{"id":359241,"date":"2020-08-04T06:16:19","date_gmt":"2020-08-04T13:16:19","guid":{"rendered":"https:\/\/www.esri.com\/about\/newsroom\/?post_type=blog&#038;p=359241"},"modified":"2025-05-08T16:49:11","modified_gmt":"2025-05-08T23:49:11","slug":"tri-county-health-improves-contact-tracing","status":"publish","type":"blog","link":"https:\/\/www.esri.com\/about\/newsroom\/blog\/tri-county-health-improves-contact-tracing","title":{"rendered":"COVID-19: Contact Tracing Is Making Progress in Colorado"},"author":811,"featured_media":0,"parent":0,"menu_order":0,"template":"","format":"standard","meta":{"_acf_changed":false,"sync_status":"","episode_type":"","audio_file":"","castos_file_data":"","podmotor_file_id":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","filesize_raw":"","date_recorded":"","explicit":"","block":"","itunes_episode_number":"","itunes_title":"","itunes_season_number":"","itunes_episode_type":"","_links_to":"","_links_to_target":""},"categories":[731],"tags":[470861,431761,581,160522,661],"industry":[],"esri-blog-category":[491702,478652],"esri_blog_department":[478192],"class_list":["post-359241","blog","type-blog","status-publish","format-standard","hentry","category-health","tag-contact-tracing","tag-covid19","tag-digital-transformation","tag-health","tag-operational-intelligence","esri-blog-category-health","esri-blog-category-monitoring","esri_blog_department-gis-for-good"],"acf":{"video_source":"","video_start":"","video_stop":"","short_description":"Tri-County Health Department harnessed the power of GIS to build a workflow-driven case investigation and contact tracing tool.","pdf":{"host_remotely":false,"file":"","file_url":""},"flexible_content":[{"acf_fc_layout":"sidebar","layout":"standard","image_reference":null,"image_reference_figure":"","spotlight_image":null,"section_title":"","spotlight_name":"","position":"Right","content":"Local leaders look to dashboards and maps of COVID-19 case and contact data to break transmission chains and guide response, keeping communities safe.\r\n\r\nKey Takeaways\r\n<ul>\r\n \t<li>Infectious disease data can be managed and mapped to provide a geographic understanding.<\/li>\r\n \t<li>Workflows of case investigation and contact tracing center on who, where, and when.<\/li>\r\n \t<li>A visualization of viral spread across space and time guides response measures.<\/li>\r\n<\/ul>","snippet":""},{"acf_fc_layout":"content","content":"The international lure of Colorado ski resorts made the state\u2019s remote communities some of the nation\u2019s earliest hotspots for coronavirus cases. Medical centers became overwhelmed as growing case numbers threatened their capacity. In these resort towns, case rates were more than eight times higher than the state average before the ski season was canceled on March 14. It wasn\u2019t long before the virus spread to population centers.\r\n\r\nAs health organizations around the world continue to struggle to identify, isolate, track, and extinguish the virus, one health department in the Metro Denver area has decided to modernize its approach to contact tracing using a <a href=\"https:\/\/www.esri.com\/en-us\/what-is-gis\/overview\">geographic information system (GIS)<\/a>. In the absence of a clear federal or state plan, Tri-County Health Department embraced location technology to investigate with <em>whom<\/em> an infected person has come into contact, <em>where<\/em> cases are occurring, and where contacts spent time, as well as introduce automation to speed the response.\r\n\r\n\u201cPublic health isn't used to having to report out data on a daily basis,\u201d said Adam Anderson, GIS and data manager at Tri-County Health. \u201cThe only thing that's come even close to this has been fentanyl overdoses where we needed to get the data out as quickly as possible. But even then, it was within a week and not within hours. People need this information immediately. If the data is 24 hours old, it means an infected person could have contact with a lot more people.\u201d\r\n\r\nCOVID-19 spreads quickly, with a current reproductive number (R0 or R-Naught to professionals) of 2-3. That means one infectious person is infecting two or three people. A more streamlined contact tracing process aims at reducing R-Naught\u2014by finding and informing contacts to self-quarantine to reduce the spread.\r\n<h3><strong>Deciding to Create a Solution<\/strong><\/h3>\r\nTri-County Health serves Adams, Arapahoe, and Douglas Counties, which include 26 municipalities. With a population of 1.5 million people within its jurisdiction, it serves half of Denver Metro\u2019s population and roughly a third of Colorado\u2019s population.