Follow-up for Positive COVID-19 Cases and their Close Contacts
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Follow-up for Positive COVID-19
Cases and their Close Contacts
Tools for LBOHs
February 16, 2021
Hillary Johnson, MHS, Infectious Disease Epidemiologist
Scott Troppy, MPH, PMP, CIC, Surveillance Epidemiologist
Alexandra DeJesus, MPH, CIC, Infectious Disease Epidemiologist
Bureau of Infectious Disease and Laboratory Sciences
MA Department of Public Health
Topics Today
• MAVEN Updates
• COVID Immediate Workflow – LOL this is the most 2021
please check your workflow rejection ever
• Broad Results Updates
• Reports Review
• Death Data
• DESE
• Transportation Guidance
• Masking Happy Valentine’s Day!
• Quarantine Discussion
• Variant Updates
2
• Vaccine Rollout Updates – brief
summary
Tuesday Webinars for COVID-19 Case
Investigation and Follow-up
• Discussing New Guidelines, MAVEN Updates, Changes in
Protocols, New Tools, Case Investigation FAQs, Follow-up
Tuesdays @ 11am Procedures.
MDPH Epi Program: 617-983-6800
MDPH MAVEN Help Desk: isishelp@mass.gov
MDPH ISIS Help Desk: 617-983-6801
MDPH ISIS Fax: 617-983-6813
COVID-19 Vaccine Rollout email COVID-19-Vaccine-Plan-MA@mass.gov
MDPH Food Protection Program: 617-983-6712
CTC Help Desk: 857-305-2828
* CTC Local Health Help ctclocalhealthhelp@covid19.pih.org
CTC Local Health Liaison List
Higher Ed Contact List
MAVEN Office Hours w/Hillary, Scott, & Alex:
Fridays 11:00-12:00
• Open Q&A. Not a formal presentation. 3
MAVEN Help has Guidance Documents and • Send us your questions or ask us live.
Previous Webinars: • No requirement to attend. Pop in, pop out.
http://www.maventrainingsite.com/maven-help/toc.html • You’ll need to register via Scott’s email.
Updates for today, Tuesday, 2/16/2021
▪ MAVEN Status – all 351 towns are online!!!
▪ LBOH Immediate Workflow – COVID-19 event only –
please check your workflow TODAY and clear out the
workflow
▪ Broad Corrected Lab Results Update
▪ MAVEN Report Recap
▪ CTC Cases – Variable Review
4
Immediate Notification workflow (COVID-19 Only)
▪ UPDATE: COVID-19 Immediate Notification Workflow -
2,061 events in this workflow this morning
▪ This will allow proper notification of all new COVID-19 events for
your jurisdiction. (Confirmed and Probable Cases)
▪ Please review all events/cases in this workflow and complete your
Step 1- LBOH Notification to “Yes” to clear out this workflow.
▪ If you are retaining ownership then complete Step 2 (Investigation
Started) & Step 3 (LBOH Investigator (name, lboh, phone number)
▪ When you are done then complete Step 4 (Case Report Form
Complete 5
▪ You can complete Step 5 if you want – if not then leave blank
Broad Corrected Lab Results
• On 1/25/21 Broad began using V3 multiplex assay, doubling capacity
to approximately 200,000 tests per day; assay became slightly more
sensitive.
• V3 Assay now uses two “probes” to detect N1 and N2 gene targets.
• From 1/25/21 - 2/5/21 specimens that were positive for only one
gene target, were reported as “Positive”.
• After review of data and clinical information, there was clinical
suspicion that these were likely NOT actual cases.
• After consultation with MDPH, and review of data it was determined
that a result of “Inconclusive” should be reported for specimens when
only one of two gene targets are detected.
6
Broad Corrected Lab Results
• Yesterday, 2/8/2021, the Broad communicated this information with
approximately 200 submitters. Samples that test positive for only
one of the two gene targets will now be reported as “Inconclusive”.
• Corrected results for approximately 2,500 lab reports were issued
yesterday, but may take time to feed into MAVEN. (These may
initially appear as “Invalid”.)
• These individuals should not be considered to be positive or
recovered.
• Unless subsequent testing indicates otherwise
• If currently isolated, these individuals can be released from isolation
and their close contacts released from quarantine.
7
• In most cases, repeating a PCR test is recommended.
Congregate Care
• MDPH has already contacted affected hospitals, LTCFs and some other
congregate care settings to make recommendations.
