Some counties are leaning on trusted community messengers to improve contact tracing success - Gettysburg Times

Some counties are leaning on trusted community messengers to improve contact tracing success - Gettysburg Times
Covid-19 behaves like a sexually transmitted infection - ThePrint
Sexually Transmitted Infection (STI) Awareness - Entertainment & Life - BC Democrat Online - Bent County Democrat

Posted: 28 Jun 2020 08:16 AM PDT

Spotlight PA is an independent, nonpartisan newsroom powered by The Philadelphia Inquirer in partnership with the Pittsburgh Post-Gazette and PennLive/Patriot-News.With all but one county in Pennsylvania now in the green phase of reopening, public health experts agree that contact tracing is a crucial element to keeping people safe.

Locating infected individuals, identifying their close contacts, and asking those contacts to quarantine limits the spread of the disease without imposing sweeping stay-at-home orders.

But success relies on voluntary cooperation from the public, which has been hard to come by in some parts of the state. That diminishes the effectiveness of what is widely considered a sound public health practice.

For example, in Lancaster County, only 58% of the 670 people identified as contacts have answered or returned calls, according to Penn Medicine Lancaster General Health, which is leading the work. In eastern Pennsylvania, the Lehigh Valley Health Network said it has contacted thousands of individuals who tested positive, but many declined to share the names of their contacts, allowing only 42% of contacts to be traced.

And so far in June, 60 infected individuals have declined to provide their list of contacts to the Chester County Health Department.

"Certainly we're not going to be able to contain the spread of the disease if we can't do the contact tracing," said Chrysan Cronin, director and assistant professor of public health at Muhlenberg College. "It will just run rampant through the population and we'll have to depend on herd immunity or a vaccine — both of which are uncertain."

Traditionally, contact tracers see much better response rates, Cronin said. But as politics and public health continue to clash at federal and local levels, more people are skeptical of government intervention and the true severity of COVID-19.

Some don't want to share who they've been in contact with for fear of being blamed for spreading the virus or because it feels like an invasion of privacy, those on the front lines of tracing said. Others are concerned that they'll be stigmatized even if they're wrongly identified as a contact, said Rep. Russ Diamond (R., Lebanon), who was identified as a contact of another legislator who tested positive for COVID-19 in May.

But information on who is a contact is confidential. It is not published in any public realm and tracers are trained in federal laws that protect medical information, Cronin said.

Rep. Aaron Bernstine (R., Lawrence) said he's concerned about technology that tracks people's movements in order to compile a list of their contacts. Such apps have been introduced by Apple and Google, but Pennsylvania's health department said it's not currently using that type of technology.

Another common concern is that people have to work and can't follow the recommended 14-day quarantine, Cronin said. While Pennsylvania does not have guaranteed paid sick leave, tracers in many cases can provide a letter to an employer explaining why an individual needs to quarantine, or can assist with social services like food and housing assistance.

Some counties are working with local nonprofits to provide these types of support.

Berks County contracted with Co-County Wellness Services, a nonprofit providing sexually transmitted infection services, to begin contact tracing in June. Tracers can connect individuals to mental health services, food banks, pharmacy deliveries, and more, said director Carolyn Bazik. So far, only two individuals called by tracers have refused to participate.

"We've been around for 35 years and we've safe-guarded HIV and STD information all that time," Bazik said, "so that reputation makes people more likely to trust the process perhaps."

Several other areas of the state have reported success in contact tracing, too. Erie County Health Department has traced 97% of contacts, and only had 12 infected individuals ignore calls or refuse to provide contact information. Allegheny County Health Department has reached 88% of contacts in the month of June, and the Penn State College of Medicine, which has been tracing patients in the Penn State health system, has reached 80% of contacts since March.

The key is building community trust, said Noble Maseru, a professor at the University of Pittsburgh Graduate School of Public Health and a former city health director in Cincinnati and Detroit. If the people doing this work are known and respected in the community, residents will be more likely to trust that their information is being used for a good purpose.

"You really want to convey that you are treating everyone fairly and no one is being singled out," Maseru said.

Covid-19 behaves like a sexually transmitted infection - ThePrint

Posted: 21 Jun 2020 02:01 AM PDT

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Viruses walk a fine line between severity and transmissibility. If they are too virulent, they kill or incapacitate their hosts; this limits their ability to infect new hosts. Conversely, viruses that cause little harm may not be generating enough copies of themselves to be infectious.

But SARS-CoV-2, the coronavirus that causes the COVID-19 disease, sidesteps this evolutionary trade-off. Symptoms often don't appear until after infected people have been spreading the virus for several days. One study of SARS-CoV-2 estimated that the highest rate of viral shedding, and therefore transmissibility, was one to two days before the person infected begins to show symptoms.

Put simply, you only feel ill once the virus has accomplished its evolutionary goal: to spread.

Viruses that are good at making copies of themselves, and then getting those copies inside new hosts, are more successful and become more prevalent until host immunity or public health efforts restrain them.

