More Than Just Names And Numbers: The Role Of Contact Tracing In A Modern Pandemic
Contact tracing is one of the easiest ways to learn about a disease. We can learn how the disease spreads, how infectious it is, and how symptoms manifest. With proper isolation, it's also one of the easiest ways to fight an outbreak.
Boulder County experienced a spike in COVID-19 cases in the last two weeks of June, reaching a county record of 45 cases per day on June 17.
Before the spike, Boulder County had three contact tracers. They now have 25. Larimer County also started with three. They now have 12 and are hiring eight more. Weld County has three and is not planning on hiring more unless daily case numbers increase.
Chana Goussetis is the communications officer at Boulder County Public Health. ("The Hill" is a neighborhood in Boulder.)
"It really does link up, actually our disease investigators were telling me yesterday that now that they've done so much contact tracing about these parties on The Hill they're starting to bump into people that they've already talked to," Goussetis said, "because we're figuring out who's connected in the web."
Modern day contact tracing dates back to the late-1800s during a smallpox outbreak in England. Smallpox is a fast-spreading, airborne virus. A vaccine existed, but a strong anti-vaccination sentiment spurred the need for different methods — like contact tracing. Anyone who developed symptoms or was exposed, was to notify the town's medical officer and quarantine in a "fever hospital" built specifically for the disease. With prompt identification and strict isolation, towns were able to keep smallpox outbreaks at bay using only contact tracing.
But what does contact tracing in the 21st century look like?
The calls are private and protected under the Health Insurance Portability and Accountability Act, or HIPAA. Information is not released to anyone outside of the health department. Contact tracers cannot track you using your phone or enforce any of their recommendations. Contact tracers are first trained by the state health department and then by the county health department. County health departments do not use volunteers because of the skill required in this delicate process.
Because of these protections, I could not sit in on a real call. Instead, I participated in two mock calls with Boulder County contact tracer Kelly MacLaurin. We pretended that Goussetis recently came down with symptoms (the first call), and I was her housemate, so I had been exposed (the second call).
MacLaurin: Bring bring bring. Goussetis: Hello. MacLaurin: Hi, my name is Kelly MacLaurin. I'm calling from Boulder County Public Health. We have here that you were recently tested for COVID-19 and that your result came back positive.
The call started out generally. MacLaurin made sure she was speaking with the correct person and then described what we know about the disease. She gathered basic demographic data and then some behavioral questions, like if Goussetis smokes or vapes. Goussetis felt a little uncomfortable answering these questions.
Goussetis: Can you say more about why you asked those behavioral questions? MacLaurin: Yeah, sure. So, the reason we ask them is because we're trying to figure out how COVID spreads.
If certain behaviors are related to the spread of the disease, the health department can learn from this and advise the public accordingly.
The questions transitioned to asking about symptoms. While contact tracers are not healthcare providers — and they're quick to remind you of this — they gather data on what people with coronavirus are experiencing.
Next, it was time for dates:
MacLaurin: Okay, so now we're going to look at our calendars and we're going to pick the date that you started having symptoms. And we're going to think about how you may have gotten COVID, who may have given it to you, and we're going to go two weeks from that date.
And they wrap up the dates part with one final question:
MacLaurin: Do you have any idea how you might have gotten COVID? Goussetis: Yes, because I forgot one thing. Last week, I went to the dentist. MacLaurin: Mm, okay.
MacLaurin says that gathering names and numbers can be the most time-consuming part of the call. For someone who's been diligently isolating, it may only take 10-15 minutes. But, "if you are a social butterfly, it could be rather long," MacLaurin explained.
MacLaurin: Do you have a separate bedroom and bathroom you could potentially use to further isolate yourself?
Contact tracers don't just collect information, they work to help you figure out how to isolate effectively. Your cooperation and participation are paramount.
MacLaurin: One tip you could use for the kitchen is having your own plate, blow, and utensils. And not sharing food with anyone. Goussetis: Okay.
Then, we began the second mock call. This time MacLaurin was calling me to tell me I had been exposed to someone who tested positive. The contact tracer is not allowed to tell me who gave her my information; that is private. Luckily, Chana Goussetis, "my housemate," told me she had tested positive.
MacLaurin asked me how I was feeling, and we talked about the people in the house. Then I learned of my fate for the next three weeks.
MacLaurin: You would quarantine yourselves for 14 days and that timeframe would start after Chana's last isolation timeframe.
This meant that the four people in our house would be quarantined, unable to go to work, the grocery store, anywhere out of the house for 14 days after Goussetis recovered over the next ten days.
My housemate is an arborist and can't work from home. He would be out of work for three weeks.
MacLaurin: If there are any resources we can give him while he's out of work or if there's anybody we can talk to, we can provide work letters for his employer. We can speak to his employer on what a quarantine period is.
My next thought was, "Is this the time for me to intentionally expose myself so that I can get COVID and get it over with?" I shared this with MacLaurin.
"What I would caution with that is that we don't know much about this virus. So, we don't know how it's going to affect people individually," MacLaurin said. "Something that may be asymptomatic or mild in one person may be a superinfection in someone else where their body takes over and they end up on a ventilator. I know that nobody wants that for their friends and family."
Okay, on to a better plan. If there was a way that Goussetis could really isolate from the entire house, we could begin our 14 days of quarantine today. MacLaurin was there to help us figure out how to do that.
MacLaurin: Maybe we can set up a meeting with your roommates and with me and we can talk about everyone's situation at once. That could be an ideal situation. I could get a layout of the house and just determine what's possible.
In Boulder County, once a contact tracer is assigned to a COVID-19 positive case, they stick with that case and all of the contacts associated. They work with you to be available for any questions you may have, and even give out their personal cell phone numbers when it makes sense to do so.
"If I trust you enough to give you my personal cell phone and you trust me enough to give me all your contacts, I think we've developed a good system there," said MacLaurin.