• If you identify a case in a congregate care setting where an individual was
cohorted with someone confirmed to be COVID-positive, the following
general guidance is recommended:
• Remove individual from cohort situation if confirmed case still potentially infectious
• Quarantine individual
• Repeat a PCR test
• If you learn of a situation where an individual with an “Inconclusive”
result was cohorted with someone confirmed to be COVID-positive and
then subsequently developed COVID, please notify MDPH Epidemiology
8
(617-983-6800).
MAVEN Reports
Report output options: HTML (view on your
screen/browser), CSV (comma separate values
report, Excel and Excel with parameters). We
recommend using the CSV format to extract
your report and then save as Excel file format.
Additional information around reports is
located in the FAQ folder.
9
MAVEN CTC Concerns – did my case go to CTC?
• COVID Assistance is Set to Yes you will see the concern around that LBOH
requested assistance (1)
• When the case is sent over to CTC the second concern will appear (2)
You can see this information in the Wizard or
the ECR#8 Question Package 10
If no date then it came from CTC to MAVENSummary of Key Guidance & Tools
Updated
• Isolation & Quarantine Guidance Documents
• 12/07/20 Updated Quarantine Guidance Doc: https://www.mass.gov/guidance/information-and-guidance-for-persons-in-quarantine-due-
to-covid-19
• Quarantine Guidance Translations available here: https://www.mass.gov/guidance/information-and-guidance-for-
persons-in-quarantine-due-to-covid-19#download-in-additional-languages
• 8/9/2020: Isolation Guidance Document http://www.maventrainingsite.com/maven-help/pdf/COVID19-Isolation-information-and-
guidance_ver2.0_August9.pdf
Updated
• Date: December 7, 2020 – Occupational Exposure & Return to Work Guidance
• https://www.mass.gov/doc/return-to-work-guidance/download
• Pediatric Clinical Testing Advisory Helpful to get
• 11/25/2020 Advises Pediatricians to Test for COVID-19 in all patients with symptoms compatible with COVID, regardless of age Docs to test Kids
• https://www.mass.gov/doc/pediatric-and-adolescent-covid-19-testing-guidance/download
• Date: 10/21/2020 COVID‐19 Testing Scenarios FAQ Lab Results Questions
• Describes different lab test results and what to do
• Outlines discordant results and what they mean
• http://www.maventrainingsite.com/maven-help/pdf/COVID-19%20Testing%20Scenarios%20FAQ_Ver%201.0_October2020.pdf
• 10/27/2020 Updated COVID-19 Case Classification Manual
• Serology positive labs are now classified as “suspect” cases.
11
• http://www.maventrainingsite.com/maven-help/pdf/case-classification-manual/COVID19__10272020_FINAL.pdfSummary of Key Guidance & Tools
• Date: 8/22/2020: - COVID-19 PCR and Antibody Testing Public Health Response
Recommendations
• Table describes different Public Health Actions based upon different testing results.
• Big take home: PCR & Antigen positive patients should be treated like cases.
• Serology + cases no longer require public health follow-up.
• http://www.maventrainingsite.com/maven-help/pdf/COVID-
19%20PCR%20and%20Antibody%20Testing%20Public%20Health%20Response%20Recommendations%20for%20LBOH%20Ver4.0_Aug22.pdf
• Date 8/10/2020: Follow-up for Positive Antigen Test Results
• http://www.maventrainingsite.com/maven-help/pdf/Antigen%20Results%20Follow-up%20Guidance_ver1.0_August_10.pdf.
• Reminder that while Antigen Tests = Probable, we still treat like a case and isolate
accordingly & do contact tracing.
• A PCR obtained at the same time (w/i 2 calendar days) will trump the antigen test result.
12Summary of Key Guidance & Tools
• Date: 7/24/2020 - Gov. Baker issued COVID-19 Order No. 45 which issues a mandatory 10 day
quarantine period for travelers to MA (including MA residents who traveled outside of MA and are
returning).
• If travelers (including returning MA residents) don’t fit into one of the Exemption Categories, must quarantine.
• IF you were a COVID case in the last 3 months, you don’t have to test/quarantine. After 3 months you do.
More Updated
• There is a form to fill out online. https://www.mass.gov/forms/massachusetts-travel-form
• A negative PCR test within 72 hours of travel can excuse you from quarantine. FAQs. Check
• https://www.mass.gov/info-details/covid-19-travel-order them out!
• Updated FAQs: https://www.mass.gov/info-details/covid-19-travel-order#potential-other-traveler-scenarios-
• Date: 10/19/ 2020 – Updated CDC Guidance on Duration of Isolation & Precautions for Adults with
COVID-19
• 10 Day Isolation Period now has more data supporting it. CDC Guidance on Duration
• Ignore most additional PCR tests up to 3 months after initial illness onset. of Isolation
• No need to quarantine up to 3 months after initial illness onset.