\r\n\r\nLike most health departments, Tri-County Health had not previously undergone a <a href=\"https:\/\/www.esri.com\/en-us\/digital-transformation\/overview\">digital transformation<\/a> for its contact tracing capabilities.\r\n\r\n\u201cIn the past we\u2019ve worked to trace one or two measles cases or a single case of tuberculosis,\u201d Anderson said. \u201cWith just a few really small events, we haven\u2019t had the need for a full-blown contact tracing system.\u201d"},{"acf_fc_layout":"image","image":359461,"image_position":"right","orientation":"horizontal","hyperlink":""},{"acf_fc_layout":"content","content":"Early on, the Colorado state health department created a shared spreadsheet for case investigation. Before long, the spreadsheet contained an unwieldy number of records, and was slowed by the large number of investigators who had simultaneous access to it. The state is now evaluating other options.\r\n\r\n\u201cRather than wait for the state, we decided to build something on our own,\u201d Anderson said. \u201cI advocated for using our GIS because we have a way to collect case data, automate the collection of a very important component\u2014the location\u2014and analyze it. We also wanted to match the speed at which people need information.\u201d\r\n<h3><strong>Tri-County Health Comes Together around Workflows<\/strong><\/h3>\r\nTri-County Health had a vision for closely integrated workflows to fit the structure of its operations. The solution includes defined roles for everyone who needs access to the information with oversight mechanisms for supervisors, security to adhere to privacy laws, and a shared geographic awareness of cases and hotspots.\r\n\r\n\u201cWe worked together so tightly as a team,\u201d Anderson said. \u201cOur data group got together with our disease surveillance epidemiologists and laid out what questions need to be asked and what happens to the data when a case comes in.\u201d"},{"acf_fc_layout":"image","image":359401,"image_position":"center","orientation":"horizontal","hyperlink":"https:\/\/www.esri.com\/about\/newsroom\/app\/uploads\/2020\/07\/TCHD_COVID19_Workflow.png"},{"acf_fc_layout":"content","content":"The team was made up of contact tracers, case investigators, program planners, data managers, and IT managers who worked to architect a solution using the Esri Geospatial Cloud. Technology components include <a href=\"https:\/\/www.esri.com\/en-us\/arcgis\/products\/arcgis-survey123\/overview\">ArcGIS Survey123<\/a> to create smart form-centric workflows and <a href=\"https:\/\/www.esri.com\/en-us\/arcgis\/products\/arcgis-dashboards\/overview\">ArcGIS Dashboards<\/a> to share and visualize case data. Esri Professional Services supported the development through an <a href=\"https:\/\/www.esri.com\/en-us\/disaster-response\/overview\">Esri Disaster Response Program<\/a> deployment.\r\n\r\nWith cases still failing to flatten, Tri-County Health was motivated to rapidly pioneer a solution others can build from.\r\n\r\n\u201cWe tested it as we went along, so it all happened simultaneously or in parallel,\u201d Anderson said. \u201cWe\u2019d be working through workflow processes, building it out, they\u2019d be testing it, and then changes would get made all at the same time. There were instances where I was finishing up parts of the functionality five minutes before they did the training.\u201d\r\n\r\nWorking from home, and with two young children out of school and without day care, Anderson made use of quiet nighttime hours to get the job done. \u201cI looked at my watch, and it said I had an average of 3 hours and 15 minutes of sleep a day last month, but I don\u2019t think that accounted for the nap I took when I put my kids to bed.\u201d\r\n<h3><strong>Capturing Every Detail and Eliminating Duplication<\/strong><\/h3>\r\nThe solution focuses on case investigation and contact tracing with workflow integration for data collection, storage, and dissemination. Keeping all the data in one system was important to Tri-County Health from an efficiency and reliability standpoint. It eliminated parallel systems that can duplicate work or report different totals, leading to misinformation. Having one source of truth for data also means there\u2019s just one system to harden and protect to comply with health data privacy regulations.