'A lot of detective work': What it's like to do COVID-19 contact tracing

"Opening with a statement that we’re doing this to help them, their families and their communities is very powerful."
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/ Source: TODAY
By Lucía Abascal and A. Pawlowski

An “army” of contact tracers is needed to stop the spread of the new coronavirus, public health experts say. As some recommend the hiring of 100,000 contact tracers, Massachusetts is among the states looking for applicants. The job calls for contacting anyone an infected person has interacted with.

Dr. Lucía Abascal, 28, has been working as a COVID-19 contact tracer in San Francisco for the past month. She shared what it’s like with TODAY.

I was recruited to be a contact tracer because of my clinical background (I was a physician in Mexico City), public health knowledge and because I speak Spanish. I was interested in the job because of how the coronavirus is impacting the Hispanic community. I thought I could be helpful with this population.

I’m definitely a data gatherer, but there’s also a lot of detective work going on. We just want to keep all the possible cases off the streets.

In San Francisco, the coronavirus is a reportable disease, so every time somebody tests positive, the doctor has to contact the department of public health. They then ask the person: Who do you live with? Where do you work?

That’s a list they give us as contact tracers. I usually handle the household list, while others handle work contacts. I’ve seen up to 10 people living in the same apartment, but the average case has around three contacts.

When we call, the first thing we try to figure out after introducing ourselves is if they know they’ve been in contact with somebody who has tested positive for COVID-19. When we’re talking about household contacts, they usually know because it’s their partner or their family member.

After that, we ask if they have any symptoms and any risk factors such as other diseases. We ask about their overall health, their living situation, whether they have the ability to self-quarantine, whether they have a separate bathroom they could use. Do they have a kitchen where everybody could cook their own food without sharing stuff?

We also ask if they have enough food and medication to stay inside for the next 14 days. If not, we’re able to offer help with those needs through social workers. We ask them to please stay home and we make it easier for them to do so.

We record the information in an online system. It lets us see if the contacts are high risk and need more follow-up. Let’s say somebody is older or has another disease like diabetes, they get called again at seven days and 14 days. Everything is confidential. All the things they tell us are protected by law because of HIPAA.

People are free to participate or not participate. There are no consequences if they don’t tell the truth. We don’t enforce anything. It’s based on trust.

Opening with a statement that we’re doing this to help them, their families and their communities is very powerful. We’re not asking hard questions. I find that most people are willing to participate.

I’ve never had somebody reluctant to share their information because they fear immigration or government retaliation. The people who don’t agree to participate usually don’t feel they need it or don’t have the time.

We never ask for personal information such as social security number, immigration status or anything that might sound sketchy. We want to avoid possible scams that can be imitating this system.

We have scripts we work from. At the beginning, you’re like a robot. Once you get practice, you realize you have to ask the important questions, but you don’t have to follow a script. People want to have a normal conversation. I’ve even called people who are happy to talk to me because they say they’ve been bored. So being approachable, being open to questions is always helpful.

One of the harder situations is when people don’t know they’ve had contact with a positive case and they insist on getting information on who that person is. If I called you right now and told you, “You’ve been in contact with someone positive with COVID-19,” it’s natural to want to know who it was. But I can’t say because that’s confidential patient information.

Some people insist, insist, insist we give the name, but we can’t. Sometimes, they won’t cooperate if you don’t tell them. That’s hard to navigate.

Once we finish our call, if they agree, the contacts are enrolled in a text message program. They’ll receive a text message every day with small reminders — stay home, wash your hands, clean the bathroom — until they’re done with their 14-day quarantine period. They have the option to report symptoms or ask for a clinician to contact them.

Contact tracing is very important during this pandemic. Countries that have implemented both increased testing and contact tracing have been able to decrease their cases. We’ve seen this in China, South Korea and Singapore. It gives us pretty good evidence that it works.

It makes sense — especially as we start to open up cities and countries — to have a system where people who are at high risk of transmitting or being infected stay inside.

Technology as a complement is always good. But an app would never be able to completely do what we are doing.

We’re navigating difficult, complex human situations that require human decisions. Does this person need to be in quarantine? Does this person need testing? Should this person seek clinical care? We need a human interface to help out.

This interview was condensed and edited for clarity.