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
• Date: 8/7/2020: Updated MA Testing Guidance MA State testing
• https://www.mass.gov/doc/covid-19-testing-guidance/download
guidance – anticipate 13
• Update says to get a PCR with ANY Antigen test
• Also says no need to test again in 90 days after initial diagnosis.
an update soon.New MAVEN Help DOCUMENTS!!!!
http://www.maventrainingsite.com/maven-help/toc.html
NEW Daycare/School
Resources Folder! LBOH Daycare Cluster Follow-
up Guidance Document
School Nurse Webinar
School Isolation & Quarantine
Calculation Tools
Generic Program Isolation &
Quarantine Calculation Tools
14
Sports FAQs & Hockey
Exposure Template LetterNew MAVEN Help DOCUMENTS!!!!
http://www.maventrainingsite.com/maven-help/toc.html
LBOH Daycare Cluster Follow-
up Guidance Document
Childcare/Daycare Close Contacts Letter
Template Letters: New
Folder! Gen Notification Letter
In Home Daycare Letter
K-12 School Template 15
School Close Contacts Letter
Letters: New Folder!
School Gen Notification LetterUpdates – A quick recap for Feb. 16, 2021
Last Tuesday Webinar – February 9, 2021
Always Remember you can
see all previous webinar
recordings and slides in
MAVEN Help.
16
MAVEN Help: http://www.maventrainingsite.com/maven-help/toc.htmlDeath Counts
• No change has been made to how deaths are counted.
• Deaths reported can currently be described as all cause mortality among people
who have been diagnosed with COVID.
• This include all confirmed cases who have died, regardless of cause of death or
time from initial diagnosis.
• We are aware that this OVERCOUNTS deaths caused by COVID.
• Changes to this process have been in discussion for many months, and will be in
implemented shortly.
• Any changes to how deaths are counted will be fully documented and communicated
to this group.
17Death Count Process
• Preliminary Vitals record file is received daily
• This data is preliminary – cause of death may be incomplete or missing entirely, and is
not yet coded
• This is part of why deaths are not excluded based on cause of death (ex: car accident)
• MAVEN data is extracted daily and matched to vital records using last name,
first name, date of birth
• Differences in spelling or birth date can cause issues with this match
• Fuzzy matching (looking for these differences) are not run daily, but are run regularly
to look for additional matches
• Twice a week code is run to look for updates to previously matched records
(hospitalization data, underlying conditions, race, ethnicity, etc.)
18
• https://www.mass.gov/info-details/covid-19-response-reportingDESE Updated Transportation Guidance
• Physical Distancing and Bus Capacities: Updated
February 11, 2021
• Revisions are based on data demonstrating significant air exchanges
on moving school buses with open windows (21-43 air exchanges
per hour) as well as the continued proven effectiveness of masking;
and
• Differentiates between elementary schools and middle/high schools
based on continued evidence that younger students are less likely to
become infected and may be less likely to transmit COVID-19.
19DESE Updated Transportation Guidance • Districts may adopt the updated standards only when the required mitigation measures outlined in the rest of the guidance document (wearing masks, opening windows, etc.) are followed. • In all cases, maximum distance between students should be maintained during boarding and transportation. Elementary schools • Capacity limitations and physical distancing requirements for students on buses are lifted. Middle and high schools • Capacity limitations and physical distancing requirements for students on buses are lifted, except for middle and high schools in districts with high community prevalence. • For middle and high schools in districts with high community prevalence, capacity limitations and physical distancing requirements on buses are amended to allow 2 students per bus 20 bench.
DESE Updated Transportation Guidance
Q. So how does this affect contact tracing?
• A. Identifying close contacts to confirmed cases has not changed. We would
still be looking for contacts on a bus that meet our current definition:
• Someone who was within 6 feet of an infectious person for a cumulative total of
15 minutes or more over a 24-hour period.
21Improve the Fit and Filtration of Your
Mask to Reduce the Spread of COVID-19
• Q. Double masking has been in the news. Should we all be double
masking?
“All masks are not equal.”
• New information from CDC shows that improving the fit and filtration of masks
helps reduce the spread of the virus.
• Mask fit can be improved by using a mask with a nose wire and by using a mask fitter
or by knotting the ear loops and tucking the sides.
• Mask filtration is improved by using multiple layers.
• Learn more about how to use masks to protect yourself and others at Improve 22
the Fit and Filtration of Your Mask to Reduce the Spread of COVID-19 | CDC.What you want to know:
• Vaccines:
• How does vaccination affect further recommendations for
quarantine, etc.?
