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You have followed the guidelines to protect yourself from COVID-19 infection. Despite your best efforts, you begin to feel a little sick. A summer cold, nothing more. Still, being responsible, you call in to the local clinic and get tested for COVID. Your symptoms begin to subside a little, but a few days later, you get the call with the result. It was positive.

The kids are driving you crazy, a summer BBQ with several other families seems like the perfect way to let them blow off some steam and give you a couple hours of relaxation. More than thirty people are together for several hours. A few days after, you get a call from the North Dakota Department of Health (NDDoH). One of the attendees took a test for COVID the day before the party. It came back positive. You and your family must now quarantine for 14 days because your family is considered close contacts.

A mass testing event is being held. You feel completely fine but decide to go anyway along with your spouse and kids. You all get tested and go about your lives, not really following the guidelines because there is no way any of you have it. Your spouse gets a call, they and one of your teens is positive for COVID.

Across the state these exact scenarios are occurring. Information is power, and in the fight against COVID, being informed on what you can do to stop the spread and implementing these practices are the best method currently available to protect yourself and your community. When the first line of defense - social distancing, masks, and hand washing – don’t prevent you from becoming infected, the North Dakota Department of Health (NDDoH) will call, not only to ask you to isolate yourself but also begin the process of tracing those you may have infected prior to knowing you had COVID.

“When a positive result comes in, the state lab calls out the positive result to the ordering provider. That gives the provider the opportunity give the person a call and let them know about their result as their medical provider,” explains Cavalier County Health District’s Steph Welsh, RN. “At nearly the same time or shortly thereafter, that positive result is assigned to a case manager who then assigns it to a case worker. The case worker calls the client and notifies them they are positive, sometimes even before their medical provider has even had a chance to let them know. It is time critical, and contact tracing starts as soon as possible.”

The case worker will then interview the client about their activities prior to being identified as a positive COVID case to try and determine a known source of infection. During this interview the case worker will focus on the two days before they began to experience symptoms or, for those individuals that test positive but have not shown any symptoms, the two days prior to being tested. COVID cases are thought to be infectious in these two days prior to symptom development or testing, up to 10 days after symptoms develop, or 10 days after testing for asymptomatic individuals. Identifying this infectious period is important to identify individuals who could have potentially been exposed.

“We go through the cases activities on a day-by-day basis and identify all their close contacts during their entire infectious period - two days before all the way up until their isolation,” Welsh explained.

The close contacts are identified by examining the activities that the client did prior to receiving the positive result. Close contacts are people that the positive case was within six feet of for 15 minutes or more during their entire time of being infectious.

“You make a list of those close contacts. The close contacts are then followed up with by the case worker and instructed they need to quarantine for 14 days after their last interaction with the infectious case,” Welsh said.

During the time frame of isolation and quarantine, the close contacts and the person with the positive are asked to do daily monitoring of their temperature. They will also receive emails from the NDDoH to report how they are feeling.

Household contacts, those that live with someone who has tested positive, will have to quarantine while the positive person recovers. Once that person is declared recovered and released from isolation, the ongoing household exposure to a case ends, and they then enter their own 14 day quarantine. This can mean that for upwards of a month, a household contact may be asked to remain away from their community to prevent further potential exposures to COVID.

“Household contacts need to begin quarantining immediately upon the notification that they have a household member that’s a positive but their 14 day quarantine countdown doesn’t really start until that case is released from isolation. That is their day zero, so it can often be 24 plus total days. Because that case is infectious up until they are released from isolation, the household contact is exposed to potential COVID infection until the case is released. Then they can incubate the virus for 14 days after that,” Welsh explained.

For households that have more than just one or two, for instance - a family of four or five, should someone within that unit develop symptoms, that quarantine resets to zero, and the other members have to start over since they continued to be exposed to an infectious COVID case. Even if the contacts were to take a test for COVID during the middle of their quarantine, they would still be required to maintain their full 14 days as an incubating virus cannot be detected by current testing.

In general, when the NDDoH asks someone to quarantine/isolate, people remain in their usual home setting. While they doing this, it is best to avoid sharing a bathroom with other members of the household. Also be sure not to share drinks or utensils. Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing. Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. Because there is a risk of our beloved pets possibly being able to become infected, it is best to restrict your contact with them, just as you would with people.

If someone does not comply with the instructed isolation and quarantine instruction, they could face legal action. Health officers in North Dakota are able to issue specific quarantine and isolation orders to individuals that would be served by law enforcement and prosecuted by the state’s attorney.

“That person needs to be found not in compliance. They actually need to be caught not following quarantine as well. It can’t just be your neighbor saying you were out and about. Law enforcement has to actually see you breaking quarantine. There are legal remedies, and I think each locality is at a different place at how aggressively they would want to pursue this,” Welsh said.

As communities across the state continue to see more and more positive cases, the chances that someone was in contact with a positive case increases. Reviewing the past few months of data, it is easy to see that instead of a continuation of only a few close contacts per case, case workers are instead finding cases with larger numbers of identified close contacts. With that comes an even greater emphasis on practicing social distancing.

“Financial and health impacts directly to families is large. The financial impacts to businesses – particularly if you are small and you don’t have a lot employees to replace employees or cross train - are also large. So the more we can do to keep those numbers low, the better off we will be,” Welsh said.

As North Dakota heads into its sixth month of positive cases with the number increasing every day, including in Cavalier County, the rest of the year looks to be the same.

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