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The home-grown public health program that fueled campus safety at UIC

Members of SPH's contact tracing team pose for a photo outside a UI Health building.

Amid the greatest public health challenge of modern times, UIC’s COVID-19 Contact Tracing and Epidemiology Program played a critical role in helping campus communities navigate anxious times.

As the novel coronavirus continued infiltrating the American landscape in the spring of 2020, University of Illinois Chicago (UIC) Chancellor Michael Amiridis convened a group of campus leaders to devise a plan for the safe reopening of the UIC campus in the fall.

That group, which included UIC School of Public Health (SPH) faculty member Ronald Hershow, MD, a renowned expert on epidemiologic research of infectious diseases, developed a plan pairing a saliva-based testing program with contact tracing. While UIC’s pathology lab was positioned to handle the testing piece, the group debated the best approach to contact tracing.

Leaning on the Chicago Department of Public Health – a plan that would mimic that of many other universities across the country which relied on local public health departments for contact tracing – represented a ready-made solution, but Hershow suggested an ambitious alternative: creating a homegrown program in which students would perform the case investigation and contact tracing.

An indigenous program, Hershow reasoned, would provide valuable controls. It could be tailored to UIC-specific needs, quickly adjusted to reflect new guidance and enable full ownership of the data to drive decision making. Yet more, students – “Inherently smart, tech savvy and adaptable,” Hershow said. – would naturally understand the unique stresses of students and others across the campus trying to navigate a global health pandemic fueling anxiety, angst and uncertainty.

And with that, Hershow, professor and director of the Division of Epidemiology and Biostatistics, suddenly had a sizable and time-sensitive task on his plate.

After crafting the program’s general blueprint, including the necessary data channels as well as the communications systems for contact tracing, Hershow then recruited two former students – Ellen Stein, MS ’ in Epidemiology 19, and Jocelyn Vaughn, MS ’ in Epidemiology 19 – to operationalize the program, moving it from his broad outline into a comprehensive contact tracing initiative that could be rolled out in the fall of 2020.

With an earnest spirit and swift action, Stein and Vaughn embraced the challenge. They created a contact tracing script, arranged a phone system, developed a secure, HIPAA-compliant database and hired and trained their first seven contact tracers – the so-called “Magnificent 7” –from a collection of some 100 student applicants from SPH and other UIC colleges.

“What they did was no small task,” Hershow said of Stein and Vaughn. “Within a few months, we had a well-developed system, built our team and set up escalation steps to drive COVID-19 mitigation activities and cooperation.”

Housed within and driven by SPH, UIC’s COVID-19 Contact Tracing and Epidemiology Program (CCTEP) debuted on August 31 with a clear two-pronged mission: first, to perform case investigation and contact tracing for employees and students infected with or exposed to COVID-19; and second, to monitor COVID-19 epidemiology on the UIC campus to create the safest possible environment for UIC students, faculty and staff as well as visitors to campus and the city at large.

“The expertise we have within the School of Public Health made this feasible,” Hershow said. “We not only understand contact tracing, but we also have great capacity to work with data and make it usable for decision making.”

Contact tracing stems transmission of COVID-19 Heading link

Collaborating with the likes of UIC’s Environmental Health and Safety Office, University Health Service, Student Health Services, Athletics, Performing Arts and Campus Housing, Stein, Vaughn and the CCTEP’s contact tracers – a number that would swell from seven to 41 – pursued a single-minded mission amid a relentless viral enemy: to isolate positive COVID-19 cases as soon as possible and identify and quarantine contacts to slow the virus’ transmission.

Whenever a member of the campus community tested positive using the COVID-19 saliva test, via diagnostic testing completed at UI Health or self-reported a positive case, the contact tracers called the individual and often established dialogue within 2-4 hours of receiving lab results.

Over a 30–60-minute conversation, the contact tracers reviewed demographic information, discussed test results and symptoms, evaluated possible sources of exposure and reviewed campus interactions to pinpoint potential exposures. Contact tracers also provided isolation and quarantine instructions, discussed any barriers to self-isolation and shared applicable resources before scheduling a follow-up call.

A similar process then occurred with those identified as close contacts. On average, CCTEP was interacting with close contacts within 14 hours of discovering who they were.

“We were able to get people into isolation and prevent high-level spread at UIC because we had a sound process for getting in touch with people quickly,” Stein, the CCTEP’s director, said, adding that CCTEP operated up to 80 hours a week and evolved its operations by hiring supervisors and installing lead contact tracer positions to propel even greater efficiencies and effectiveness. “We essentially became a mini-public health department within the university.”

As other campuses across the country closed due to outbreaks or uncontrollable transmission, UIC was intercepting the chain of transmission on campus thanks to CCTEP’s efforts. CCTEP reached 96 percent of positive cases and their close contacts and then kept in touch with 93 percent of those individuals for the duration of their isolation or quarantine.