• Variants of Concern:
• What are we doing about them and what do we need to
know?
23We must all continue to exercise precautions:
All People (COVID-Recovered, Vaccinated, both or neither) should continue to
follow current guidance to protect themselves and others, including:
• Wearing a mask,
• Staying at least 6 feet away from others,
• Avoiding crowds,
• Avoiding poorly ventilated spaces,
• Covering coughs and sneezes,
• Washing hands often,
• following CDC travel guidance, and
• following any applicable workplace or school guidance, including guidance
related to personal protective equipment use or SARS-CoV-2 testing. 24Vaccines & Quarantine
• CDC updated their guidance around quarantine and how to treat
vaccinated individuals following an exposure to a confirmed case last
week.
• This update to how we treat vaccinated individuals is currently under review by
MDPH but we have not yet updated our guidance language here in MA.
• At this time, vaccinated individuals would still need to quarantine following an
exposure per our current guidance.
• This will likely be updated shortly, but as of this morning, has not been updated yet.
25Vaccines & Quarantine
• While mRNA COVID-19 vaccines have demonstrated high efficacy at preventing
severe and symptomatic COVID-19, there is currently limited information on
how much the vaccines might reduce transmission and how long protection
lasts.
• In addition, the efficacy of the vaccines against emerging SARS-CoV-2 variants is
not known.
• It will be very important, even if this change is made, that vaccinated persons
continue to follow current guidance to protect themselves and others:
• Mask wearing
• Social distancing at least 6 feet
• Avoiding crowds & avoiding poorly ventilated spaces,
• Hand hygiene
26
• Reducing travelVaccines & Quarantine
CDC’s updated guidance (still pending adoption in MA), can be summarized as
follows:
• Vaccinated persons with an exposure to someone with suspected or confirmed
COVID-19 are not required to quarantine if they meet all of the following criteria†:
• Are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series,
or ≥2 weeks following receipt of one dose of a single-dose vaccine)
• Are within 3 months following receipt of the last dose in the series
• Have remained asymptomatic since the current COVID-19 exposure
• Persons who do not meet all 3 of the above criteria should continue to follow
current quarantine guidance after exposure to someone with suspected or confirmed
COVID-19.
† CDChas not systematically evaluated the efficacy of COVID-19 vaccines from manufacturers that have not sought an EUA in the
United States. For the purposes of these quarantine criteria, considerations for accepting a vaccination series that is not FDA-
authorized include whether the vaccine product has received emergency approval from the World Health Organization or 27
authorization from a national regulatory agency.Vaccines & Quarantine
CDC’s updated guidance (still pending adoption in MA):
• This guidance from CDC is nuanced and also has more specifics for
Vaccinated healthcare personnel, patients, and residents in healthcare
settings.
• Additionally, these quarantine recommendations for vaccinated persons,
including the criteria for timing since receipt of the last dose in the
vaccination series, will be updated when more data become available and
additional COVID-19 vaccines are authorized.
• So please stay tuned. We will go over in detail once the guidance is adopted
in MA. We will also update relevant tools and materials appropriately. 28Vaccine: The Big Questions
• Do vaccinated individuals have to quarantine if identified as a close contact of
a confirmed case?
• A. Yes. Treat them like regular exposed contacts at this time. No Changes Yet.
• If a vaccinated individual tests positive, are they considered a case?
• A. Yes. The vaccine will not cause a COVID test to be positive. These people are cases
and should isolate and contact tracing should occur.
• Do vaccinated individuals have to comply with the travel order?
• A. Yes. They must test 72 hours prior to arrival through arrival or quarantine for 10
days. No Changes Yet.
29Vaccine: The Big Questions
• Can vaccinated individuals discontinue any current practices?
• A. No. Vaccinated individuals should continue using masks, practicing hand hygiene,
and social distancing.
• Should vaccinated individuals be included in surveillance testing at IHEs,
LTCFs, etc.?
• A. Yes.
• Where do I get all my vaccine questions answered (about recommendations,
timing, etc.?)
• A. Here: Interim Clinical Considerations for Use of mRNA COVID-19
Vaccines Currently Authorized in the United States
• Hillary is also a fan of this site (Immunization Action Coalition FAQs Page): 30
https://www.immunize.org/askexperts/experts_cov.aspUpdate: COVID-19 Breakthrough Case Definition PER CDC: • After several pilot investigations, it became clear that cases identified
Documenting Vaccination Among Cases
If not vaccinated,
why not received?
• Missed Opportunity
• They didn’t go back for their
second dose.
• Haven’t gotten around to it.
