North Dakota Department of Health COVID-19 Investigation Protocol & Resource Guide
Date of Last Update: November 16, 2020
2 Updated November 9, 2020
Contents Introduction ...... 6 Definitions ...... 6 Laboratory testing ...... 8 Onboarding and Training ...... 9 Accessing Dynamics 365 ...... 9 Training ...... 10 Scheduling ...... 11 Data Quality ...... 12 Voicemail ...... 12 Case & Contact Hotline Operator ...... 12 Case Investigation ...... 13 How to Receive a Case to Investigate ...... 13 Contact Tracing Modifications ...... 14 Data Capture Through Surveys ...... 14 Changes in Race Field:...... 16 Critical Fields: ...... 17 Case Interview ...... 17 Monitoring of Cases ...... 30 Non-compliant cases ...... 31 Navigating Workflow Screens in Dynamics 365 ...... 31 Wrong Demographic Information ...... 34
Out of Jurisdiction (OOJ) Cases ...... 35 Cases That Leaves ND During Their Isolation Against Public Health Advice……………………………….35 Special Cases……………………………………………………………………………………………………………………………….36 Case Investigation for Out of State Residents……………………………………………………………………………..37 Hospitalized Cases ...... 37 Pregnant Case ...... 37 Death Case ...... 37
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Active Military ...... 38 Care19 Applications ...... 38 What is Care19 Alert?…………………………………………………………………………………………………………………..38 What is Care19 Diary?………………………………………………………………………………………………………………….38
Release from Isolation Criteria ...... 39 Symptom-based strategy: ...... 39 Test-based Strategy ...... 40 Asymptomatic Cases: ...... 40 Symptom-based strategy for determining when HCP can return to work………………………………….40 Test-Based Strategy for Determining when HCP Can Return to Work………………………………………..41 Previously Positive Cases: ...... 41 Release from Quarantine Criteria ...... 42 Close Contacts ...... 42 Household Contacts ...... 42 Previous Cases ...... 42 Essential Workers ...... 42 Quarantine FAQs ...... 43 Public Assistance/Wrap-around Services ...... 44 Lutheran Social Services North Dakota (LSSND) ...... 44 Special Circumstances ...... 45
Long Term Care/Basic Care/Assisted Living ...... 45 Group Homes ...... 47 Homeless Individuals ...... 47 Childcare Facilities ...... 49 K-12 Schools ...... 49 Universities ...... 51 University COVID-19 Contacts……………………………………………………………………………………………………..52 University Procedures in Dynamics……………………………………………………………………………………………...56
Correctional Facilities ...... 57 Workplace ...... 57 4 Updated November 9, 2020
Healthcare Workers not Otherwise Discussed ...... 57
Covid Mapping (Contact tracing) leads: [email protected] ...... 58 Subject Matter Expert Contact Information ...... 58 COVID-19 Case Manager Map ...... 63 Dynamics 365 Interactions Cheat Sheet………………………………………………………………………………………62
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Introduction COVID-19 is a new coronavirus that has spread throughout the world. Infection with COVID-19 may result in cough, shortness of breath, and fever among other symptoms. COVID-19 symptoms can range from mild (or no symptoms) to severe illness. Case investigation and contact tracing is an essential public health methodology aimed at slowing the spread of COVID-19.
Definitions Close Contact: A person who has been within approximately 6 feet of a COVID-19 case for 15 minutes or more. Having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on) will also constitute someone as a close contact. However, just being in an indoor environment (i.e., in a store, workplace, restaurant) with someone is not a close contact. Close contact can be cumulative within a 24- hour period, for example, if you met with someone in an enclosed space for 10 minutes in the morning and 5 minutes in the evening.
Wearing a mask will not prevent someone from being a close contact, however if both individuals are wearing masks at all times during their exposure, then the close contact will not have to quarantine. Rather, it is recommended that one self-monitor and continue to mask while in public as asymptomatic and pre-symptomatic transmission of COVID-19 could occur. If the individual is in full personal protective equipment (PPE) when the exposure occurs, then it does not count as an exposure.
Congregate settings: Crowded public places where close contact with others may occur, such as shopping centers, movie theaters, stadiums. This may also include living situations such as group homes, long term care facilities, prisons, dorm rooms, and homeless shelters.
Incubation Period: The time it takes an individual to develop symptoms after an exposure. For COVID-19 the estimated incubation period is 2-14 days.
Infectious Period: The time period when a case can spread a virus to others. For COVID-19, the infectious period begins 48 hours prior to the onset of symptoms through the end of their isolation period. If case is asymptomatic at the time of testing, but becomes symptomatic later, the infectious period is from the onset of symptoms.
Isolation Period: The time period when a case needs to separate from people that are not sick. For COVID-19, the isolation period is 10 days after the onset of symptoms and at least 24 hours after recovery (resolution of fever, without the use of fever-reducing medications, AND progressive improvement or resolution of respiratory symptoms (e.g., cough, shortness of breath)).
Isolation: separates sick people with a contagious disease from people who are not sick. People who are in isolation should stay home and separate themselves from others in the household as much as possible. In some cases, isolation may take place in a hospital setting. • Anyone who is deemed a COVID-19 Case or is experiencing symptoms compatible with COVID- 19 will be placed on isolation.
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Quarantine: separates someone who might have been exposed to COVID-19 away from others. Someone in quarantine should stay separated from others, limiting movement outside of the home or facility where they are staying, however they do not need to separate themselves from their household. The recommended time for a person to be quarantined for COVID-19 is 14 days after their date of last exposure to an infectious person. On October 1, 2020, North Dakota Department of Health issued new guidance for exposures to COVID-19 where both the infected person and the contact were wearing appropriate masks, correctly during the entirety of the exposure. In these situations, the recommendations to the close contact would have an option to self-monitor instead of self-quarantine. While self-monitoring, these contacts should continue to: • Wear a mask. • Practice social distancing. • Avoid larger crowds. • Watch for symptoms and seek testing if they develop any symptoms. • Be tested 7-10 days after the last exposure if they remain asymptomatic. • Practice good hand and respiratory hygiene.
This guidance does not apply to household contacts or to health care settings. Household contacts need to quarantine. Healthcare settings need to continue following their infections control policies and procedures.
OOJ: Out of Jurisdiction. A case that is reported to the North Dakota Department of Health, but belongs to another jurisdiction (i.e., state).
SARS-CoV-2: the virus that causes COVID-19.
Social distancing: also known as “physical distancing”. Individuals should keep space between themselves and people outside of your home. Practicing social distancing involves: • Staying six feet away from other people. • Not gathering in groups. • Staying out of crowded places and avoiding mass gatherings.
Type of Spread: also known as source of exposure. The following distinctions are used to identify how an individual contracted COVID-19: • Close Contact – an individual that has had direct contact with a COVID-19 positive individual within 14 days of their symptom onset or positive PCR (polymerase chain reaction) test result. • Community – an individual that has had no known contact with a positive COVID-19 case, no travel outside of North Dakota, no healthcare exposure and no exposure to a cluster of people/event with COVID-19 within 14 days of their symptom onset or positive PCR test result. • Confirmed Travel – was out of the state of North Dakota the entire 14 days prior to their symptom onset or positive PCR test result. • Household Contact – an individual that lives in the same house as a COVID-19 positive individual that was released from their isolation less than 14 days prior to the new case’s symptom onset or positive PCR test result. • Nosocomial – used primarily for hospital-acquired cases. Patients classified as nosocomial spread should be in hospital care for the 14 days prior to illness onset, or collection date if asymptomatic.
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• Possible Travel – no other reason is determined for how an individual contracted COVID-19 and they were outside the State of ND for periods within 14 days of their symptom onset or positive PCR test result.
Laboratory testing Providers should order PCR testing in order to diagnose COVID-19. Providers should collect nasal, nasopharyngeal or oropharyngeal swabs for testing (dependent on type of test kit from NDDoH laboratory).
Testing guidance is regularly updated on the NDDoH website. Health care providers are encouraged to test patients with any one symptom of COVID-19. Additionally, providers should test asymptomatic contacts of cases. Ideally, this should occur 7 -10 days after last known exposure. If ongoing exposure or part of an outbreak, testing of close contacts can occur immediately. If contacts ask about being tested, they can be referred to their primary care provider or local testing site. It can take up to 14 days to develop COVID-19 after being exposed. Therefore, even if a close contact tests negative, they still must complete their 14-day quarantine, or monitoring period as recommended.
Persons who receive inconclusive test results should be retested as soon as possible as an inconclusive result cannot be inferred as either positive or negative. People should continue to isolate as recommended until a conclusive (positive or negative) result can be obtained.
Test Results Process Map
Rapid Antigen Test:
Although PCR is the “gold standard” for clinical diagnostic detection of SARS-CoV-2, Rapid Antigen Tests can be used to conduct diagnostic or screening testing. These tests can return results in approximately 15 minutes but are generally less sensitive (84%-97.6%) than viral tests, which detect nucleic acid RT-PCR. Thus, it may be recommended to confirm a rapid antigen test result with a nucleic acid test, especially if the result of the antigen test is inconsistent with the clinical context. When confirming an antigen test with a RT-PCR test it is important that the time interval between collection of samples for the two tests is less than two days, and that there have not been any opportunities for new exposures between them. If more than two days takes place, the two tests should be considered separate.
