Post on 29-Jan-2021
transcript
COVID-19 Contact Tracing in Navajo NationJI LL MOSES , MD, MPH
DI RECTOR, D I V I S ION OF PUBL I C HEA LTH
CHI NLE SERVI CE UNI T , NA VA JO A REA I NDIAN HEA LTH SERVI CE
IHS ECHOSEPTEMBER 3 , 2020
Acknowledgements and DisclaimersThe opinions expressed in this presentation do not necessarily reflect the official views and policies of the Department of Health and Human Services, and the Indian Health Service, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Disclosures:
Dr. Moses serves as the HCOC Case Management Lead for Navajo Nation and is the Director of Public Health at the Chinle Service Unit, NAIHS
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ObjectivesTo share information on the Navajo Nation experience with the COVID-19 pandemic and the evolution of the public health response.
To provide an overview of the case management and contact tracing system established to contain COVID cases.
To demonstrate how contact tracing workforce measures can play a role in determining reopening readiness
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4https://navajo-nation-coronavirus-response-ndoh-nec.hub.arcgis.com/
Navajo Nation• 3 states (NM, AZ, UT)• 2 IHS regions (Navajo, ABQ)• 13 Navajo healthcare
organizations (federal and 638)
COVID Unified Command • NAIHS + 638 + Navajo DOH• Medical and PH branches• Close coordination with
Navajo Leadership (President Nez)
https://navajo-nation-coronavirus-response-ndoh-nec.hub.arcgis.com/
• Rapid epi responses at service unit/tribal health organizations
• Staff reassigned to COVID response
• Different data systems• Limited home support• Recruited key partners
Immediate Response
(March – April)
• Unified contact tracing data system
• Standard Operating Procedures
• Volunteer assistance for contact tracing
• FEMA & NGO’s assist with home support
Coordinated Efforts
(May – June)
• Aim for suppression• Gating Criteria & Standardized Metrics • Community of Practice - best practices• Workforce planning and sustainability
Unified StrategiesJuly - August
Navajo Nation Contact Tracing Response
Core elements of Navajo Nation COVID-19 Public Health Response
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Navajo Nation Health Command - Public Health Emergency Orders
Public Health Ops
Epidemiology Case ManagementPublic Health
MessagingCommunity Mitigation
Medical Ops
Isolation facilities
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Navajo Nation Case Management Strategies / Teams
https://time.com/5838271/utah-navajo-health-system-coronavirus/https://www.npr.org/sections/health-shots/2020/04/15/828084250/how-to-get-the-most-out-of-your-virtual-medical-appointmenthttps://www.abqjournal.com/1463859/navajo-community-health-reps-play-key-role-in-contact-tracing.htmlhttps://www.youtube.com/watch?v=9zB_wJIPJBE
PresenterPresentation NotesCase Management (TTSI)TestingCase investigation Contact tracingSupported isolation and quarantine
https://time.com/5838271/utah-navajo-health-system-coronavirus/https://www.abqjournal.com/1463859/navajo-community-health-reps-play-key-role-in-contact-tracing.html
Expanded Contact Tracing - Progress to date
Contact Tracing Volunteer program • Diné and regional public health
students • Training, certification, quality
assurance
Site support • Team integration on CommCare• Case Management huddles• Team / 1:1 check-ins
Transition to sustainable workforce • Certification & work study
opportunities• Paid workforce
Expanded Contact Tracing - Program Goals
Unified data and workforce
system
Flexible and
responsive team
Long-term public
health capacity in
Navajo Nation
Case Management Metrics
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Workforce
# of Contact Tracers is >5 per average new daily
case
Cases
90% of cases investigated and
instructed to isolate within 24
hours of dx
>80% of cases identified among contacts during
14-day quarantine.
Contacts
90% of close
contacts notified to quarantine within 24
hours of case investigation
Testing
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Gating Measures and Indicators
*Gating Threshold Ver 3.0. Analysis are completed over a 14 day period and there is a 3 week assessment time after each transition
Phase 0 Phase 1 Phase 2 Phase 3Cases
Downward trajectory Downward trajectory
Downward trajectory and no evidence of sustained
rebound
Downward trajectory and no evidence of sustained
reboundAverage daily number of new cases per 100000 population over the last 14 days ≥25 cases per 100K 10-24 cases per 100K 1-9 cases per 100K 10%
*Percentage of positive tests equal to or less than
7-10%.
*Percentage of positive tests equal to or less than
4-6%
*Percentage of positive tests equal to or less than
≤3%
Hospital CapacityInpatient or ICU beds
A1. Cases – Is there a 14 day downward trajectory ?
A3. Cases – Incidence
Navajo Nation has moved from 34th rank to 38th rank out of 51
Interpretation: The Navajo Nation COVID-19 7-day incidence rate in comparison to state-level rates across the United States. The Navajo Nation’s rate is 49.86/100,000 persons, which is 38th highest compared to states. State-level data were obtained from CDC on August 27, 2020 via: https://www.cdc.gov/covid-data-tracker/index.html#cases.
A3. Cases – Incidence
9 Average Daily Cases per 100000 population over the last 14 days
7 Average Daily Cases per 100000 population over the last 7 days
13 IHS-THOs and Gating Measures – Includes Border Towns
Risk level calculated as average daily cases per 100000 population over 14 days.
Numbers are too small to report
Risk Level
Service Unit Average daily new cases per 100K
population over 7 days
Average daily new cases per 100K
population over 14 days
30 Day Trend Decrease Percent Positive (14-day rolling average
of 3DCS)
Number of New Cases in 14-Day
Period
Ratio of Contact Tracers to Average
Daily Number of New Cases
SU1 0 0 0
SU2 3 9 YES 3% 36 8
SU3 1 3 YES 3% 14 6
SU4 11 16 NO 11% 35 10
SU5 5 11 YES 7% 47 8
SU6 2 4 YES 2% 5 10
SU7 0 0 YES 7% 0
SU8 1 4 YES 3% 6 5
SU9 4 8 YES 4% 50 5
SU10 11 11 2 11
SU11 4 9 YES 8% 47 4
SU12 3 10 YES 5% 6 4
SU13 3 12 YES 6% 16 8
Navajo Nation with Border Towns 4 10 YES 6% 278 6
Next StepsContact Tracing Community of Practice
◦ Communicate issues and needs◦ Share best practices
Fully implement contact tracing key performance indicators and use to drive system improvements
◦ Dashboard with SU/THO specific data
Use CARES Act and other funds to support core contact tracing workforce
Strengthen contact tracing critical incident and situational awareness reporting to inform community mitigation and public health messaging
Acknowledgements and DisclaimersThe opinions expressed in this presentation do not necessarily reflect the official views and policies of the Department of Health and Human Services, and the Indian Health Service, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Disclosures:
Dr. Moses serves as the HCOC Case Management Lead for Navajo Nation and is the Director of Public Health at the Chinle Service Unit, NAIHS
Ahéhee’To all of our partners!
Jill Moses, MD, MPHDirector of Public Health Chinle Service Unit, Indian Health ServiceJill.moses@ihs.gov
COVID-19 Contact Tracing in Navajo NationAcknowledgements and DisclaimersObjectivesSlide Number 4Navajo Nation Contact Tracing ResponseCore elements of Navajo Nation �COVID-19 Public Health ResponseSlide Number 7Slide Number 8Slide Number 9Case Management MetricsSlide Number 11Gating Measures and IndicatorsA1. Cases – Is there a 14 day downward trajectory ?Slide Number 14Slide Number 1513 IHS-THOs and Gating Measures – Includes Border TownsNext StepsAcknowledgements and Disclaimers