Imagine receiving a call tomorrow from the Benton County Health Department and being informed that you have been exposed to someone who has tested positive for COVID-19.
The conversation that follows will likely bring to mind a number of disquieting questions. Such as, where did I come into contact with the virus? Who did I meet with the virus? What was I doing to prevent transmission when this exposure occurred? Who have I been in contact with since? Do I feel sick right now?
Now, imagine being on the other end of the line — cold-calling someone you’ve likely never met and posing some of these same questions as they come to terms with the implications of their answers. This is a routine endeavor for the team of contact tracers working at the Benton County Health Department Communicable Disease Program.
Over the last several months, their job has become an integral pillar of the ongoing response to the global public health emergency posed by COVID-19.
An Inside Look at Contract Tracing
In order to find out more about how the contact tracing program has been operating here in Corvallis, I spoke to Benton County Communicable Disease Nurse Mary Shaughnessy. With the help of Public Information Officer Lili’a Neville and Communications Coordinator Kelley Locey posing as interviewees, I was able to observe two mock contact tracing interviews conducted by Shaughnessy. Here’s what I learned from the exercise:
First off, these are by no means quick and easy exchanges. The interviews usually take 20-45 minutes — whether they are with someone who has tested positive for COVID-19 or with someone who has been identified as a “named contact” that has been exposed to the virus.
After making sure the contact has time and feels up to the task, Shaughnessy assures them that the answers to these questions are subject to medical privacy laws and will remain strictly confidential.
Carriers Remain Anonymous
As Benton County interim co-director Charlie Fautin emphasized, maintaining anonymity is an essential component of the contact tracing mission.
“They get the names and the numbers, but they don’t tell anyone who the contact was,” said Fautin. “This is important. We know from history that naming people turns to shame and drives illness underground. HIV is a perfect example of that. It’s important that people know that if someone is ill and they are sharing the identity of their contacts, they won’t be tied to that. We take that medical confidentiality very seriously.”
Once a sense of confidentiality is established, Shaughnessy moves to a series of questions that varies based the situation of the interviewee.
For someone who has tested positive for COVID-19, the first step is to establish a timeline of when their particular symptoms began, and whether or when they began to self-quarantine as a result.
This timeline aids in the attempt to figure out where the patient might have been exposed to the virus, which is currently believed to occur within 12-14 days before the presentation of symptoms. The timeline also helps in the effort to figure out who they might have exposed to the virus after becoming infected. Questions that surround this part of the investigation pertain to the interviewee’s living and work situations, travel history, and immediate circle of friends and family members.
This leads to the sometimes difficult portion of the conversation, where the interviewee is asked to provide the names and numbers of those they have had a concerning degree of contact with since becoming exposed.
When arriving at this point of the mock investigation, Shaughnessy reminds the interviewee that most people really want to know that they’ve been exposed to COVID-19. And that these folks should be thankful for the patient’s willingness to provide their names.
“You have to remember that having COVID-19 is not your fault. This is something people get from breathing the air basically. There could have been somebody at your workplace who gave it to you. And I’m sure you would have liked to have known that they were sick and could pass it on to you. Gathering and communicating this information is a way of trying to protect everybody in the community.”
Overcoming Shame and Blame
Shaughnessy stressed that contact tracing transverses a very stressful situation for a lot of people. There are misplaced senses of blame and shame that can emerge during these investigations that she hopes will soon fade as people learn more about COVID-19.
“When we talk to people, if we hear that people want to blame, we usually do step in and try to give them an explanation that nobody is to blame for COVID-19,” she said. “It just spreads through the population and seems pretty indiscriminate about who gets it.”
After obtaining the list of at-risk contacts, Shaughnessy goes over a number of questions and topics that deal with both the medical components of the recovery process and the logistical components of the quarantine process. She urges that the interviewee — if they do not require hospitalization — continue to self-quarantine for 72 hours after their symptoms have cleared.
Contacting Possibly Exposed
The agenda for conversations with named contacts who have been exposed to the virus is of course a bit different than the one outlined above. Unlike someone who has tested positive for COVID-19, named contacts are less likely to be aware of their current situation. And, if whoever exposed them wishes to remain anonymous, the named contact will not receive an answer to one of the first questions that comes to mind.
This can be a real one-two punch, as questions about whether they will soon be experiencing symptoms begin to emerge. As Shaughnessy reminds them, the main reason she’s calling is to make sure that they know what to do if they come down with any symptoms of COVID-19 and that they know how to best protect their family members, friends, and co-workers.
She asks that the named contact take their temperature and monitor for symptoms twice a day, and provide daily reports of these results for the next fourteen days. She then explains the importance of taking scrupulous precautionary measures because they could be an asymptomatic carrier that can transmit the virus to other people.
Because of the potential for rapid and asymptomatic transmission of COVID-19, the work of contact tracing and case identification that the Benton County CD program is performing will be critical in the coming months as social distancing measures across the state begin to ease.
It is worth understanding the value and nuances of the contact tracing system because, as Fautin puts it, “This is the first time a lot of folks have heard about this methodology. This is unfamiliar to people. We’re living history.”
As a recent Johns Hopkins report notes, the U.S. must implement a robust and comprehensive system to identify all COVID-19 cases and trace all close contacts of each identified case, “in order to live, reduce COVID-19’s burden on our healthcare system, ease strict social distancing measures, and confidently make progress toward returning to work and school.”
By JD Brookbank