Serologic Assays:
Serologic assays which measure antibodies to SARS-CoV-2 do not replace direct PCR detection methods as the primary tool for diagnosing an active SARS-CoV-2 infection, but they do have several important applications in monitoring and responding to the COVID-19 pandemic. As antibodies may not be detected during early days of infection, a negative result does not rule out infection. Unlike direct detection methods, such as viral nucleic acid amplification or antigen detection tests that can detect acutely infected persons, antibody tests help determine whether the individual being tested was previously infected—even if that person never showed symptoms. Serologic tests detect resolving or past SARS-CoV-2 virus infection indirectly by measuring the person’s immune response to the virus by
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detecting antibodies. Antibodies are often detectable 1–3 weeks after symptom onset, at which time evidence suggests that infectiousness likely is greatly decreased and that some degree of immunity from future infection has developed.
There are currently 22 FDA approved serologic assays. Sensitivity ranges from 88-99%, specificity ranges from 95-100%, and PPV ranges from 50-100%. Orthogonal testing algorithms can be used to improve these values.
Although there is limited information regarding immunity, the more recent literature suggests that the duration of antibody response for SARS-CoV-2 is roughly 82 days. There is also evidence that serology that uses the spike protein will last longer than one that doesn’t. Further research is needed regarding reinfection rates.
Additional information about PCR and serology is on the NDDoH fact sheet.
Case Definitions
The NDDoH uses the Council for State and Territorial Epidemiologists case definitions.
Onboarding and Training The following section details the process developed by the NDDoH to access the disease information system, Dynamics 365, as well as the steps needed to complete and document a case investigation and the information related to identified contacts.
Accessing Dynamics 365 Before receiving access to Dynamics 365, all users who are not employed by the NDDoH or Local Health Departments must sign non-disclosure agreements that protect both the User and the NDDoH. These agreements are coordinated between your agency lead and the NDDoH.
Once a user is granted access, the Dynamics 365 production environment can be accessed by the following link: https://nddoh-prod.crm9.dynamics.com/
The username that is used will be: [email protected]
Utilize the temporary password you received, and you will be prompted to change it.
If you have had access to the system and have issues with your password or other issues logging into Dynamics 365, contact the ND IT Help desk at https://www.nd.gov/itd/support
If you are having trouble navigating Dynamics 365, contact your case manager or utilize this document for step by step navigation instructions.
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All users prior to utilizing Dynamics 365 should take the self-guided courses listed below: https://www.train.org/ND/course/1090790/compliation and utilize the access code: C19DOH
Training The following are the required steps to onboard new case workers. Case workers are expected to take the following courses, watch the listed videos, and complete the required shadowing before working independently.
Training: Please take time to complete the following trainings:
1. Johns Hopkins Case Investigation and Contact Tracing Training: https://www.coursera.org/learn/covid-19-contact-tracing?edocomorp=covid-19- contact-tracing If you have already completed this, you do not need to take it again.
2. Dynamics Training: Dynamics is the data management system used in North Dakota to case investigation and Contact Tracing. Please take the courses related to this within the train.org system. https://www.train.org/ND/course/1090790/compilation Code: C19DOH
3. Review COVID 19 Mock Scenarios via YouTube via You Tube links below:
a. Case Investigation: https://www.youtube.com/watch?v=4k6KwYebbHs&feature=youtu.be b. Contact Investigation: https://www.youtube.com/watch?v=05SCG0Vdt4M c. Mock Interview with a Student: https://www.youtube.com/watch?v=FDgXeyd6mCs&feature=youtu.be d. Mock Interview with a Daycare: https://www.youtube.com/watch?v=6flCaaT3EG4&feature=youtu.be
4. Review COVID 19 DYNAMICS Data Entry for Interactions Scenarios via You Tube links below: a. Congregate Settings 24 min. b. Childcare and School Data entry 52 min c. Occupations 31 min. d. Travel During Infectious and Incubation Periods 33 min. e. Healthcare Exposures including Hospitalization 20 min.
5. Review CDC’s Interview Case Investigation Guide
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This guide will help you to prepare for the recommended language to utilize to collect the necessary information in your case investigation and contact tracing process. https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/case-investigator-guide- final.pdf
6. CDC Sponsored COVID-19 CASE INVESTIGATION VIRTUAL TRAINING (Optional but preferred) Register for one of the Region 2 COVID-19 Case Investigation Virtual Training sessions sponsored by CDC. These interactive, instructor led trainings will take place over three mornings or afternoons (Tuesday, Wednesday and Thursday) and will provide case investigators with the interviewing skills needed to perform a through case investigation. You and other enrollees will perform mock interviews and your instructor will provide you with feedback on how to improve interviewing skills. The Johns Hopkins trainings are a prerequisite for this course and your certificate must be uploaded when you register. • https://www.nnditc.org/upcoming_classes.html • Find the heading for COVID-19 Case Investigation Virtual Training- R2. • Register for the next available class that best works for your schedule. o If there is a long wait for classes, consider the training for Contact Tracing Only to get a foundation.
If you have experience with case interviews through previous work or training, this may not be needed, however, for those of you with no experience in case investigation, this course will be beneficial to your success. We understand that there is a delay in these offerings and if the time to next offering is a substantial wait, work with your case manager on your next steps for training as they can offer this same type of instruction to you individually.
7. Shadowing with a Trainer During your onboarding process you will be assigned a trainer to shadow and mentor you. You will also be assigned a case manager in your onboarding that will provide guidance in your final stage of training and will approve you to move forward as a case worker.
Scheduling The North Dakota Department of Health is utilizing an online scheduling tool called SLING (getsling.com) to schedule case workers according to predicted need based on trends in the number of reported cases of COVID-19. Newly onboarded case workers will receive a registration link to join. People who are staff of NDDoH will submit a matrix of availability to Patrick Sitter ([email protected]) as well as a targeted number of hours to be scheduled each week. People working for other agencies should work with their agency’s or regional case manager for details on how to use the scheduling tool for your situation.
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If you are scheduled for a shift on SLING, you will be expected to be available for that time period if contacted by a case manager as well as to release previous cases and contacts from isolation, etc.
If you are unavailable for your scheduled shift, let your agency case manager or Patrick Sitter ([email protected]) know as soon as can.
Data Quality All fields in Dynamics 365 should be filled out to completion. For example, if the case was not hospitalized, don’t leave it blank, mark it as “no.” Correct and quality data is critical to being able to use it for decision making purposes in response to the outbreak.
Voicemail Every case worker should set up a voicemail recording so that cases can get ahold of them easily.
• Link to set up flip phone: https://www.verizon.com/support/knowledge-base-210673/ • The voicemail recording should include your name and information for the hotline. Listed below is a potential voicemail script: o “You have reached (insert name) with the North Dakota Department of Health Case Investigation Team. I am currently unable to answer your call. Please leave your name and number and I will get back to you as soon as I can. If you need an immediate, please call the North Dakota Department of Health Hotline at 1-866- 207-2880. They will be available for questions from 8 am to 5 pm Monday through Saturday. Thank you!”
Case & Contact Hotline Operator- The role of the position of operating the Case Investigation & Contact Tracing Hotline includes:
• Answering calls from cases and contacts regarding questions about their isolation/quarantine periods based on the information recorded in Dynamics. • Providing cases and contacts letters per their request based on their monitoring periods and status. o These letters should be uploaded into the case in Dynamics and the case worker and case manager originally assigned should be CCd on the email. • If cases call the hotline to report additional contacts, add the information regarding those contacts to the case in Dynamics and assure that the contact is notified and followed up accordingly. • Answer general questions about COVID-19 with cases and contacts. • In time not answering calls, work to identify cases and contacts that can have monitoring ended and follow-up with guidance on being removed from isolation and quarantine.
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Hotline number: 1-866-207-2880
Case Investigation How to Receive a Case to Investigate Case managers are responsible for managing and assigning cases to case workers in Dynamics 365. Case managers are available to provide technical assistance to case workers and provide guidance on the case investigation process.
There are many ways that case managers will communicate with you and you with them on your availability to start a case investigation:
• Case managers will search the staff scheduled to work in SLING and contact you to take a case.
Utilize the Need for Case Workers message string in SLING to alert case managers that you are available to take cases. Case workers are responsible for the follow up of assigned cases. This includes the collection of required data, ongoing monitoring of cases through the release from isolation. New cases assigned to a case worker will appear in the Dynamics 365 window labeled My Clients-Investigating.
1. Click on the client record to view the information that has been reported about the patient from the disease report 2. Verify that you are moving into the investigation phase by moving the bullseye from Creation to Investigation. Most clients should already be in the Investigation phase upon investigation initiation.
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Contact Tracing Modifications To improve and automate data collection, positive test records (i.e. patients who have tested positive for COVID-19) will be imported from “DoH COVID - Test Registration” into the “DoH COVID - Contact Tracing” system. This will include a person’s General and demographic information (e.g. address, phone number, email, gender, race, ethnicity).
Data Capture Through Surveys Initial Surveys will be used to capture demographic and other Health and Medical related information from cases. A person’s record will be auto populated or updated within dynamics to reflect any information gathered when cases fill out their surveys on the portal. Cases will also have an opportunity to complete this information on their daily monitoring surveys as well.
Case workers will still need to verify the information but may not have to manually do data entry with the above-mentioned data collections fields.
NOTE: Case Workers will need to verify symptom onset date and if the case is symptomatic, presymptomatic, or asymptomatic. Cases that complete their initial survey and report symptoms before the case worker interviews them will automatically have their symptom status set to presymptomatic and the onset date the date they completed the survey. This is because of the symptom accumulation functionality. You MUST verify and update this information.