\r\n\r\nAutomating data pulls from the state database eliminated the need to retype case information daily within Tri-County Health Department\u2019s own system. Automated workflows check for accurate reporting of every case. For instance, early in the crisis, multiple tests were offered to those displaying symptoms, and Tri-County Health Department found that some people received as many as eight different tests. This prompted safeguards within the system to make sure each repeat positive test aligns with just one individual.\r\n\r\n\u201cWe\u2019re now having to deal with the issue of duplication across cases and contacts,\u201d Anderson said. \u201cA person that tested positive in March might recover and then get a resurgence of symptoms and get retested or individuals may be getting tested multiple times due to the more widespread availability of tests. We had to work through all of these scenarios on the front end.\u201d\r\n\r\nThe gallery below displays many of the different views specific to the roles of both case investigators and contact tracers. Personal identifiable information has been removed and the records displayed in these tables and maps have been altered to protect patient privacy."},{"acf_fc_layout":"gallery","gallery_images":[359371,359391,359361,359341,359491,359351,359381]},{"acf_fc_layout":"content","content":"The workflows are spread across nine different forms with 280 data fields. Case investigators fill in details on demographics, symptoms, possible location of exposure, the people the infected individual might have exposed, the person's relevant medical history, and testing information.\r\n\r\nContact tracing gets complex. If six people live in a house with a person who is infected, the contacts for each exposed person must be gathered and called. Each person is likely to list some of the same contacts. The system needed a way to surface shared contacts so that investigators don\u2019t call the same shared contact multiple times. Deduplication is needed at every touch point where data is updated or brought in, with each change checked against data in the databases for case investigation, contacts, and testing.\r\n\r\nIt can be confusing to deduplicate contacts. If somebody asks, \u201cwho was at a dinner party?\u201d for instance, the infected person may know their friends and friends\u2019 phone numbers but may not know the names and contact information for acquaintances at the same event. Incomplete information for each contact takes time to sort out.\r\n\r\n\u201cIt\u2019s just never standard in terms of what details we\u2019re able to collect at one time from each contact,\u201d Anderson said. \u201cIn smaller outbreaks of measles or hepatitis A, an epidemiologist got really familiar with each case, the family, the contacts\u2014there just wasn\u2019t a lot of overlap. Nothing in the past even comes close to the scale of this.\u201d\r\n<h3><strong>The Importance of Maps<\/strong><\/h3>\r\nInvestigators can flag aspects of cases that require more attention or mark trends, such as cases requiring a translator or involving an outbreak in a long-term care facility.\r\n\r\n\u201cWe have a team of four people dedicated to investigating long-term care facilities, knowing that they contain one of our most vulnerable populations,\u201d Anderson said. \u201cWe\u2019ve also been reporting race and ethnicities to understand if there\u2019s a disproportionate burden for specific populations.\u201d\r\n\r\nA local picture of disease spread is a key component of Tri-County Health Department\u2019s efforts. In addition to daily dashboard updates for its whole jurisdiction, the team compiles 15 separate municipal dashboards.\r\n\r\n\u201cThe dashboards let you see individual cases, along with testing data, aggregated for every neighborhood in our jurisdiction,\u201d Anderson said."},{"acf_fc_layout":"image","image":359411,"image_position":"center","orientation":"horizontal","hyperlink":"https:\/\/tchdgis.maps.arcgis.com\/apps\/opsdashboard\/index.html#\/bcf71927e04c43dcaa4d52b445ada60e"},{"acf_fc_layout":"content","content":"Seeing the spread at the neighborhood level adds context and helps guide the response. It has allowed epidemiologists to see that the spread isn\u2019t random and it happens in waves even across a small geographic area.\r\n\r\n\u201cMaps are essential to our reporting,\u201d Anderson said. \u201cAll details have to go into a map to quantify and contextualize what\u2019s going on.