Case Investigation and Contact Tracing

Source:  Wildland Fire Medical and Public health Advisory Team (MPHAT)

Coronavirus Disease 2019 (COVID-19) is a Nationally Notifiable Disease and must be reported to State, Tribal, Local, or Territorial (STLT) health departments. All test results, information on confirmed and probable cases, and deaths must be reported. Health departments are responsible for leading case investigations, contact tracing, and outbreak investigations. They also have the authority to administer communicable disease control measures within a jurisdiction to protect public health. This includes receiving reports of COVID-19 cases, having right of entry to workplaces and access to follow up with COVID-19 cases, and establishing, maintaining, and enforcing isolation and quarantine or changing workplace operations, if needed.

Given the large volume of COVID-19 cases reported to health departments, coupled with how quickly COVID-19 is spreading and the impact a wildland fire event may have on a community, STLT health departments have the potential to be overwhelmed. For these reasons, case investigation and contact tracing activities performed by health departments could be delayed.  The health department may also ask for assistance from a fire agency with case investigation and contact tracing.

When a case of COVID-19 is identified that impacts a fire environment, the STLT health department may:

• Ask for help in understanding the workplace and identifying exposures and contacts in the workplace. This may include health department-initiated interviews, site visits, and record reviews.
• Not engage with the fire agency. The health department may decide they do not need any assistance or information from the fire agency. Or they may not be permitted to involve a fire agency (an employer) because privacy laws may not allow their involvement in case investigation and contact tracing without the employee’s consent.
• Rely on the employer to carry out the workplace investigation and contact tracing of employees. While this is not typical, some health departments have or may set up agreements with employers with occupational health and medical programs that have trained staff who can formally carry out the aspects of case investigation and contact tracing in the workplace. If a fire agency is interested in this option, they should reach out to their health department in advance to discuss the possibility and details of such an agreement.  In such situations, to protect employees’ privacy, health departments should still take responsibility for case investigation and contract tracing outside of the work environment.

Fire agencies should proactively engage with STLT health departments

To prepare to work with STLT health departments, fire agencies should consider identifying COVID-19 Coordinators (points of contact) on home units and incident management teams.

Health Department Contact Information for Home Units and Health Department Contact Information for Incident Management Teams (IMTs) are resources that can be used by agency COVID-19 Coordinators to help proactively interact and actively plan with the local health departments.

Fire agencies may be able to support Contact Tracing in the workplace

The list of items below is an example of important information that will be useful to collect at home units and on incidents in support of health departments.  In addition, COVID-19 Case Information and Tracking provides pertinent questions and information that can be gathered to support health departments in conducting case investigation and contact tracing.

General workplace information:

• An up-to-date organization chart with incident management structure/home unit structure. This includes camp crew, transport, food-service, and other staff in each facility.
• List of all the personnel/firefighters and contact information.
• Contact information for all contracting companies who have employees who support wildland fire
• All visitors or customers who were at fire camp/home unit and may have interacted with any agency personnel.
• Work hours and shifts including accurate shift start, shift end, and break times. Information about whether the shifts overlap or rotate. A mechanism to efficiently obtain an accurate list of personnel and a list of contractor companies that work these shifts.
• On-call personnel who can be or have been pulled in from on-call status.
• Agency or employer provided transportation and shared housing (including fire camp/bunk houses/spike camps). Information and listing of personnel who ride in employer-provided vehicles to/from the work sites and workers who reside in employer provided-housing. Up-to-date written information about daily activities conducted at the fire/home unit (both on and off the fire. Include information about all activities and roles (e.g., IMT, management, volunteers, vendors, food service, camp crew, aircraft)
• An up-to-date and efficient way to contact all personnel and contract companies.
• Some fire agencies may consider using digital contact tracing tools. The Centers for Disease Control and Prevention (CDC) has provided considerations on how these may be used. Before deciding to use these tools, employers should review state and local laws as some states prohibit the use of these technologies, without employee consent, for contact tracing due to privacy and civil liberty concerns.
• When possible, information about personnel interactions in social areas when on-duty ONLY (without violating privacy).

In addition, The Employee Contact Assessment Form, found within the NWCG COVID-19 Medical Concept of Operations Plan, can also be used to collect information on close contacts of a confirmed or probable COVID-19 cases among employed. This information may help health departments determine and recommend who should be monitored, tested or quarantined.

Fire agencies should continue to work to stop the spread of COVID-19 at a fire incident or at their home duty station

All fire personnel must take preventive measures to protect themselves and others (refer to MPHAT Prevention and Mitigation Recommendations). Fire agencies should use proper controls from the hierarchy of controls to limit the spread of COVID-19 in the workplace setting. An employer should quickly take action if an employee, customer, or other visitor in the workplace has symptoms consistent with COVID-19 or self-reports a COVID-19 diagnosis or that they were in close contact to someone with a confirmed or probable COVID-19 case. These actions will help limit the spread of COVID-19 in the workplace. Fire agencies should also complete a hazard assessment  to identify potential hazards related to COVID-19. A framework to complete this assessment can be found in the MPHAT Guidance for Prevention and Management of COVID-19 During Wildland Fire Operations Hazard Assessment and Prevention Toolkit for COVID-19.

One of the most useful things an employer may choose to do, regardless of how a health department responds, is to collect information about COVID-19 in the workplace. MPHAT encourages fire agencies to create a COVID-19 preparedness, response, and control plan, prepare to use, and distribute it to all levels their organization. This plan will help fire agencies evaluate the COVID-19 hazard in the workplace and decide upon actions to take to prevent the spread of the virus. Having the plan will also allow fire agencies to rapidly gather employee and workplace records when needed and assist possible health department-initiated case investigations and contact tracing. The CDC provides a toolkit to create a COVID-19 preparedness, response, and control plan titled: Interim Customizable Non-Healthcare Workplace Infection Control Assessment and Response (WICAR) tool — Coronavirus disease 2019 (COVID-19) In addition, the hazard assessment tool in Hazard Assessment and Prevention Toolkit for COVID-19 of the MPHAT Prevention and Management of COVID-19 During Wildland Fire Operations should also be part of this plan.

Resources

• Health Department Contact Information for Home Units Guidance
• Health Department Contact Information for Incident Management Teams (IMTs)
• COVID-19 Case Information and Tracking Form (pdf)