Portal Survey Overview:
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Changes in Race Field: The ‘Race’ field has been modified to list “Asian” and “Native Hawaiian or Other Pacific Islander” as separate option sets. There is a multiselect option for race under the “Race” field.
Since ‘Asian’ and ‘Native Hawaiian or Other Pacific Islander’ are no longer listed as ‘Asian/Pacific Islander’ or ‘American Indian/Alaska Native’, any record that contained such values has been updated to display as ‘Other’ for the Race field, and as ‘Asian/Pacific Islander’ for the ‘Race Other’ field:
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Case workers will have to check the race fields and ensure the appropriate matching is selected. Because Race is multi-select in the General Tab but not in Test Reg or the initial and daily monitoring surveys, Case Workers will NEED to complete the Race field with what was entered by the case in the survey (portal facing race field). You also should verify race with the case in the event the case reports multiple races.
Example of case completing Race on their survey (portal facing race field):
Critical Fields: In dynamics, critical fields will be marked with blue icons.
Case workers will have to check and make sure these fields are not blank. [see sample below]. School team will complete the # of School Contacts and # of School Masked Contacts.
Case Interview 1. Ensure that you are in a space where you can have upwards of an hour of uninterrupted time to perform a case investigation. This will include collecting information regarding general demographics, living setting, any symptoms experienced during the course of illness, clinical history, occupational history.
Sample scripts to utilize when contacting a case could include:
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“Hello, may I please speak to Sam? My name is John and I am part of the North Dakota Department of Health COVID-19 Case Investigation Team. I have some questions for you about your recent diagnosis with COVID, is now a good time?”
Refer to the Case Investigator’s Guide for COVID-19 for more sample language to utilize throughout the investigation.
If the case does not speak English, please notify your case manager, so an interpreter can be facilitated.
If the case is 17 years of age or younger, talk to the parent. Adolescent cases should also be interviewed to obtain their close contacts or additional information that the parent may not know. Case investigators should not discuss cases who are 18 or older with their parents. Only information that needs to be released to a parent of an adult should be provided.
2. In the General tab in Dynamics 365, start by verifying the demographic information with the client. Safety Questions For Investigation • Essential demographic information to gather includes: i. First Name, Last Name, Birthday, Gender, Race, Ethnicity, Email, Phone Number, Address and Living Setting.
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1. If the case is a resident of a congregate setting, the case worker should following guidance in the special circumstances section. Complete all fields that are shown when an individual resides in a congregate setting (resident of hospice, DNR). a. Congregate Living (shared housing facilities): include residents of long-term care facilities, group homes, jails/prisons, college dorms, fraternities, shelters, etc.
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Congregate living does not include places such as apartment buildings, or hotels.
2. Verify that the County of residence is correct. Sometimes county that comes from Maven may not be correct. This is especially important when the case lives close to county borders or has a PO Box address. You want the county where the individual physically lives. a. If the individual lives in a neighboring county than the usual City-County assignment, select “Yes” to the question “Lives in Neighboring ND County”. By default, this checkbox will be unchecked.
3. Move to the Case Report tab in Dynamics 365 and answer all questions listed.
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• Critical and Time Sensitive Elements: The information in this section is essential to be completed. These are the fields that drive the data that is presented on the NDDoH website around case counts and hospitalized or recovered status. i. County of Residence: This will be the county in which the case is reported (see additional guidance for determining residency that can apply to county of residence determination). ii. Hospitalized: If the healthcare provider or the case indicate that they were admitted to the hospital for this illness, please report yes in this field. 1. If the case is hospitalized for reasons outside of their COVID-19 symptoms this should be marked no. iii. Released from Isolation: This will initially be marked no for most cases until they complete their monitoring period. In rare cases an individual could already meet the release from isolation criteria when a case investigation is conducted. This will need to be changed to yes before the case can be closed. iv. Complete the # of Household Contacts. The school contact numbers will be completed by their respective investigation team.
• Onset and Recovery i. Symptoms Present during illness: This is a question for the interviewer to answer after asking the case about any symptoms that they had leading up to their positive test result. If the case does not report any signs of symptoms of infection as listed in the section below, choose Asymptomatic. If the case indicates that they had any symptoms of infection, choose Symptomatic. If the case did not have symptoms when they were tested but develops symptoms either when you interview them or on subsequent monitoring surveys, choose Pre-symptomatic.
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1. Dynamics will accumulate symptoms reported in surveys in the Case Report tab. If an asymptomatic case subsequently develops symptoms, Dynamics will automatically change the case to Pre- symptomatic and fill in the onset date. ii. Onset Date: This date is the earliest date the case can recall any symptoms of infection. This date is crucial to the calculation of release from isolation so is very important to collect. If the case is asymptomatic, the lab collection date (in the Maven section) should be used for the onset date, and the onset date field should be left blank. If a case is asymptomatic and goes on to develop symptoms, the onset date should be used to determine the release from isolation, not the collection date of the test.
NOTE: Case Workers will need to verify symptom onset date and if the case is symptomatic, presymptomatic, or asymptomatic. Cases that complete their initial survey and report symptoms before the case worker interviews them will automatically have their symptom status set to presymptomatic and the onset date the date they completed the survey. This is because of the symptom accumulation functionality. You MUST verify and update this information.
• Clinical History i. These questions could be asked of the case but would be more appropriate to gather from the pre-interview discussion with the healthcare provider around the clinical history of the case. Document if a diagnosis of Pneumonia, Acute Respiratory Distress Syndrome or Another Diagnosis for this illness was made. Abnormal chest x-ray would be reported by a radiology report at a healthcare providers office.
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• Outcome: i. Was patient/case hospitalized: If the case was hospitalized for this illness, choose Yes. If yes is selected, you must complete an interaction for each hospitalization or place they were hospitalized. Document all information you have about the status of the client, where they were hospitalized, the date of admission and discharge when it is available as well if they received intensive care and/or mechanical ventilation.
1. If this individual is not hospitalized due to their COVID-19 symptoms mark no. Notify your case manager or [email protected] as this may require additional follow-up with the facility.
This is how the interaction should look on the Interaction Details Tab for someone who was hospitalized.
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ii. Did the patient die as a result of this illness: Should be defaulted to No, unless you receive information that case expires during the course of their illness prior to recovery to baseline. Document date of death if it is known. For more specific guidance about COVID-19 deaths see the guidance below. iii. If a case is unable to be interviewed due to being intubated or other reason, case workers should work with others in the household, a family member and/or an employer to determine who is close contacts to the case. • Health and Medical information: i. Discuss with the case if they have any diagnosed pre-existing medical conditions. Please complete all pre-existing fields if the case died or is/was hospitalized due to their COVID illness. This includes the following data fields: Chronic Renal Disease, Chronic Lung Disease, etc. It is recommended to prepare them by saying, “I have a list of some chronic medical conditions or risk factors, as I go through them one by one, please indicate yes or no if you have ever been told you have these.” ii. All other cases will only need to compete the questions noted in yellow below. iii.
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• Occupations:
i. If a case is unemployed or retired, select “Yes” next to Retired, Unemployed, N/A in the Occupations question block. Do not create an occupation interaction for cases who are not employed. For cases who are employed, select “No” and complete an interaction for each occupation. To add
occupation information, click New Interaction in the Occupations section of the Case Report tab.
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ii. Once you click New Interaction, you will be redirected to a new window specific for occupation information. iii. Type of interaction: Occupation iv. Name: Enter the case’s job title or occupation v. Location Type: Select the appropriate employer facility category from the drop-down list. If the employer facility type is not specifically listed, select “Other.” vi. Location: Enter the name of the case’s employer. *Tip: Search for the Location (employer facility) before creating a new record. If you aren’t sure whether the employer facility you’ve found is the correct location, click on the blue employer facility name to view details. If it is not the right location, click the back button on your browser and click the X next to the blue employer facility name to remove that employer facility. If the employer facility is not listed, create a new record by clicking New Account. o Account Name: Enter the name of the employer facility. If there are multiple locations, specify the location in parenthesis. For example, enter “Burger Shack (S Broadway, Minot)” rather than “Burger Shack.” o Type of Location, Place, or Event: Select the employer facility type from the drop-down list. o Main Phone: Enter the main phone number for the employer facility. o Street 1: Enter the street address for the employer facility. Do not enter a post office box number. o City: Enter the city in which the employer facility is located. o State: Enter the state in which the employer facility is located. o Zip Code: Enter the zip code. o Contact person for the facility: Enter the name of the point of contact for the case’s employer.
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o If the case works in an institutional setting that serves susceptible populations (e.g., LTC, basic care, corrections, group home, homeless shelter), they need to notify their facility’s occupational health representative about their diagnosis. o Health Care Worker: i. If work in the health care field notify the HAI COVID Team to review potential coworker exposures and patient exposures. This includes dental, vision care, clinics, hospitals, ambulatory surgical, chiropractic clinics, pharmacies, etc. o School or Child Care: i. If the case indicates that they work at a school or childcare, notify the school team or childcare team. • Other areas where notification needs to occur (healthcare-related) o If the case volunteered, had a healthcare appointment (i.e., dentist appointment, therapy session) at a clinic or hospital or had other instances in which they would have exposed people during their infectious period please enter each as an Interaction as you will need to work with those agencies to notify and find any potential close contacts. These that are healthcare-associated will need to have the Interaction Type as Clinic/Other Medical. You can enter these healthcare interactions directly in the Interactions Tab.