As professors who study evolutionary medicine, we know the trade-off between virulence and transmissibility helps keep a pathogen in check. The very destructiveness of a virus keeps it from spreading too much. This has been the case with other pandemic pathogens, including Marburg, Ebola and the original coronavirus responsible for SARS. Outbreaks that consistently cause severe symptoms are more easily corralled by public health measures because infected individuals are easy to identify. SARS-CoV-2, however, can invade communities stealthily, because many infected individuals have no symptoms at all.

Also read: Scientists are already fighting the next pandemic — superbugs

Covid-19 behaves like an STI

Looking at it this way, COVID-19 resembles a sexually transmitted disease. The infected person continues to look and feel fine while spreading the illness to new hosts. HIV and syphilis, for example, are relatively asymptomatic for much of the time they are contagious. With SARS-CoV-2, recent research suggests that 40-45% of people infected remain asymptomatic. And those carriers seem able to transmit the virus for a longer period.

COVID-19 has another similarity to many sexually transmitted diseases. Its severity is not the same across hosts, and often it's dramatically different. There is evidence that the ability to fight the infection differs among people. The severity among strains of the virus might also differ, though there is no solid evidence of this yet.

Even for a single strain of SARS-CoV-2, the virus can affect people in different ways, which could facilitate its spread. The SARS-CoV-2 virus – or any other pathogen – is not deliberately changing what it does in order to exploit us and use our bodies as vehicles for transmission, but pathogens can evolve to look like they are playing games with us.

Studies show pathogens can express conditional virulence – meaning that they can be highly virulent in some individuals and less virulent in others – depending on host characteristics, like age, the presence of other infections and an individual's immune response. This might explain how SARS-CoV-2 escapes the trade-off. In some individuals, virulence is maximized, such as in older hosts. In others, transmissibility is maximized.

Age matters

Age, so far, seems the critical factor. Older people tend to get highly destructive infections, while younger hosts, although just as infectious, remain largely unscathed. This might be because different hosts have different immune responses. Another explanation is that as we get older, we are more likely to develop other illnesses, such as obesity and hypertension, which can make us more susceptible to harm from SARS-CoV-2.

Regardless of the mechanism, this age-based pattern permits SARS-CoV-2 to have its evolutionary cake and eat it too: ravaging older individuals with high virulence, yet maintaining younger individuals as vehicles for transmission. Some studies suggest younger people are more likely to be asymptomatic. Both presymptomatic and asymptomatic carriers can transmit the virus.

What do we know about the evolution of SARS-CoV-2? Unfortunately, not much yet. There is some evidence that the virus may be adapting to us as its new hosts, but so far no evidence shows that these mutations are causing changes in the virulence or transmissibility of SARS-CoV-2. And because SARS-CoV-2 may be able to circumvent the typical trade-off between virulence and transmissibility, there may be little evolutionary pressure to become less severe as it spreads.

For all the mysteries surrounding COVID-19, one thing is certain: We cannot be lulled into a false sense of security. As Sun Tzu warned in "The Art of War," know your enemy. There is a great deal more to know about SARS-CoV-2 before we claim any victories.

Athena Aktipis, Assistant Professor of Psychology, Center for Evolution and Medicine, Arizona State University and Joe Alcock, Professor of Emergency Medicine, University of New Mexico

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Also read: Widespread use of face masks could prevent further waves of Covid-19: UK study

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Sexually Transmitted Infection (STI) Awareness - Entertainment & Life - BC Democrat Online - Bent County Democrat

Posted: 10 Jun 2020 01:51 AM PDT

Tuesday

Jun 9, 2020 at 11:33 AM

What is an STI? An STI is a Sexually Transmitted Infection passed from one person to another through sexual contact. Some common STIs are chlamydia, gonorrhea, syphilis, HIV, HSV (herpes) and HPV.

Not all STIs can be cured.

Medication can manage the symptoms of those STIs that cannot be cured. Did you know "half of all newly diagnosed STIs are among 15-24-year-olds," according to the Centers for Disease Control and Prevention (CDC)?

The CDC also reports "there are more than 20 million new STI cases each year." Some STIs have no symptoms. When symptoms occur, they vary depending on the disease. To help prevent contracting or spreading STIs, always use a condom when having sex and get tested. A vaccine is available to help prevent the HPV virus, which can cause genital warts and cancer.

The Pueblo Department of Public Health and Environment (PDPHE), 101 W. Ninth St., is committed to promoting healthy behaviors and preventing illness. The family planning program at PDPHE offers STI testing for males and females and free condom, from 8 a.m. to 5 p.m., Mondays through Fridays. In addition to testing, patients who come to the clinic receive detailed education on the following:

– Various STI's and education on how to protect themselves from STIs.

– How to prevent the spread of an STI.

PDPHE also offers a confidential email/texting service that provides medically accurate answers to sexual health questions.

To submit a question, you can text or e-mail goasktara@gmail.com or visit Go Ask Tara's Facebook page.

To schedule an appointment or for more information contact our family planning clinic at 583-4380 and one of the clinic receptionists will be happy to assist you.

This health trip is provided as a public service by the Pueblo Department of Public Health and Environment.

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