• Underage
• Select ifVariants
• MDPH Press Release: https://www.mass.gov/news/state-public-health-officials-
announce-new-covid-19-variant-cases-urge-continued-protective
33Variants of Concern
• Numerous SARS-CoV-2 variants have emerged over the last several months.
• Variants known as B.1.1.7 (first identified in the United Kingdom) and B.1.351 (first
identified in South Africa) concern scientists because of emerging data suggesting
their increased transmissibility.
• Variant P.1. (found in travelers from Manuas, Brazil) may also be more transmissible
and early data indicate vaccination and prior infection may provide less protection –
leading to possible increases in re-infection.
34Variants of Concern
• Variants can carry several different mutations, but changes in the spike
protein of the virus, used to enter cells and infect them, are especially
concerning.
• Changes to this protein may cause a vaccine to be less effective against a
particular variant.
• Additionally, we worry about resistance to therapies as well
• The B.1.351 variant may be partially or fully resistant to certain SARS-CoV-2
monoclonal antibodies currently authorized for use as therapeutics in the United
States.
35Variants of Concern – Why We Care
• Mutations can:
• Change disease characteristics
• Make virus less detectable by current tests
• Increase reinfection frequency
• Reduce efficacy of vaccination
• Reduce efficacy of therapeutics
36Variants of Concern – How We Track
• Specimens of interest are identified through a PCR test result that may be
positive, but has a few key markers that look different that what we normally
see.
• Laboratories have been asked to be on the alert for unusual result patterns and
know to contact SPHL directly to forward specimens.
• There is a surveillance system in place for sequencing of results that aims to look
at a representative sample of tests
• State Lab
• Broad
• Academic Labs
37
• Some commercial labs as wellVariants of Concern – Tracking
• We want to know both when and where these variants are being detected
• Have they transitioned from travel –associated to community spread?
• And we want to know the research behind their characteristics
• Do they cause more severe disease, vaccine effectiveness, etc.?
• Current State of Surveillance:
• B.1.1.7 is being spread in the community in Massachusetts so individual cases are not
prioritized.
• Recent travel to Manaus Brazil or South Africa with a positive test in the 14 days
following return may be considered for sequencing.
• Other situations where sequencing could be considered: explosive outbreaks
and vaccine break through, an unexpectedly high rate of negative tests during an
outbreak. 38Notification of SARS-CoV-2 Variants
• When MDPH receives notifications from CDC or other lab of MA residents
identified with a Variant
• MDPH Epidemiologists will reach out to the LBOH to conduct case re-interview.
• LBOH serves as primary on this interview but may touch base with CTC representative if the
case was originally interviewed by CTC to coordinate the re-interview.
• LBOH should discuss with MDPH if unable to conduct re-interview.
39Follow Up on SARS-CoV-2 Variants
• LBOH will
• Reach out to case to inform them of their sequencing result
• Confirm what has been recorded in the Clinical and Risk Question packages
• Verify if there was any travel related exposures
• Make a note in the case that the re-interview has taken place and all risk/travel
information has been updated and confirmed.
• At this time, there are no additional isolation/quarantine
recommendations for cases and their contacts. Please follow current
isolation/quarantine practices.
40Variants of Concern: Surveillance Data
• Best Realtime State Data is available here:
https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html
• You can hover over each state and see their currently reported official total.
41Current Vaccination Phase
42Updates to Defining Workers in a
Health Care Setting
• The prioritization website has been updated to clarify that interpreters working
in "health care settings" (was hospital before) are eligible in Phase 1, non-covid
facing health care workers https://www.mass.gov/info-details/covid-19-
vaccinations-for-health-care-workers
43Phase 2 – Group 1 is Now Eligible!
• Effective Thursday, February 11th, an individual who accompanies a person age
75 or older to a mass vaccination site to receive the vaccine will be eligible to
receive the vaccine too, if they have an appointment booked.
• Both the companion and the individual age 75 or older must have an
appointment for the same day and both individuals must be present. Only
one companion is permitted. The companion must attest that they are
accompanying the individual to the appointment.
44Additional Tools for Vaccination
Appointments
• Additional CVS locations for vaccination. See - COVID-19 vaccination
locations | Mass.gov
• There is a new tool available on mass.gov to help find a vaccination location
near you using your zip code - https://vaxfinder.mass.gov -
45Updated CDC Guidance – Clinical Considerations
for Vaccinating Homebound Persons
• https://www.cdc.gov/vaccines/covid-19/clinical-considerations/homebound-
persons.html
• DPH’s Immunization Program is working on developing guidance for vaccinating
MA residents that are homebound…More to come!
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