• Care19 Alert or Diary o Ask the case if they have currently been using the Care19 Alert or Diary apps. If Yes, ask if they will consent to allowing you to report their number to the Care19 application portal to activate their notification feature on their application. If Yes, document the Care19 number. If using the Care19 Diary, ask if they will look through the locations they have been during their infectious period. This can be used to help the case remember where they have been and if there were any close contacts. i. Each application has a different unique application number • Monitoring and Isolation
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o The last step in the interview is to discuss the importance of isolation to the case and how ongoing monitoring will occur. Primarily this will be done through an email survey sent through Dynamics 365 that will be triggered daily at 7:00 AM. Do not ask the case what type of monitoring (email, phone, text) they prefer. Notify the case that they will receive a daily email. If they do not have email, then offer text or phone monitoring. Alert the case that this email survey will be coming, and it is important that they complete it daily. If they do not see the email survey in their inbox, instruct them to check their junk inbox or search for an email from the state of North Dakota - State of ND, DoNotReply o A drop-down menu will appear, select “Word Template” and then select the appropriate letter (ASYMP CASE- Need to Isolate or -SYMP CASE Need to Isolate). 28 Updated November 9, 2020 • Download the appropriate letter, convert the document to a PDF, and email it to the case. You will also need to send the case a release from isolation letter when the case is done with their monitoring period (ASYMP CASE – Release from Isolation & SYMP CASE – Release from Isolation). • Put a note in the timeline that a letter was sent and attach the letter into the timeline (see image below). • Education on Notifying Close Contacts o Cases are now expected to notify their own close contacts. Therefore, it is essential that the case worker educates the case on how to identify their close contacts and how to access the reference materials for close contacts within their letter. This is done by completing the following steps: i. Provide the case with their infectious period: beginning two days before symptoms started or date tested (asymptomatic) and 10 days after their onset or test date. ii. Read the definition of a close contact to the case you are interviewing: 1. Close Contact: anyone who you were within 6 feet for 15 or more cumulative minutes in a 24 hour period, or anyone you coughed or sneezed on while you were infectious (48 hours prior to your onset of symptoms; for asymptomatic cases, 48 hours prior to the date you were tested). iii. Instruct the case to notify all their close contacts. Ask the case to notify their workplace, school and/or childcare (if the case is a child), college/university, and other social interactions. iv. Instruct to reference the following documents on their letter and to follow the recommendations: 1. Close Contact Factsheet - https://www.health.nd.gov/sites/www/files/documents/Files/MSS/coro navirus/Factsheet_for_People_Who_are_Close_Contacts.pdf 29 Updated November 9, 2020 2. Household Contact Factsheet – https://www.health.nd.gov/sites/www/files/documents/Files/MSS/coro navirus/Factsheet_for_People_Who_Are_Household_Contacts.pdf 3. Close Contact Notification Guide – https://www.health.nd.gov/sites/www/files/documents/Files/MSS/coro navirus/Contact_Notification_Guide.pdf o There is a NDDoH landing page with all of these links and instructional video for Close Contacts at https://www.health.nd.gov/what-do-if-you-are-close-contact. *NO data entry into Dynamics for close contacts or household contacts is needed. Use the letter templates in Dynamics to easily provide the case with the links to the factsheets and notification guide. On the process bar in Dynamics 365, move the status from Investigation to Monitoring. How Do I Access the ND Guard Workflow? Go to the people view and click on the down arrow. Select All – Active – ND Guard. Monitoring of Cases To help monitor your current status and prevent further exposures of COVID-19, your participation in daily survey is needed. If you choose to no longer participate in email monitoring. 1. Monitoring the health of cases and contacts will be done daily using the Monitoring Surveys in Dynamics. The bullseye must remain on Monitoring, the monitoring status be set to Monitoring, and the Preferred Method of Contact to Email to trigger email surveys to the cases or contacts. Do not offer text or telephone monitoring unless the individual does not have an email. Minimum recommended monitoring includes twice-daily temperature checks and a daily symptom log. If the case is hospitalized, daily communication with the hospital Infection Preventionist is needed. See Hospitalized Case. • Case self-reporting symptoms using email surveys: case managers should check monitoring info daily in order to determine release from isolation dates and to update any other info if required. • If case is unable to access email monitoring surveys, case workers can continue to communicate using traditional methods. Mark the preferred method of contact as phone or text in the General Tab section. 30 Updated November 9, 2020 • Daily monitoring surveys will be automatically created each day in the Monitoring Surveys tab regardless if the case/contact is receiving the surveys via email or not. You should not need to create a daily survey. If you do: select + New Monitoring Survey in the Monitoring Surveys tab. This will allow for the client to maintain compliance with monitoring. 2. If an asymptomatic case becomes symptomatic during monitoring, then case workers must go back into the case report and change to pre-symptomatic, add an onset date and add symptom information for the case. The isolation dates will need to change accordingly to reflect removal discontinuation of isolation for symptomatic cases. 3. Notify your case manager if a case becomes noncompliant – does not return a survey or respond to calls after 36 hours. Attempts to contact someone who is noncompliant should be documented in the Monitoring Surveys tab after selecting No to the question “Case or contact cooperating with Public Health?” Record your attempts by answering the subsequent questions. Cases are asked if they agree to continue to receive daily monitoring email surveys: • I agree • I do not agree Cases and contacts that select “I Do Not Agree” will be marked as Opted Out in the General Tab. Non-compliant cases If a CASE is not complying with isolation, notify the case manager. The case manager should notify the local public health unit administrator. The administrator may choose to notify the city/county state’s attorney. If the attorney has questions on how to handle the situation, he/she can contact Tara Brandner ([email protected]), from the ND Attorney General’s Office. Attempts to contact someone who is noncompliant should be documented in the Monitoring Surveys tab after selecting Yes to question “Case or Contact with Public Health?” Record your attempts by answering the subsequent questions. Also, on the General Tab, indicate that the client is not maintaining isolation in the Monitoring Details block of questions. Navigating Workflow Screens in Dynamics 365 The My Clients system dashboard tab view in the drop-down menu list in Dynamics 365 will display six distinct windows: • My Activities – these are activities that need to be completed. • Timeline – these are updates for cases and contacts that are active. • My Clients – Investigating o This is the listing of new clients who need to have an investigation completed. 31 Updated November 9, 2020 • My Clients – Monitoring o This is the listing of the cases and close contacts that are currently under monitoring o Cases listed here that have a compliance status of Non-compliant are not fulfilling the monitoring surveys and need to be contacted for ongoing monitoring. • My Clients – Closed o This is the listing of the cases and close contacts that have completed their isolation or quarantine period • My Clients – Opted Out o These are the cases and contacts that have opted out of the self-monitoring surveys in Dynamics 365 and need ongoing follow-up. The My WORK dashboard can be used by both Case Workers and Case Managers. • “My Open Activities”- Shows open activities for users. Once a task is marked as complete, that task will drop from “My Open Activities” list. Any activity left open for more than 21 days will automatically be dropped from the open actives list. • “ • “My (Case Worker) Clients- Creation or Investigation older than 20 hours” – This view is to display cases and contacts that have been either at the creation or investigation stage for more than 20 hours. • Care19 Tasks: public health portal used to activate Care19 alert notifications once a consent is given to from cases. • Symptomatic change (on monitoring survey) – This view displays clients who had a symptomatic change within the last 7 days. Visible to both case workers and case managers. The Workload window is utilized by Case Managers in Dynamics 365 to show the case manager the status of the cases that are assigned to them to manage. The four windows displayed are: • Manager – My Clients – All: These are all of the cases that are assigned to a case manager in all stages of follow-up. • Manager – My Clients – No Case Worker Assigned: These are the new cases assigned to a case manager that need to be assigned to a case worker. • All – Active – No Case Manager Assigned: These are cases that came into the system that were unable to be assigned to a case manager utilizing the algorithm. • All – Active – No Case Worker Assigned: These cases are for all case managers that don’t have case workers assigned. This window can be used for outside case 32 Updated November 9, 2020 managers to help colleagues with assigning cases to co-workers without having access to their My Clients workflows. The Case Management 2 window is utilized by Case Managers in Dynamics 365 to show the case manager the status of cases that are assigned to them to manage. The six windows displayed are: • Manager – My Clients – All: These are all of the cases that are assigned to a case manager in all stages of follow-up. o With included pie chart for pictorial view of all clients (case or contact) monitoring status. The display of the pie chart when opened in a new window by clicking on the 3 vertical dots can be changed to: ▪ Created On – this indicates the date in which the managers case/contacts were created in Dynamics 365 ▪ Persons by Case Worker and Monitoring Status – bar graph is generated indicating each case worker under the case manager and the monitoring status of the cases/contact. ▪ Persons by County – indicates each county the case managers case/contacts are located ▪ Symptomatic by Symptomatic – indicates how many cases/contacts are symptomatic or not symptomatic • All – Active – No Case Manager Assigned: These are cases that came into the system that were unable to be assigned to a case manager utilizing the algorithm. o With included bar graph at right indicating caseloads of all case managers. • All – Active – No Case Worker Assigned: These cases are for all case managers that don’t have case workers assigned. This window can be used for outside case managers to help colleagues with assigning cases to co-workers without having access to their My Clients workflows. o With included bar graph at right indicating active case counts for every case worker. The display of the bar graph when opened in a new window by clicking on the 3 vertical dots can be changed to: ▪ Case Worker Bottom 25 – indicating case workers with the least amount of currently active cases/contacts being monitored. ▪ Case Worker Top 25 – indicating case workers with the most amount of currently active cases/contacts being monitored The National Guard Dashboard is in the Workload view. It can be used to keep track of contact assigned to the National Guard team and to identify those contacts that become cases or probable cases and are still assigned to a National Guard team member. 