit County Public Health are good sources of current, local information.
  • Know the signs of any major illnesses in the area. For example, the CDC recently updated the range of COVID-19 symptoms, including:
    • Fever or chills
    • Cough
    • Shortness of breath or difficult breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea
  • Think through how you can keep others safe if you were to fall ill during an emergency. Plan ahead for a safe location where you can maintain appropriate distance from other people if you need to leave your home. Consider ways to limit other’s exposure to you, such as wearing a face mask and isolation.

Planning for emergencies is a never-ending process. If you don’t have a plan, talk with your household and come up with one. If you do, you can find ways to make your plan better. Adding a few things to your plan to keep you healthy during a disease outbreak — even if it’s not a pandemic — makes you and your family better prepared for anything that happens.

COVID-19: Lessons Learned from a Skagit Dairy Farmer

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Guest Author: Skagit County Commissioner, Ron Wesen

As many of you know, I am a fourth-generation dairy farmer. Herd management, which is key in dairy farming, involves creating the conditions that allow cattle to thrive and includes everything from cow nutrition, to farm finances, to cattle comfort and milking. It also includes the important area of disease management.

As a Skagit County Commissioner, much of my time lately has been focused on working with our Public Health officials and medical professionals to slow the spread of COVID-19. As my time in the dairy industry has often been focused on preventing the spread of communicable diseases in cattle, local coronavirus efforts are familiar to me in many ways.

A number of common communicable diseases can affect a herd. Just like humans, some cattle are going to become ill even when using the best management practices. Unchecked, these diseases can drastically reduce milk output and, in some cases, affect the safety of the milk product for consumers. Disease is not something dairy farmers take lightly. Some of these illnesses do not have a medical cure or the treatment of cattle conflicts with national organic standards. Instead, farmers regularly use a number of strategies to prevent illness from spreading through the herd:

  • Separating sick cows from healthy ones keeps illness from spreading either through secretions or close contact.
  • Keeping a clean, dry, comfortable environment reduces the cows’ stress (and makes it more likely they will recover) and keeping the area as clean as possible prevents disease spread through surface contact.
  • Wearing gloves during milking time reduces the spread of certain diseases of the udder, like mastitis.
  • We use iodine to disinfect milking equipment between every cow.
  • Farmers test and isolate any new cattle before bringing them into the herd to ensure that cows aren’t infected with a disease that can spread.
  • Making sure that cattle are healthy before they arrive on the farm can save a lot of heartache later.

Does this sound familiar to you? It should. It’s physical distancing and good hygiene.

We use these techniques because, like COVID-19, many herd diseases can be passed from cow to cow even when the animals do not yet show symptoms.Although tests exist for many illnesses, it’s still possible for some diseases to spread between cattle before any test can detect them. Also, cattle may become infected after you have tested. Testing is a tool, not a silver bullet, so physical distancing is key.

Further, as the old adage goes, “an ounce of prevention is worth a pound of cure.” Treating communicable disease outbreaks in a herd can be very expensive for farmers and have long-term repercussions for the productivity of the farm. Regularly using physical distancing practices and good hygiene keeps disease from becoming rampant in dairy herds. Continuing to stay home, stay healthy will likewise keep Skagit County from potentially reaching a crisis situation in our food banks, social service organizations, hospitals and other medical services.

I know physical distancing works and that it is the best tool for stopping the spread of COVID-19 because I’ve seen it work every single day on the farm. For generations, ranchers have relied on these tried and true measures for promoting the health of a herd.

Obviously, this isn’t a perfect comparison; people aren’t cows. For one, cows don’t suffer economic hardship from physical distancing – farmers continue to feed animals regardless of whether or not they’re being milked or are “working.” However, we can see that social distancing is working among people, as it does with cattle, and slowing the transmission COVID-19 in Skagit County. We have seen long-term success in our local dairy industry, and we have demonstrated success among Skagitonians in our open and safe hospitals, as well as our low level of coronavirus illness and loss of life.

As we wait for a vaccine, we will need a robust statewide contact tracing process and enough supplies to test people frequently before we can begin reopening large portions of our community. This is our new normal. We’ll have to continue observing many of these practices, much like our dairy farmers have been doing for hundreds of years.

Thank you to everyone who has been practicing physical distancing and following Governor Inslee’s Stay Home, Stay Healthy guidelines. My fellow Commissioners and I are so proud to represent each and every one of you. Please, continue to think like a dairy farmer: stay strong, stay home, and stay healthy.

Skagit County Commissioner, Ron Wesen.
Ron Wesen, Skagit County Commissioner and fourth-generation dairy farmer.