“Those numbers are an incredible testament to the dedication of our contact tracers as well as our campus community for taking public health seriously,” Stein said.

By quarantining 696 contacts, 19 percent of whom converted to positive COVID-19 cases, the CCTEP directly removed 132 cases from the UIC population prior to their ability to infect others. CCTEP conservatively estimates that effort prevented approximately 140 additional exposures and 27 infections.

“If our program didn’t exist, then these people would have been free to circulate in the university and freely spread the virus,” Hershow said.

Another point of pride for the CCTEP: no cluster went beyond a second wave and further propagated the epidemic. For instance, the team rapidly investigated 13 clusters – multiple linked cases connected epidemiologically by a certain person, place or event – and prevented transmission of COVID-19 beyond the original cases and close contacts in each of those 13 instances. Such results, Hershow said, underscore the diligent, speedy and productive work of the entire CCTEP team.

“It’s fair to say that this program was an important part of ensuring safety on campus from the COVID-19 perspective,” Hershow said.

Notably, the program also provided invaluable public health experience to students such as Antonio, now pursuing his MPH in epidemiology at UIC, and Morgan Turner, an MPH student in Community Health Sciences.

“As a contact tracer, I learned how to convey public health information in different ways to different people because not everyone digests information the same way,” Turner said. “It was also valuable to learn about proper data-gathering procedures, which is so critical to running an effective public health program.”

Fueling even greater impact Heading link

Beyond its contact tracing efforts, CCTEP played a key role in driving safety and confidence on the UIC campus. Leveraging its own home-built data collection reporting system, CCTEP shared COVID-19 data on the incidence, distribution and control of the novel coronavirus within the UIC community to inform decision making, policies and courses of action.

As the CCTEP’s research data scientist, Vaughn oversaw data management and epidemiological reporting, which included maintaining a secure database, keeping pace with changing public health guidance and university protocols and ensuring the overall data integrity. She helped direct CCTEP’s efforts to identify gaps in mitigation through comprehensive case investigations, provided feedback to stakeholders to prevent further COVID-19 spread on campus and collaborated with UIC and UI Health experts on a weekly basis to translate the data collected and analyzed by CCTEP into public health action, including how open the campus should be.

Vaughn also disseminated a weekly report to stakeholders leading COVID-19 response in their respective campus communities and highlighted key metrics, such as testing positivity rates and contact tracing performance numbers. In collaboration with campus COVID-19 leaders, CCTEP helped design the UIC COVID-19 Tracking Dashboard, and regularly provided data for the contact tracing metrics on the dashboard. The dashboard, which is published on the website and is available to the entire UIC community to view, tracks COVID-19 epidemiology, contact tracing, and campus density at UIC.

“Because we built our program database from the ground up, we’re able to continuously adapt our data collection and reporting procedures, which is crucial given how rapidly public health guidance has evolved,” Vaughn said. “We routinely analyze our data to answer epidemiologic questions about COVID-19 on campus and translate what we learn into public health action, for example, through campus communications and policy.”

Due to the rich and accurate data maintained by the CCTEP, which showed no evidence of classroom transmission at UIC, the university was able to safely expand in-person learning and help people feel confident about in-person campus activities even before a vaccine became widely available. Embracing a public health education role, CCTEP personnel also provided relevant information and support via communications and interactive presentations to distinct communities across campus as well.

“People were overwhelmed with all of the information out there and our conversations with colleges, units and departments across campus has been a big help in making people feel comfortable on campus,” Stein said.

In one particularly novel effort that showcases the CCTEP’s enterprising and empathetic spirit, the CCTEP mobilized a group of representatives from Campus Housing, the Counseling Center, the Wellness Center and Student Health Services to improve the experience of students isolating and quarantining in on-campus dormitories. Given how distressing it can be to be uprooted, physically isolated from their support system and placed in a stressful situation capable of exacerbating underlying mental health conditions, CCTEP spearheaded an effort to address mental health and wellness concerns. The collaborative is now working to develop programs for students isolating and quarantining in campus housing units, from helping them learn a new hobby to introducing academic support.

“We saw quarantine taking a toll on our students and found we needed to take more of a case management approach to help them access resources and confront the stress of being socially isolated,” Vaughn said.

Though COVID-19 incidence rates are falling as vaccinations mount here in mid-2021, the CCTEP team remains active. While contact tracers continue reaching out to members of the campus community impacted by COVID-19, leadership is promoting vigilance and safety through public health programs on campus and persistent data-tracking, including an ongoing investigation of breakthrough cases.

For Stein, who said she gained decades worth of applied public health experience in months as CCTEP director, it remains important and meaningful work for the health and safety of UIC as well as the city at large.

“Everyone cares so much and has invested a lot of long hours so our campus can operate safely,” Stein said. “To know we’ve been a part of helping ensure that has been incredibly rewarding.”

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