33 Updated November 9, 2020 The Death Verification Dashboard is in the Dashboards view. This dashboard is used by NDDoH central office staff to manage and report COVID-related deaths. This dashboard can also be used by Case Managers to see deaths in their COVID team area. • All Clients - Recently Deceased” dashboard– View for all recently deceased clients • “All clients - Verified Deaths” dashboard – View for all deceased clients within the last 2 day. Case Report for Death cases: This is for when a person is reported to have died from COVID-19. For a case, if a ‘Yes’ radio button is selected to the question “Did the patient die as a result of illness?” then an automatic date and timestamp is recorded. This Date and time-stamp feature is found under the Case report tab for under a person’s record. Death Verification check box- This will be used to get verifications on reported deaths on cases for disease control (NDDoH) central office staff only. Not to be used by case workers. Wrong Demographic Information If demographic information such as name is misspelled or date of birth is incorrect in Dynamics, case workers should fix the mistake in Dynamics. They should then notify their case manager of the error. Case managers need to fix this information in MAVEN as well to avoid problems. 34 Updated November 9, 2020 Out of Jurisdiction (OOJ) Cases If a case is found to reside outside of North Dakota follow the steps below. • Change the address in the General Tab. • Change the Bullseye to investigating. • Assign Robert Peters as the Case Worker and email [email protected] OOJ cases who work in North Dakota should still be interviewed to see if they work in a North Dakota healthcare facility. Notify the HAI COVID team at [email protected] of any OOJ cases working in ND Healthcare facilities. OOJ cases that are living in North Dakota during their infectious and/or quarantine period should be investigated as cases and counted in North Dakota’s morbidity. An example would be oil field workers or college students. Cases That Leaves ND During Their Isolation Against Public Health Advice If there is a case that leaves North Dakota to return to their other residency (e.g., oil-field worker leaves ND to TX) during their isolation period, the case should be closed in Dynamics. Mark the case as Monitoring Ended, release them from isolation and enter the date they leave ND as the isolation end date. In the General Tab indicate that the case is not Maintaining Isolation. If a case chooses to fly while in their isolation period: • They need to be made aware that non-compliance will get them placed on the no-fly list. • If non-compliant, notify your case managers and please email Robert Peters at [email protected] and he will add them to the DGMQ no-fly list. The Centers for Disease Control and Prevention (CDC) provides Guidelines for determining residency for disease notification purposes, which are followed by the NDDoH when determining if we will report a case as North Dakota morbidity, or if we will send to another state. The CDC’s guidelines are based on residency provisions developed for the U.S. Census, and the instructions apply to all reportable diseases including the novel coronavirus, COVID-19. This document outlines how we determine residency, and what additional procedures we have for monitoring of individuals with COVID-19 and their contacts. 35 Updated November 9, 2020 Special Cases Despite certain epidemiologic benefits to using a reference point or period, the CDC has created guidelines for special cases. Please review the CDC guidance for a complete outline of these criteria if needed. A brief summary is presented here. • For individuals on temporary stays in another jurisdiction, such as vacation or business, they will be reported to the jurisdiction of usual residence. o Example: A case who lives in Cass county is visiting and saying with her daughter in Burleigh county for the past two weeks. She was tested and has been staying in Burleigh county for her entire incubation period. Her county of residence will be Cass county because that is where she lives. Case are reported based on their residence, not where they were exposed. • For individuals who have established residences in multiple locations, they will be reported to the jurisdiction in which they live for most of the time (week, month, year) depending on the type of cycle. For individuals without an established cycle for travel between residences, they will be reported to the jurisdiction in which they were staying at the time of disease onset. o Example: Child who lives with mom 50% (Morton county) and dad 50% (Burleigh county). Child was with dad when she became sick. Because this is a situation with equal time spent at two different residences. You will enter in Dynamics the Burleigh county address because that was where the child was staying when she got sick (or if asymptomatic, when tested). • For individuals without permanent housing, they will be reported to the jurisdiction in which they were staying at the time of disease onset (or test date if asymptomatic). • For individuals who are patients in hospitals, but who’s usual residence is in another jurisdiction, they will be reported to the jurisdiction of their usual residence. If the individual is institutionalized for an indefinite, or long-term stay, they will be reported to the jurisdiction they are staying at the time of disease onset. o Example: Case was living at home in Emmons county but recently moved in with Daughter in Burleigh county because case could not live on her own, developed COVID while living with daughter and later was put on hospice with no plans to go back to Emmons county residence. Would put Burleigh county address as residence. o Example: Case was a resident of a LTC facility in Grand Forks county. Got sick with COVID while at the LTC facility. Moved to daughter’s house for hospice care in Nelson county. Case would have their residence listed at the LTC facility in Grand Forks county. • Foreign citizens with an established household in the U.S., including those here for work or study, should be made to the jurisdiction of this household. • For non-U.S. residents diagnosed in the U.S, they will be reported to the location in which they are diagnosed. 36 Updated November 9, 2020 Case Investigation for Out of State Residents While disease status may be reported to another state, and not included in ND morbidity, we continue to have a public health responsibility to conduct an adequate investigation of the individual’s time in our state. Even when not reported under ND morbidity, cases and contacts will be monitored by NDDoH while they are residing in our state. Hospitalized Cases Due to the current strain on the hospital system, you do not have to follow up with cases in the hospital daily. Rather, notify your case manager and follow up with the case upon discharge. Pregnant Case If you have a case that is pregnant, put the following information into the Notes section in Dynamics and email Levi ([email protected]) the Dynamics ID: • Total Pregnancies • # of live births • Pre-pregnancy height and weight • Number of fetuses (current pregnancy) • Did the mother receive prenatal care? • Estimated due date? • Pregnancy conditions? (Gestational Diabetes, hypertension starting this pregnancy, intrauterine growth restriction) • Trimester of COVID-19 infection Death Case Deaths Case worker calls and is informed that case actually is OOJ → Case is re-assigned to and sent to OOJ investigator in “investigating” → When OOJ investigator updates Maven they can push case to “Monitoring ended” Case worker calls and is informed that case that was thought to be OOJ actually is a ND resident → Case is worked up like normal. Any deaths should immediately be reported to the Case Manager. The Case Manager should report these deaths to Levi Schlosser (cc. Molly Howell and Michelle Dethloff). Information should include gender, age range, county, type of spread, LTC or hospital, if they were on hospice or if they have a do not resuscitate order, date and time of death and if they have any underlying health conditions. If a death occurs 14 days after a positive test and the individual has never returned to baseline that should be counted as a COVID-19 death. 37 Updated November 9, 2020 If an asymptomatic case dies more than 14 days after a positive COVID-19 test that will not be counted as a COVID-19 death, unless it is included in the death certificate as COVID for immediate or contributing cause of death. Active Military If the case is active military notify the case manager immediately. The case manager will notify the appropriate U.S. Air Force Base personnel. Care19 Applications What is Care19 Alert? Care19 Alert app uses the Bluetooth proximity technology provided jointly by Apple and Google Exposure Notification Systems to keep track of the anonymous keys (transmitted by phones near you) that a user encounters over time. Care19 Alert quickly notifies you if you've likely been exposed to COVID-19 - empowering you to make decisions that are best for you and your loved ones: like seeking medical advice or staying home. When lots of people use the app it can help public health systems manage the disease and save lives by flattening the curve. Care19 Alert is the first exposure notification app to connect with the National Key Server provided by the Association of Public Health Laboratories (APHL). Use of this server allows different states’ apps to communicate with each other, protecting North Dakotans when they are traveling across state borders or when others are visiting North Dakota and subsequently become COVID-19 positive. What is Care19 Diary? The Care19 app that launched in April, by Gov. Doug Burgum and the North Dakota Department of Health (NDDoH) in partnership with ProudCrowd, creators of the popular Bison Tracker app, is NOW Care19 Diary. This application is an easy way for you to record your activity which will be important should you or a close companion test positive. Individuals will be given a random ID number and the app will anonymously cache the individual’s locations throughout the day. Individuals are then encouraged to categorize their movement into different groups such as work or grocery. The app will only store the location of any place a person visits for 10 minutes or more, and the ID number of each individual contains no personal information besides location data. If an individual test positive for COVID-19, they will be given the opportunity to consent to provide their information to the NDDoH to help in contact tracing and forecasting the pandemic’s progression with accurate, real-time data. 38 Updated November 9, 2020 Privacy: Care10 Diary and Alert applications are 100% anonymous. If a case consents to share their number(s) with the NDDoH, only their Care 19 Diary and/or Alert number