Cases, Clusters, and Outbreaks

We are fortunate that our region of Vermont and the surrounding towns in Massachusetts and New York have seen relatively few cases of COVID-19. It’s thanks to careful adherence to precautions shown to stop the spread: masking, distancing, and handwashing. Keeping visits outside and to just a few minutes also help. These five precautions provide an interlocking shield against COVID-19; but while following all of the precautions is great protection, it’s not perfect. Individual cases will happen.

When cases do arise, especially more than one, both the media and the public are quick to refer to the situation as an “outbreak.” The word brings the horrifying 1995 film by that name to mind. Raising our alarm repeatedly may relate to our becoming desensitized. Using the appropriate terms for the number and characteristics of the cases can help us know what to expect and respond appropriately.

A case refers to one person whose condition matches the criteria for a disease or illness. For COVID-19,  someone is considered a case when they have symptoms and a positive test. Someone with a positive test but no symptoms is referred to as a positive test, rather than a “case.” Those who test positive should isolate, in the same way as people with symptoms do.

A cluster is a small group of cases connected by time, geographic location, or by common exposures. A cluster could arise if an infected person attended a small gathering and infected a few people, who went on to infect members of their household. Clusters of cases are likely. Activities within infected people’s close community—their extended family, school, and religious group—will likely be and should be suspended until all of the contacts are traced and testing is done. The cancellations will likely last 2 weeks beyond the discovery of the last infected person.

An outbreak is either a large number of cases not linkable to transmission chains or multiple seemingly unrelated clusters in several areas. It indicates widespread community transmission. An outbreak could occur if one or more infected people went to large gatherings, infected many others, and those infected passed the disease to others. If we all follow precautions, outbreaks will be rare or may not occur. In this case, the local municipality may temporarily close places of business or public buildings to slow the spread.

If you have had close contact with a positive case, you will be contacted by a contact tracer. If you develop symptoms, contact your healthcare provider. (If you don’t have a healthcare provider, call the SVHC COVID-19 Informational Hotline at 802-440-8844.) The contact tracer and/or physician will be able to provide detailed instructions tailored to your specific situation. Follow their instructions.

Most importantly, whether there are no cases in your community or many, follow the precautions—masking, distancing, and handwashing—consistently. If you must, visit outdoors and only for a short time. Make these precautions a part of your everyday routine. If we all work together to follow these steps, I am confident we can keep the impact of COVID-19 on our communities low throughout this fall and winter.

Donna Barron, RN, is the infection preventionist at Southwestern Vermont Medical Center in Bennington, VT.