\u201d\r\n\r\nMaps also cut through data complexity, which can otherwise be overwhelming.\r\n\r\n\u201cWe had a request the other day to create a much simpler dashboard with just the totals of cases, hospitalizations, and deaths,\u201d Anderson said. \u201cBut that doesn\u2019t give you information about what\u2019s going on now, what\u2019s happened prior, or allow you to compare cases to policies such as shutting things down, or bringing things back online, or school closings, or masking. As a data person, I assume that people want as much data as is understandable.\u201d\r\n<h3><strong>Opportunity for Further Analysis<\/strong><\/h3>\r\nTo date, Tri-County Health Department analyzes the data to simply see infection rates at different scales of geography\u2014for its full jurisdiction, a municipality, or a neighborhood.\r\n\r\n\u201cThe data leads to more complex analysis,\u201d Anderson said. \u201cThere are a lot of questions about the relationships between cases, contacts, and the distances between them. Understanding the size of networks for urban and rural cases will help improve our recommendations to deal with the spread in a more effective way.\u201d\r\n\r\nEpidemiologists and researchers are starting to have conversations about how this data could be used to predict emerging hotspots to get ahead of an outbreak.\r\n\r\n\u201cUnderstanding where flare-ups will occur is going to be critical,\u201d Anderson said. \u201cThe implications of gatherings such as a protest, a political rally, a party, or at a reopened workplace are another thing we\u2019d like to work on.\u201d\r\n\r\nTri-County Health Department has captured disease progression for each case, including details about when symptoms started, when the person was tested, when the test results were returned, when tests resolved or when a case led to hospitalization. Having these details and the capabilities to analyze cases across both space and time is of great interest within Tri-County Health Department, the region, and the nation. All health departments are working in uncharted territory with new volumes of data that promise to shed light on how viruses spread.\r\n\r\n\u201cThe whole thing has been pretty energizing,\u201d Anderson said. \u201cThe pandemic helped us improve data collection and create a workflow process from start to finish. The mental gymnastics of that has been pretty exciting.\u201d\r\n\r\n&nbsp;\r\n\r\nView the video below for a short demonstration regarding the community contact tracing capability of ArcGIS. A more detailed video demo <a href=\"https:\/\/youtu.be\/XKDx5oGw8kE\">can be found here<\/a>."},{"acf_fc_layout":"youtube","youtube_video_url":"https:\/\/youtu.be\/QKQFRY4YlJ4"},{"acf_fc_layout":"sidebar","layout":"standard","image_reference":null,"image_reference_figure":"","spotlight_image":null,"section_title":"","spotlight_name":"","position":"Center","content":"<h2><strong>Interconnectedness Heightens Need for Collaboration<\/strong><\/h2>\r\nColorado is home to the mountain town of Gunnison, famous for <a href=\"https:\/\/www.npr.org\/2020\/04\/02\/826187854\/the-colorado-county-with-a-long-history-of-shutting-itself-off-to-a-pandemic\">protecting its citizens from the 1918 flu pandemic<\/a>. At that time, the town quarantined early and shut down its mountain pass with armed guards and wouldn\u2019t let anyone get off the train unless they went into quarantine.\r\n\r\nFor the current outbreak, Gunnison had one of the highest infection rates per capita in the state between early March and early April. The global interconnectedness of people, with vast freedom of movement, makes it harder to achieve containment.\r\n\r\nTri-County Health Department has reached out to partner organizations to share details about the contact tracing tool it has built in the hopes of increasing collaboration and further understanding the spread of disease in Colorado.\r\n\r\n\u201cAt this point, people are having a hard time keeping up, much less paying attention to what other people are doing at other health departments,\u201d said Adam Anderson, GIS and data manager at Tri-County Health Department. \u201cWhen they do see it, they\u2019re pretty blown away that this level of data is available.\u201d","snippet":""}],"references":null},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.9 (Yoast SEO v25.9) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>COVID-19: Contact Tracing Is Making Progress in Colorado<\/title>\n<meta name=\"description\" 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