will be used to activate the application alert features. No personal or identifiable information will be entered in the notification activation portal used by Public Health. The Care19Diary application is helpful even if nobody around the case is using the application. It helps the case remember where they have been so that more accurate information can be provided to the case worker. With the history of where the case has been, they are more likely ro remember the people they have been close to. Care19 Alert is extremely private, and it helps to notify those people who may not be identified during the contact tracing process that they could have been exposed. Care19 Alert requires that both people in an interaction are using the application. Even if the case does not know a person that they were around (such as in a public setting), they can be anonymously notified when the case tests positive. The Care19 Alert helps us get more people notified to take precautionary measures than we can capture with the current contact tracing efforts. Release from Isolation Criteria Based on the evolving information about COVID-19 infectiousness, the NDDoH updated its guidance on discontinuation of isolation across healthcare and non-healthcare settings. It is thought that the ability to culture virus is the most direct measure of contagiousness. A symptom-based strategy is now considered acceptable based on growing evidence that, even in the presence of ongoing detection of viral RNA in molecular assays, recovery of virus by culture has not been found after 9-10 days from symptom onset. Symptom-based strategy: • At least 10 days have passed since symptoms first appeared and • At least 24 hours have passed since last fever without the use of fever-reducing medications and 39 Updated November 9, 2020 • Symptoms (any COVID symptoms, not just respiratory) have improved Test-based Strategy: A symptom-based strategy is preferred due to people testing positive for prolonged periods of time, but the inability to culture virus. A test-based strategy should very rarely be used, if ever. • Resolution of fever without the use of fever-reducing medications, AND • Improvement symptoms, AND • Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive upper respiratory specimens collected at least 24 hours apart (total of two negative specimens). Asymptomatic Cases: • For patients with laboratory-confirmed COVID-19 who have not had any symptoms, health care providers might use either: o Time-based Strategy (preferred to test-based strategy): At least 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test. Because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness. Healthcare Personnel (HCP): Except for rare situations, a test-based strategy is no longer recommended to determine when to allow HCP to return to work. Symptom-based strategy for determining when HCP can return to work. • HCP with mild to moderate illness who are not severely immunocompromised: o At least 10 days have passed since symptoms first appeared and o At least 24 hours have passed since last fever without the use of fever-reducing medications and o Symptoms (e.g., cough, shortness of breath) have improved o Note: HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test. • HCP with severe to critical illness or who are severely immunocompromised1: o At least 20 days have passed since symptoms first appeared o At least 24 hours have passed since last fever without the use of fever-reducing medications and o Symptoms (e.g., cough, shortness of breath) have improved 40 Updated November 9, 2020 o Note: HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 20 days have passed since the date of their first positive viral diagnostic test. Test-Based Strategy for Determining when HCP Can Return to Work. In some instances, a test-based strategy could be considered to allow HCP to return to work earlier than if the symptom-based strategy were used. However, as described in the Decision Memo, many individuals will have prolonged viral shedding, limiting the utility of this approach. A test-based strategy could also be considered for some HCP (e.g., those who are severely immunocompromised) in consultation with local infectious diseases experts if concerns exist for the HCP being infectious for more than 20 days. The criteria for the test-based strategy are: HCP who are symptomatic: • Resolution of fever without the use of fever-reducing medications and • Improvement in symptoms (e.g., cough, shortness of breath), and • Results are negative from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) tested using an FDA-authorized molecular viral assay to detect SARS-CoV-2 RNA. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV). HCP who are not symptomatic: • Results are negative from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) tested using an FDA-authorized molecular viral assay to detect SARS-CoV-2 RNA. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV). Previously Positive Cases: • For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 infection. In addition, quarantine is not recommended in the event of close contact with an infected person. • For persons who develop new symptoms consistent with COVID-19 during the 3 months after the date of initial symptom onset, if an alternative etiology cannot be identified by a provider, then the person may warrant retesting; consultation with infectious disease or infection control experts is recommended. Quarantine may be considered during this evaluation based on consultation with an infection control expert, especially in the event symptoms develop within 14 days after close contact with an infected person. CDC Guidance on Discontinuation of Isolation: 41 Updated November 9, 2020 • Symptom-based Strategy to Discontinue Isolation Decision Memo • Healthcare Provider Return-to-Work Criteria • Discharging Hospitalized Patients • Ending Home Isolation • Ending Home Isolation for Immunocompromised Patients Essential workers who are COVID-19 cases are required by law to remain in isolation at their place of residence, hotel room, or rented lodging until released by the NDDoH. COVID-19 cases cannot return to the workplace during their home isolation period. The isolation period can vary and depends on the presence and duration of symptoms. For more information, please see NDDoH State Health Officer Order #2020.05. Release from Quarantine Criteria Close Contacts Close contacts without ongoing exposure to a case who is still in the infectious period (i.e., household contacts) should complete their 14-day quarantine or monitoring period as recommended, even if a close contact tests negative during the quarantine period. Household Contacts Household contacts should be quarantined for 14 days after their last exposure. Because they have ongoing exposure, the 14 days does not start until after the case is released from isolation. If a household contact is able to completely separate themselves from the case within the house, then the household contact may start the quarantine period immediately. See scenario 2. Previous Cases If a close contact was previously PCR positive for COVID-19 and it has been 3 months since their positive test, then the contact needs to quarantine. If it has been less than 3 months since their positive test, then quarantine is not warranted. Essential Workers The NDDoH strongly recommends that all close contacts, including essential workers, quarantine at home for 14 days past the last day they were in contact with the person who tested positive. The risk is high that a close contact will go on to develop COVID-19. Unless there are critical workforce shortages, close contacts should not go to work during their quarantine periods. Cases cannot work during their isolation periods, regardless of whether they are critical infrastructure workers. According to CDC guidance, individuals who are considered critical infrastructure workers and who are household or close contacts to COVID-19 cases may return to work with several safety 42 Updated November 9, 2020 practices in place. Employers should use caution in implementing this guidance as it is possible to spread COVID-19 up to 48 hours prior to developing symptoms or testing positive, so there is risk in allowing these employees to work. If a close contact is considered a critical infrastructure worker, provide them with the NDDoH factsheet. Close contacts who are critical infrastructure workers working during quarantine must remain asymptomatic and should follow these precautions: • Pre-Screen: Employers should measure the employee’s temperature and assess symptoms prior to them starting work. Ideally, temperature checks should happen before the individual enters the facility. • Regular Monitoring: As long as the employee doesn’t have a fever or symptoms, they should self-monitor under the supervision of their employer’s occupational health program. • Wear a Mask: The employee should wear a face mask at all times while in the workplace for 14 days after last exposure. Employers can issue facemasks or can approve employees’ supplied cloth face coverings in the event of shortages. • Social Distance: The employee should maintain 6 feet and practice social distancing as work duties permit in the workplace. • Clean and Disinfect Workspaces: Clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment routinely. Quarantine FAQs Q.) Is an individual under quarantine able to do lawn work? A.) Yes, as long as they are on their own property Q.) Is an individual under quarantine able to go for a drive? A.) Yes, as long as they are alone and not stopping for gas or at other public places. Q.) Is an individual able to do laundry in an apartment building? A.) No, since this is a shared space that is open to others you would not be able to properly social distance in that space. Q.) Is an individual in quarantine able to sit on an apartment balcony or townhouse patio? A.) Yes, if it is part of their residence. Q.) Is an individual under quarantine able to go on a bike ride or run? A.) Yes, if they have no contact with anyone and are not stopping in public places. Q.) Is an individual under quarantine able to take the trash out of an apartment complex? 43 Updated November 9, 2020 A.) Yes, if they have no contact with anyone else. Q.) Can an individual under quarantine walk around their neighborhood? A.) Yes, if they have no contact with anyone. Q.) If an individual under quarantine lives alone can they go to the grocery store? A.) No, since this is a public place. Q.) Can an individual under quarantine go get curbside groceries? A.) Yes, if they have no contact with anyone. Public Assistance/Wrap-around Services Cases and/or contacts may need assistance or wrap-around services during isolation and/or quarantine. If a case or contact needs assistance, notify the local public health unit administrator in that area. Information about services for homeless individuals can be found in the Special Circumstances section. Other assistance is available for the following groups: Meals on Wheels https://www.mealsonwheelsamerica.org/find- meals United Way https://www.unitedway.org/recovery/covid19/luw -responses If a case does not have access to a telephone for monitoring, please notify Kirby Kruger. He will facilitate access to a temporary cell phone. Lutheran Social Services North Dakota (LSSND) LSSND will be able to provide resource coordination and interpretation services to COVID- impacted refugee families in the communities across North Dakota. The services will include, but not limited to, • providing or connecting families with available local resources for emergency rent payment, unemployment paperwork, culturally sensitive education/awareness via translation and dissemination, SNAP+MA enrollment assistance, and connecting them with grassroots ethnic agencies involved in COVID response. In addition, follow-up services to families impacted with COVID on a daily basis to complete their daily surveys and provide testing recommendations via phone as most families do not have access to email surveys. LSSND will be able to offer these services in Nepali, Arabic, Kurdish, French, Hindi, Pashto, Dari, and Urdu languages. 