Driver Erik Jones gets his temperature taken as he arrives at Darlington Raceway before the Real Heroes 400 NASCAR Cup Series auto race Sunday, May 17, 2020, in Darlington, S.C.

Driver Erik Jones gets his temperature taken as he arrives at Darlington Raceway before the Real Heroes 400 NASCAR Cup Series auto race Sunday, May 17, 2020, in Darlington, S.C. AP / Brynn Anderson

Why South Carolina Is an American Model for Coronavirus Response

As other states reopen, Dr. Fauci said he'd like to clone what they're doing in the Palmetto State.

Author: Jenny Meredith 
The Conversation

After weeks of keeping people home to “flatten the curve,” restrictions on U.S. businesses are loosening and the coronavirus pandemic response is moving into a new phase. 

Two things will be critical to keep COVID-19 cases from flaring up again: widespread testing to quickly identify anyone who gets the virus, and contact tracing to find everyone those individuals might have passed it to.

It’s a daunting task, but states are working hard to take the necessary steps to reopen safely. When Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Disease, explained that task to the U.S. Senate recently, he pointed to South Carolina as a model for the country, one that he would “almost like to clone.”

So, what is South Carolina getting right? 

Related: A New Statistic Reveals Why America’s Coronavirus Numbers Are Flat

Part of it has to do with contact tracing. Since early March, when South Carolina’s first coronavirus case surfaced, investigators have reached out to every person who tested positive for SARS-CoV-2 in the state, and all of the people they came into close contact with. To help prevent the virus from spreading farther, they hired 1,800 additional workers who will follow up with those contacts each day for 14 days to make sure they haven’t become ill.

Fauci’s compliment didn’t surprise me. I spent the first nine years of my career as a public health microbiologist in South Carolina at the Department of Health and Environmental Control’s State Public Health Laboratory. South Carolina already had disease reporting requirements in place and the cutting-edge laboratory technology needed for testing. Together with skilled epidemiologists, these laid the groundwork for an effective response to a pandemic that, nationwide, has now claimed more than 100,000 U.S. lives.

The first step was scaling up testing – fast. To find and contain the virus, officials need to know where to look.

South Carolina is poised to conduct 220,000 tests in May and June, close to the total for the previous three months combined, with a goal of testing 2% of the population. That’s still a low percentage, but it’s only an initial goal in the push to test more people. According to the Safra Center at Harvard University, testing between 2% and 6% of the population, coupled with effective contact tracing afterward, will be required to control the pandemic.

Partnering with private entities is an important part of how South Carolina has been able to ramp up testing and process those tests quickly. Prisma Health, the state’s largest health care system, and the Medical University of South Carolina have facilitated a large portion of the state’s testing, including providing the resources to collect thousands of samples at pop-up testing sites

These community testing sites are initially focused on providing free screening and testing to underserved and rural communities across the state. The state is also working with partners across the state to provide testing for every nursing home resident by the end of May. 

What happens after the diagnosis is crucial for changing the course of the COVID-19 pandemic. 

Once a positive case is identified, testing labs are required by law to report that patient’s contact information to the state health department. Case investigators then interview every person who tests positive for SARS-CoV-2, as they have been doing since the outbreak began. 

These interviews can be lengthy, and they require staff with excellent interpersonal communication skills and training. The interviewers help patients recall their activities in the previous days and identify people they came in close contact with starting 48 hours before the onset of symptoms. Sometimes patients can’t recall specifics, or know only that they’ve been to a certain restaurant or event. In these cases, the investigation can take much longer as the health department tracks down event participants or alerts restaurant patrons that they may have been exposed when visiting during a particular time period. 

The investigators also help patients understand what self-isolation means and what they’ll need to do to self-isolate for 10 days from the start of their symptoms. 

The contacts who are identified during the case interview then go into a work queue for follow-up by contact tracers. Contact tracers want to reach these contacts before they spread the virus farther.

There isn’t much time. The respiratory symptoms of coronavirus take, on average, five to six days to appear, but they can take as long as 14 days, and a person can be shedding the virus during that time and getting more people sick. Finding those people quickly and isolating them is critical. One study found undocumented infections caused about 80% of China’s documented cases. 

Tracers next alert these contacts that they may have been exposed to SARS-CoV-2 and advise them to self-quarantine for 14 days. This includes limiting their activities by staying home as much as possible and wearing a mask if they must go out.

Once fully staffed and adequately trained, contact tracers will follow up even more often, performing a “virtual handshake” with each identified contact every day for 14 days to ensure that those individuals are monitoring symptoms and taking precautions not to spread the illness. This could be a phone call or a quick text to check on symptoms.

In the future, contact tracing and follow-up could be performed digitally via cellphone apps like those being used in other countries. 

South Carolina was one of three states to announce on May 20 that they were partnering with Google and Apple to develop ways to use new smartphone technology designed to quickly notify people when they have been exposed to someone who has tested positive for the coronavirus. The technology has drawbacks, but it could provide quick notifications if people widely adopt it.

No matter the method, daily communication is key so state health officials know if that person becomes ill during the 14-day window. Testing can then be arranged and, if positive, the case investigators start the process again with a detailed interview to locate the next ring of contacts. 

Contact tracing is an important piece of the puzzle to reopening the economy without triggering a spike in coronavirus cases and overwhelming the medical system.

The CDC and George Washington University recommend states have 30 tracers for every 100,000 residents. South Carolina’s 1,800 contact tracers meet that target. These tracers are a combination of newly hired Department of Health and Environmental Control staff and staff retained through private staffing companies. Members of the public have also expressed an interested in helping with contact tracing, and may be used if future need arises.

Will this workforce, coupled with an increase in test availability, be robust enough to contain a rebound in cases? This answer will depend on the responsiveness of public health authorities and the willingness of the citizens of the state to self-isolate and quarantine. Swift action by both will be needed to save lives. 

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.