Exposure notification key to countering COVID-19 spread

A crucial component of Stanford’s new testing program for faculty, staff or postdoctoral scholars conducting work on campus is the notification process when someone tests positive for COVID-19.

More than 8,000 employees and postdocs who are approved to come on-site at least one day per week are eligible for the university’s voluntary testing program, which launched in late August and provides self-swab collection kits for COVID testing.

A separate, mandatory testing program for students began Aug. 31. It provides regular testing for graduate and professional students who live in on-campus housing or off-campus housing – if they are coming to campus – assigned by Stanford. It’s also for incoming new students and undergraduates who are living on campus due to special circumstances.

These programs implement recommendations from a COVID-19 testing task force convened by Provost Persis Drell and chaired by School of Medicine Dean Lloyd Minor.

Rich Wittman serves as medical director and heads up the team of clinicians at the university’s Occupational Health Center, which provides on-campus medical services to employees. He is also a clinical assistant professor of medicine. In a Q&A with Stanford Report, he describes the testing and exposure notification processes and the guidelines Stanford follows.

 

What happens when someone working on campus tests positive for COVID-19?

Once an individual tests positive, we want to make sure that they receive the care and attention they need, that anyone potentially exposed to them is notified and tested, and that areas they may have used are cleaned and disinfected in accordance with county protocols.

We want to ensure a timely response following notification of a positive test result or identification of an individual with highly concerning symptoms. At Stanford, this response process begins when an individual reports symptoms or a positive test through HealthCheck, the online reporting tool developed by our Workplace Health Innovation Lab in collaboration with University IT, or when someone reports a positive test to Human Resources or Occupational Health.

Our Medical Support Team in Occupational Health promptly reaches out to the infected person for case details. It’s important to learn where and when they worked on-site, identify any personnel with whom they may have worked closely, and determine the time and proximity of those contacts.

Simultaneously, the support team also notifies the index case’s HR manager and/or principal investigator, and together they develop their own comprehensive list of potential close contacts. All individuals who are deemed potential close contacts are then offered testing and provided with return-to-work guidance.

 

What is the process when students test positive?

Vaden Health Services oversees student testing and follow up, and the process is very similar. Following a positive test result, students are notified and contacted by a physician within 24 hours. In some cases, they will be offered the option of a test to confirm the result but, at that point, they need to begin isolation. Staff follow up to discuss clinical care and exposure notification and communicate with each student on their timeline for quarantine/isolation. Everyone wants to ensure they feel safe and supported.

Campus partners who coordinate housing and meal delivery service are notified on a confidential, need-to-know basis. The university will provide wi-fi, laundry, linens, meal delivery, care kits, disability accommodations, gender-neutral bathrooms, and other amenities and services as needed to meet the isolated student’s daily needs.

 

When can someone who is a close contact of a positive case return to work?

A true close contact who meets the Centers for Disease Control and Prevention definition – “anyone who was within six feet of an infected person for at least 15 minutes” – is required to remain off-site for 14 days after the last known infectious contact with the positive case. In most circumstances, the close contact will be tested initially and then a second time near the end of this quarantine period, prior to return to campus.

Those who do not meet the close contact definition but who may have had meaningful interactions with the positive case will still be tested and likely restricted from on-site work until their negative test result returns, if not for the full 14 days. This is in accordance with local guidelines.

As an additional safeguard, these individuals are also temporarily restricted in HealthCheck from coming on-site, with automated email notifications triggered for both HR and the principal investigator.

 

How will co-workers be informed and what happens to workspaces in their building?

Facilities and department managers work together with Human Resources to issue a local notification, which alerts anyone who works or resides in that building – not just close contacts – that someone has tested positive, even if they do not qualify as close contacts.

EH&S will determine whether particular areas – typically those used by the person who tested positive in the past 48 hours – will need to be closed and/or cleaned. Many buildings and work areas, including labs, undergo enhanced cleaning of high-touch surfaces on a routine basis. So, it’s likely the area in question will already have been cleaned on multiple occasions by the time the positive notification is received.

 

What should people do if they heard someone in their building tested positive but they haven’t been contacted?

Individuals who may have occupied a building in the same general time period as a case, but who were not in direct contact with the case, are not high-risk and are not generally considered to have had meaningful case contact. If you are concerned that you may have been a potential close contact but have not been notified, we recommend that you contact your HR manager, principal investigator or the Occupational Health Center.

If you are generally concerned about your exposure risk but have had no known contact with the positive case in your work area, you may use your self-swab COVID test kit from the voluntary surveillance testing program. If you are not eligible to use the kits, you may schedule a test at the Occupational Health Center.

 

What about testing for Stanford community members who do not come to campus but believe they have been in close contact with an individual who has tested positive?

In this case, the best option is to contact your personal physician or pursue testing at one of Stanford Health Care’s locations. Tests can be scheduled online using or creating a MyHealth account. Everyone, not just SHC members, may use this option.

 

How do privacy regulations affect positive test results, both for those who are tested and for Stanford’s ability to share information?

While our responsibility is to notify people of potential transmission risk as a precaution, we must also uphold the personal privacy of the person who tested positive, in accordance with federal and state laws and guidelines.

Santa Clara County does encourage individuals who test positive to notify everyone they had close contact with, beginning 48 hours before the onset of symptoms and until self-isolation began. We have found that this practice has simplified the contact tracing process.

That noted, when we follow up with close contacts after a potential exposure, we do not disclose names, job titles or other identifying details. We err on the side of caution when the details about “degree of contact” are unclear, casting a wider net of concern around any positive case.

 

Why does the testing requirement differ between students and faculty even though they may work in the same area?

Stanford is currently requiring testing for those students residing on campus in university-provided housing and for off-campus students who are coming to campus, such as to work in a lab or attend a class. This is prompted by a number of factors, including the added close contact that is inherent to congregate and high-density living situations, as well as the rates of transmission observed in dormitory-style residences around the country. Postdoctoral scholars living in R&DE housing have the same testing requirement.

Faculty and staff are subject to somewhat different living situations generally, and our work environment has seen low rates of on-site secondary case transmission. Stanford’s new COVID dashboard shows our positive test rates are currently below that of the state and local counties as well as the positive rates reported by Stanford Health Care.

This very fact is a testament to our community’s compliance with safety protocols. We cannot overemphasize the value of physical/social distancing, the proper use of face coverings – double-layered and valve-less – enhanced cleaning and heightened hand hygiene practices, and daily completion of HealthCheck when coming on-site.