44 Updated November 9, 2020 Special Circumstances Long Term Care/Basic Care/Assisted Living Long term care facilities have large groups of vulnerable individuals housed together. This makes follow up with any case (resident or worker) in these facilities extremely important. A group of facility coaches is in place to lead these investigations within the facility. Case workers and case managers still play an important role in this process. The duties of the involved individuals are explained below. Case Manager: • Receive results from lab. • Assign case to case worker • Notify the HAI COVID Team ([email protected]) of location worked, onset of symptoms (if any) and last day of work at each facility. The HAI team will work with the facility on assessing level of exposure to their coworkers and residents. • Once close contacts are identified, the HAI COVID Team will send the Case Managers the list of close contacts to be assigned to the case workers. • Assign any contacts in the facility to case workers for monitoring. • Link each case in Maven to the exposure site. You can also email case information to Miranda to link the exposure site. Case Worker: • Conduct initial interview with positive HCW to work on contacts outside of work setting. Follow the positive HCW as a confirmed case. • Ask where they work and the HAI team (if your case manager hasn’t) of those locations, onset of symptoms if any and last days of work for each facility the HCW works at. The HAI team will work with the facility on assessing level of exposure to their coworkers and residents. • Conduct/receive follow-up daily self-assessments from residents if they become positive. Ask facility contact to email you a daily update. • Follow coworkers who are furloughed due to their contact with this case as you would a close contact. That information will be shared with field epis to share with case worker once received by the HAI team. HAI COVID Team: • Receive results from lab. • Notify facility of positive resident or HCW cases and verify resident(s) is in droplet precautions and/or staff is furloughed. • Notify Rapid Response Team via email of initial positives who will initiate Rapid Response call. 45 Updated November 9, 2020 • AA Rapid Response Team call initiates a detailed coaching call with facility’s infection preventionist or other as designated by facility leadership. • Email Kirby, Molly, Michelle, Case Manager, and Miranda with summary of positives broken out by residents/HCWs (ongoing as positives are identified). • Email summary with recommendations to [email protected] and case manager. • Coordinate exposure contact form completion; upon receipt from facility and email to [email protected] and cc: [email protected] and case managers if close contacts identified. • Ongoing follow-up and communications with facility as needed and to notify of additional cases making sure ability to continue to cohort and dedicate staff as well as PPE/staffing needs. • May initiate additional Rapid Response Team calls if need if identified. • Upon receipt of Congregate Living/Exposure Response Plan and Report after Rapid Response call, upload it to Facility Information in Teams • Calls from the public regarding family or loved ones in LTC should be send to the following: o Concerns about Quality of Care should go to Bridget’s group at (701)-328-2352 o Questions or concerns about visitor restrictions, staffing, or resident transfer should go to the VP3 State Regional Coordinators during normal business hours at the number or email provided below: ▪ Rosanne Schmidt – (701) 328-8234 or [email protected] ▪ Seth Fisher – (701) 328-8232 or [email protected] ▪ Jan Kamphuis – (701) 328-8239 or [email protected] o If there are specific infection prevention questions email the question and call back name and number to [email protected] – someone from the HAI COVID team will pick up the question. Questions about what the Governor said at a press briefing can be answered by hotline staff. Rapid Response Team: • Designated Call Lead receives notification from HAI COVID Team of positive resident or HCW. • Organize Rapid Response call with facility point of contact – set time and share Facility Information form. • Contact Rapid Response call participants with time and access for Rapid Response call. • Discuss infection control, ability to cohort and dedicate staff. Check if any needs with PPE, EVS or staffing. Discuss ability to care for resident. • Complete the Congregate Living/Exposure Response Plan and Report. • Send completed Congregate Living/Exposure Response Plan and Report to Disease Division HAI COVID team. Local Public Health Unit: • May be contacted if help is required to do additional testing. 46 Updated November 9, 2020 Both Rapid Response TEAM and Coaching Team member can email the testing team (if additional testing is recommended but they will be notified automatically through the daily update email. Group Homes Case Manager: • Receive results from lab. • Assign case to case worker • Notify [email protected] of location, onset of symptoms, if any, and last day of work if applicable. • The HAI Team will let you know if anyone needs to be assigned to case worker for monitoring. Some facilities will monitor the health and symptoms of their staff and individual on their own and won’t require public health assistance. • Link each case in Maven to the exposure site. Case Worker: • Conduct initial interview with positive staff to work on contacts outside of work setting. Follow the positive staff as a confirmed case. • Notify [email protected] of group home location (f your case manager hasn’t) of locations, onset of symptoms if any and last days of work for each facility if applicable. • Monitor any contacts in the facility if notified by the HAI team. Some facilities will monitor the health and symptoms of their staff and residents on their own and won’t require public health assistance. HAI COVID TEAM • Notify group home of positive resident or staff. • Work with facility on testing planning. • Make sure facility has appropriate PPE. • Review processes in place to prevent transmission. Homeless Individuals Case Manager: • Receive results from lab. • Assign case to case worker • Notify Robert Peters ([email protected]) of location, onset of symptoms if any and last day of work if applicable. • Assign any contacts in the facility to case worker for monitoring. Some facilities will monitor the health and symptoms of their staff and residents on their own and won’t require public health assistance. • Link each case in Maven to the exposure site. • Work with Human Service Zone contact to refer individual in for temporary housing. Case Worker: 47 Updated November 9, 2020 • Conduct initial interview with positive HCW to work on contacts outside of work setting. Follow the positive HCW as a confirmed case. • Notify Robert Peters ([email protected]) of group home location (f your case manager hasn’t) of locations, onset of symptoms if any and last days of work for each facility if applicable. • Monitor any contacts in the facility. Some facilities will monitor the health and symptoms of their staff and residents on their own and won’t require public health assistance. Robert Peters: • Notify shelter of positive resident or staff. • Work with facility on testing planning. • Make sure facility has appropriate PPE. Community Intake: Human Service Zone Cass HSZ: Chip Ammerman Fargo Phone: 701-239-6701 701.238.2732 Grand Forks HSZ Name: Luellen Hart, Cindy Dahl and Debbie Grinde Grand Forks Phone: 8:00 am to 5:00 pm M-F: 701-787-8540. After hours and weekends: 218-779 1558 Email: [email protected] Burleigh County HSZ Name: CPS Intake (M-F 8-5p) On-Call (after-hours) Bismarck Phone: 222-6754 (M-F 8-5p) 527-8723 (after hours) Email: [email protected] Dickinson Roughrider North HSZ: 48 Updated November 9, 2020 Name: Melissa Slominski/Faye Krebs Phone: 701-290-3292/701-502-1767 Email: [email protected] Childcare Facilities If a COVID-19 case is reported in a child who attends childcare or in a childcare worker, that case should be reported the Childcare team. Email the childcare team at [email protected]. The email should include the following: • Subject line: COVID Notification • Body: Dynamics Case ID of the case (example: C-01253456) The facility will be notified by the Childcare team and they will send a letter to the childcare provider. K-12 Schools If a case of COVID-19 is reported in a person who attends a K-12 school, a teacher or worker within the school, investigate the case as you would normally. 49 Updated November 9, 2020 Document the information about attendance in the K-12 setting in the School section of the Case Report in Dynamics. For more information on how to enter this data, see the training video on Children in Childcare and School which can be accessed in the link provided in the Sling Newsfeed. Create an Interaction for the school exposure and provide the information listed in the Interaction Details section. The details about the teacher, classroom, activities, etc. will be updated by the School Response Team when they do the investigation with the school/LPHU. The notification of the school and all of the close contacts within those settings will be identified within the school setting, report the case to the School Response Team. The school response team will complete the number of school contacts field in the critical and time sensitive data element section. The School Response Team will work with the local health department and/or the school to identify all close contacts within the following settings: • School/classroom • Busses to and from school • School sanctioned practices, extracurricular activities, etc. • Events held at the school in which there may be public attendees (sports, plays, concerts, etc.) To notify the School Response Team. Email the following individuals: • School Response Team ([email protected]) • Sarah Massey ([email protected]), • Case Manager The email should be comprised of the following details: Subject Line: Case Report in a School Setting Body of the email should include: • Dynamics Case ID of the case (example: C-01253456) • Name of the school • Whether the case was a student, teacher or other type of faculty • Indicate if the case was symptomatic or asymptomatic, include the onset date/testing date as applicable • Dates they attended or were at school if you could assess that from the interview. • Provide a brief synopsis of what you could gather from the case interview for context. 