VNA team supporting local COVID-19 containment efforts 

Health experts know that containment of the COVID-19 outbreak is the key to reducing exposures and saving lives. The Visiting Nurse Association of Cape Cod (VNA), acting as a public health nurse for 12 of the Cape’s 15 towns, is communicating daily with the state Department of Public Health (DPH). The two entities are working to identify COVID-19 patients and their contacts, monitoring them daily in order to stop the spread of the disease on Cape Cod.

There was a time on Cape Cod when every town’s Health Department had its own public health nurse as a team member, working under the guidelines of DPH. The role of a public health nurse includes “the practice of promoting and protecting the health of populations using knowledge of nursing, social and public health science,” according to the American Nurses Association. For the most part, the town nurse would track any community members identified by DPH/town as having a communicable disease – traditionally something like tuberculosis, food-borne illnesses, hepatitis, etc.

Over the years, rather than every town having its own nurse, it became more efficient for towns on the Cape to simply contract with the Visiting Nurse Association (VNA) of Cape Cod.

Fast forward to today.

The COVID-19 pandemic has presented new challenges for the towns in their ability to assess and assure individuals, families and their communities that they are doing everything possible to keep them safe and healthy.

Today, VNA nurses, as the public health nurses for most of these towns, are making literally hundreds of calls to help identify, track and educate patients who have tested positive for COVID-19.

How does that work?

DPH maintains the database of everyone in the Commonwealth who has been tested – as well as the results of those tests.

Note: testing laboratories are required by law to share their results with DPH.

That information is available to the town’s public health department, of which the VNA is, by contract, now a part. The VNA team gets an alert as an authorized provider for the department, as soon as a new positive test has been identified.

How does the patient find out?

The physician who ordered the test informs the patient directly of their test results. If positive, they are also then contacted by the VNA team nurse. The VNA team is authorized as the public health nurse/team to log into a software program called MAVEN that is a database for the state of all the names, results, etc. When a patient is identified, the MAVEN software is set up to send out an alert and the VNA team checks the file regularly to see the postings of the area.

The nurse calls and guides the patient, giving them direction on hygiene, strict isolation guidelines, temperature log, other symptoms to watch for – all under the guidelines provided by the DPH. This person then gets a call from their VNA nurse every day for 14 days to check on their status, any updates on symptoms, any questions or concerns, etc.

If, after 14 days, or until the resident has had no symptoms for minimally 7 days, all is well, the VNA surveillance ends. If, during that time, they present with any symptoms, they are guided to next steps, depending on those symptoms. During this time, the VNA does a daily “report back” to DPH on their full list of patients.

What about close contacts?

As part of the initial phone call, the VNA nurse also asks the “tested positive” patient to identify who else in their world they may have been in close contact with within the past 14 days. This could include family members, co-workers, friends or anyone else who may have had close contact with the patient. Once identified, the nurse reaches out to them, as well, and, in accordance with DPH guidelines, guides them on self-quarantine, symptom tracking, when to call their primary care provider to request a test, etc.

Note: if, for example the person recently traveled, the VNA then contacts the airline/DPH with the information and a “hand-off” is made for follow-up accordingly.

The close contacts also are called regularly for 14 days. If they end up getting tested and test positive, the same procedure is followed.

In the end, it is ultimately up to the DPH to clear the person from further follow-up and report this back to the town/VNA. When the DPH is satisfied with the results of the tracking, the person is taken out of the database and the town/VNA is released from duty.

The VNA now has a command central set up which includes 8-12 nurses on the phones every day with availability 24/7. It is important for the community to know that these nurses are in a call center and NOT out visiting the patients who tested positive for COVID-19.

Patients and their contacts are also given an emergency number to call with any concerns they might have during their time in self-quarantine and observation.