50 Updated November 9, 2020 • If there is a “Special Circumstance”, primarily if household contacts are quarantining away from the case in the home and their quarantine period can start earlier, please make a note in the timeline of why the date quarantine ends is calculated as such. The School Response Team will coordinate the notification of close contacts within their purview and will document the number of identified contacts within the case in dynamics in aggregate. There will be no requirement that the cases identified through the school response team will be entered into monitoring in dynamics nor reported back to the case worker for monitoring. People identified will be provided with a letter indicating their recommendations regarding their quarantine. For more information on the School Response Team process and guidance being provided to schools, visit: https://www.health.nd.gov/child- careschoolsuniversities. If you need to reach the school response team by phone, please call (888) 788-2510. This number is for the case manager on call and should not be shared with parents or members of the public. It can however be shared with the school identified COVID-19 point of contact and local public health departments. Universities Case managers will assign cases that are suspected to be college students due to testing location, age (18-24), or other factors to the designated university investigation team. • Suspected college students in Ward (Minot), Bottineau (Dakota College), and Williams (Williston State) county should be assigned to the Minot Team lead on duty (Jamie Bechtold and Lori Johnson). • Suspected college students in Traill (Mayville State), Barnes (Valley City), Richland (NDSCS), Burleigh (BSC), Stark (DSU), Ramsey (Lake Region), and Grand Forks (UND) county should be sent to the UND Campus Team lead on duty (schedule is on Sling). The UND campus team leads include: o Emily Vonasek o Leah Borgren o Julie Brenno o Bethany Cunningham o Elizabeth DeJaeghere o Linda Emery o Dawn Hanson o Kayla Johnk • Suspected college students in Cass county (NDSU) should be assigned to the NDSU Team lead on duty (Luke Unger & Sandy Nasr). 51 Updated November 9, 2020 Once sent to the college teams, the cases will be cross-referenced using the NDUS student database—BEFORE initiating the interview. Once the college team confirms that the case is a college student, they will conduct a full investigation with contact tracing, rather than the condensed interview. This includes all relevant interaction information in Dynamics. If the case is not a college student, the college team may send the case back to the DoH Case Manager depending on the college team’s capacity or they will conduct a condensed interview. If a DoH case worker is conducting an interview and it is determined that the case attends college or university or is a faculty member, complete the following steps: • Complete the condensed case interview (like you would any other case) ensuring that you complete a university interaction. • Notify the case that a university case worker will be following up with them to conduct contact tracing. o The college team case worker will remove your name as the designated case worker and will follow your case from that point on. • Notify your case manager. • Notify the university that there is a case in that institution (see detailed instructions below) University case workers and DoH case workers will need to notify the respective university contact of a case in that institution. You can notify them by the following methods: • If you have a student ID number, you can email the university contact. o Subject line: COVID Notification o Body: ▪ Student ID number ▪ Dynamics Case ID of the case (example: C-01253456) ▪ Indicate if the case was symptomatic or asymptomatic, include the onset date/testing date as applicable • If you do not have a student ID number, you will need to call the university contact. o During the call or voicemail, you will need to provide the student name. University COVID-19 Contacts Bismarck State College Jay Meier Dean of Students [email protected] 701.224.2701 PO Box 5587 Bismarck, ND 58501 52 Updated November 9, 2020 Dakota College at Bottineau Susan Indvik Campus Nurse [email protected] Office 701-228-5460 Dickinson State University [email protected] 701-483-2304 Stickney Hall 121 Student Affairs Lake Region State College Sandi Lillehaugen, HR Manager 701-662-1543 [email protected] Mayville State University Lindsay M Hall Covid Liaison Office Location: Old Main 13 [email protected] P: 701-788-4795 C: 901-355-6148 Minot State University Deb Haman Director of Student Health Minot State University 500 University Avenue, West Minot, ND 58707 Phone 701-858-3018 [email protected] North Dakota State College of Science Melissa Johnson Executive Director of Student & Residential Life email: [email protected] Phone: 701-671-2520 North Dakota State University 53 Updated November 9, 2020 Patricia Dirk, MBA Director | Student Health Service NORTH DAKOTA STATE UNIVERSITY Wallman Wellness Center 156 Dept 2842, PO Box 6050 Fargo ND 58108-6050 phone: 701.231.8758 cell: 701.793.5564 fax: 701.231.6132 [email protected] University of North Dakota Rosy Dub, RN, BC Director Student Health Services University of North Dakota McCannel Hall, Room 100 2891 2nd Ave N, Stop 9038 Grand Forks, ND 58202-9038 O 701-777-4500 | D 701-777-3854 F 701-777-4835 [email protected] AND UND Response Team. Email the following individuals: • UND Response Team ([email protected]) • Shawn McBride ([email protected]); Arianna Larson [email protected] • Deanna VanBruggen ([email protected]) • The Cases’ Case Manager if different from the Grand Forks CM Team Williston State College John Miller President [email protected] 701-774-4231 (office) 208-420-1412 (cell) Valley City State University Betty Tykwinski, MSN, RN 54 Updated November 9, 2020 Director for Health & Wellness Services Valley City State University 101 College St SW 701-845-7305 [email protected] Contacts at Private Universities Regarding COVID-19 Testing Plans for Students - July 2020 University of Mary Alex Cournoyer Director of Residence Life 701-355-8026 [email protected] University of Jamestown Dean of Student Engagement & Student Affairs Dustin Jensen 701-252-3467 ext 5442 [email protected] Mobile 701-320-5719 Main campus in Jamestown also has a satellite in Fargo Contacts at Tribal Colleges and Universities Regarding COVID-19 Testing Plans for Students - July 2020 Cankdeska Cikana Communty College Dr. Cynthia Lindquist [email protected] 701-776-4055 Fort Totten, ND 58335 Turtle Mountain Community College Dr. Kellie M. Hall [email protected] c. 701-953-7314 off. 701-477-7822 Belcourt, ND 58316 Sitting Bull College Laurel Vermillion, PhD [email protected] 55 Updated November 9, 2020 701-854-8014 Fort Yates, ND United Tribes Technical College Leander R. McDonald, PhD [email protected] off. 701-255-3285 C. 701-955-2343 Nueta Hidatsa Sahnish College Twyla Baker, Ph.D [email protected] direct- 701-627-8095 University Procedures in Dynamics 1. Within a person, navigate to the Case Report tab, then find the section labeled University. As if they are a university student. 2. If the case answers “yes” to attending a university then complete an interaction with the following data fields. 56 Updated November 9, 2020 Correctional Facilities Case managers or case workers should notify the Faye Salzer, [email protected] and Nicole Lennick at [email protected] of any cases in a correctional facility. Case Managers should link these events to an exposure site in Maven following the guidance. Workplace Instruct your case to notify their employer. The case should tell their employer when their infectious period started and work with the employer to identify any close contacts in the workplace. The case or the case’s employer should notify each close contact from work that they were potentially exposed to COVID-19 and inform them of their recommended quarantine period based on their date of last exposure. Notify the business SME team ([email protected]) of workplaces with 3 or more cases within a 14-day time period. Additional follow-up may be needed at workplaces with suspected outbreaks. The Health Alert Network can be used to notify attendees of exposures if email or cell phone numbers are available. Ryan Dreher can facilitate this. You need to send the attendee list, letter and the message that should be in the text/email. Healthcare Workers not Otherwise Discussed All healthcare workers should be reported to [email protected]. A member of the team will follow up with the facility to discuss healthcare worker and patient contacts. 57 Updated November 9, 2020 ND Guard Leads- Covid Mapping (Contact tracing) leads: [email protected] Ronnie Garza Sean Vannett 612-741-7194 720-315-0935 [email protected] [email protected] Ryan Fontaine ` Aaron Robinson 716-307-4286 612-741-7512 [email protected] [email protected] James Svenson Ashley Monreal 701-52-8141 701-330-4024 [email protected] [email protected] Evan Thomas Mathew Henderson 612-741-7238 720-491-0799 [email protected] [email protected] Subject Matter Expert Contact Information Long Term Care/Basic/Assisted Living, Group Homes, Correctional Facilities, and Health Care Facilities: [email protected] Faye Salzer (Lead) 701-333-8389 [email protected] Candy Wormsbecker 701-425-8658 [email protected] Morgan Messer 701-425-6118 [email protected] Nicole Lennick 701-425-7798 [email protected] Sheila Netz 701-425-6083 [email protected] Joan Cook (Sanford Fargo) 701-425-6995 [email protected] Wanda Rosenquist 58 Updated November 9, 2020 701-425-7786 [email protected] Katelyn Glatt 701-425-6820 [email protected] Michele Sorenson 701-202-6680 [email protected] Brittany Hanson 701-425-7979 [email protected] Cynthia Grant 701-955-5375 [email protected] Eric Appiah 701-425-8231 [email protected] Sherry Walters 701-955-2382 [email protected] Katherine Griffith 701-214-7350 [email protected] Childcares: [email protected] Abbey Fraser (lead) 701-202-5201 [email protected] Tatia Lopez 701-400-0595 [email protected] April Johnson 701-425-6451 [email protected] Travel and Homeless: Robert Peters 701-319-8876 [email protected] Schools: 59 Updated November 9, 2020 Kasi Eisenzimmer 701-516-6913 [email protected] Universities: Ben Schram 701-328-3331 [email protected] Workplaces: [email protected] Kalee Werner 701-805-1071 [email protected] Larry Shireley 612-741-7234 [email protected] Ruth Roman 701-214-8837 [email protected] NDDoH Case Manager Contact Information Fargo Area: Saurav Dahal 701-516-6445 [email protected] Danielle Pinnick 701-204-1604 [email protected] NDSU: Luke Unger 701-226-7862 [email protected] Field Epi: Brenton Nesemeier 701-730-4804 [email protected] Grand Forks Area: Deanna VanBruggen 701-204-3502 [email protected] Arianna Larson 701-214-9375 [email protected] 60 Updated November 9, 2020 Field Epi: Shawn McBride 701-739-2054 [email protected] Jamestown Area/Devils Lake: Crystal Duncan 701-516-6589 [email protected] Melissa Anderson 701-226-7138 [email protected] Field Epi: Jennifer Schmidt 701-320-5644 [email protected] Minot Area: Primary: Carolyn Linster 701-595-1382 [email protected] Kathleen Dennison 701-204-3945 [email protected] Field Epi: Linda Larson 701-838-3340 [email protected] Bismarck Area: Primary: Brianna Wolford 701-516-6873 [email protected] Jhoana Nordstrom 701-204-3724 [email protected] Field Epi: Gino Jose 701-328-9760 [email protected] Dickinson Area: Sarah Swartz 701-215-1379 [email protected] Melissa Smeby 61 Updated November 9, 2020 704-450-8152 [email protected] 704-450-8152 Williston Area: Kelly McShane 701-516-2671 [email protected] Christina Nelson 701-226-1379 [email protected] 62 Updated November 9, 2020 COVID-19 Case Manager Map Northeast East Southeast North Central South Central Northwest Southwest [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 63 Updated November 9, 2020 Dynamics 365 Interactions Cheat Sheet 64 Updated November 9, 2020