The United States is building a contact-tracer army


Since late April, Jana De Brauwere has added a new routine to her homework schedule. For four hours a day, four days a week, she calls strangers, asks if they have symptoms of the new coronavirus, and suggests next steps if they are.

De Brauwere, 44, director of the library at the main branch of the San Francisco library, was retired in mid-March when the city issued its residence orders. About a month later, the city called on her and other office workers to help her find her contacts.

De Brauwere is now one of the thousands of contact tracers that states are recruiting as part of the re-emergence of home stay orders. Experts say a robust and comprehensive “disease finder” system is necessary to get as close as possible to all COVID-19 cases and to contact those who may have been exposed as cities and states try to reduce the spread of the disease.

These efforts to “test, trace and isolate” also require a simultaneous intensification of tests to identify those infected. Up to 180,000 contact tracers will be needed until an effective vaccine reaches the market, Andy Slavitt, former acting administrator of the Centers of Medicare and Medicaid Services, and a group of doctors told members of Congress last month.

So far, about 66,000 contact tracers have been hired, according to the data NPR collected.

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De Brauwere’s phone number is protected when making home calls as a contact tracer.

States and cities are largely left to their own devices to rally these armies of contact tracers. And the number a region needs depends on the average workload expected, said George Rutherford, head of disease and global epidemiology at the University of California, San Francisco, who advises the California Department of Public Health. on contact tracing.

If it takes about an hour on the phone with each new person who tests positive and each appoints four contacts on average, that’s five hours of follow-up per case. The United States has been adding about 20,000 new cases per day for weeks now, to give an idea of ​​what it looks like nationally.

Public health researchers have urged states to speed up contact tracing as quickly as possible before communities return to a new normal.

Anyone can do it if they are properly trained.

“If we can find almost all the cases and trace the contacts of each case, it will be possible, in time, to relax the most brutal of approaches: extreme measures of social distancing, such as orders for home support, and proportionate social and economic benefits, “said a report from the Johns Hopkins Bloomberg School of Public Health.

But even when states strengthen this capacity, contact tracers face limitations, including speed of testing, poor memory, and mistrust of phone calls from strangers.

An old method for a new disease

Contact tracing is a public health technique developed in the 1930s to largely control sexually transmitted infections. After a diagnosis, health workers record patient information in a centralized database to contact tracers to find out who to contact. provide medical advice and services. For the coronavirus, the methodology is largely the same.

In early April, officials in San Francisco appealed to medical and nursing students to volunteer. They also sent an email to city employees asking them to take on a new role if needed, as all are designated as disaster service workers.

“I remembered it was in my contract,” said De Brauwere, who has worked at the library for eight years. “And I specifically remember thinking,” I wonder what that means? “”

Like many Californians, his first thought was an earthquake. But De Brauwere said she was grateful that the city had asked for volunteers to do the contact tracing work. “Our goal as a library is to connect people to information, and that’s what we basically do with contact tracing. The stakes are just higher. ”

The city considers contact tracing work to be a higher priority than its library work, which means that De Brauwere’s post can be extended as long as there is a need.

Christie Hemm Klok for HuffPost

De Brauwere while she works at home.

Volunteer requests have “poured in,” said Rutherford. The city now has 150 contact tracers and has started partnering with the University of California at Los Angeles to train up to 3,000 civilian workers like De Brauwere per week in early July to work across the state. According to Rutherford, civilian workers are paid the same way as their previous job, and medical and nursing students are paid by receiving course credits.

Massachusetts launched its contact tracing program in late March with public health students after Governor Charlie Baker (R) called for volunteers. Over 1,000 students have registered.

In April, the state has turned tothe global non-profit health organization, Partners in Health (PIH), to help recruit and select candidates for the right skills and interests.

Our goal as a library is to connect people to information, and that’s what we basically do with contact tracing. The stakes are just higher.

“We wanted empathetic and knowledgeable people,” said Joia Mukherjee, who runs the PIH contact tracing program. The group hired doctors, guards and musicians – “anyone who can bond with people and who is not too afraid to make phone calls.”

Plotters hired for PIH are paid $ 27 an hour, according to Mukherjee. To date, it has hired 1,700 contact tracers and plans to hire more, depending on the workload.

San Francisco interns receive 20 hours of virtual instruction and can listen to calls from experienced plotters. They also practice making such calls with advice.

After someone tests positive for the coronavirus, a health official registers the case in a central database. Contact tracers use the database as a starting point to determine who these people may have been in contact with. De Brauwere, other plotters in the San Francisco area use a desktop app called RingCentral that protects their phone numbers when they make calls from their homes.

The tracers ask a set of questions intended to refresh the memory of those who have shown themselves to be positive. Could they have been in touch with someone from outside the house? Did they shop for groceries? Will they still work or take public transportation? Could someone visit them from outside the city? Have they stopped for gas?

Determining who can be called a “contact” can be one of the most difficult questions. In Washington State, a contact is considered to be anyone who has been within 6 feet for 10 minutes or more. In Massachusetts, a contact is a person within 6 feet for 15 minutes or more. And many parts of the country still face long testing times – which means tracers ask people to remember who they were in contact with five to seven days ago.

The tracers then call anyone who was in close contact with this person to check their health and recommend tests and self-quarantine. For confidentiality reasons, they do not disclose the name of the person positive for COVID.

“You can’t force anyone to say anything”

Jessica Schiff began volunteering as a contact tracer as she completed her semester at T.H at Harvard University. Chan School of Public Health, on work weekends and during breaks between classes. The 25-year-old had previously studied exposure to methane and other public health issues.

One of the challenges she encountered was getting people to speak. Some people who were exposed hung up on her, or didn’t trust her when she mentioned that she was working with the state.

“People have different degrees of what they would share or not,” said Schiff. “Beyond believing that we are contact tracers, they may not be comfortable sharing information. ”

These two elements combined can make it difficult for contact tracers to communicate with those who may have been exposed.

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Jessica Schiff, a graduate T.H. student at Harvard Chan School of Public Health, volunteered to help Massachusetts reconnect during free time between classes and studies.

“You cannot force anyone to say anything,” she said. For contacts who have not picked up the phone after three attempts, Schiff would write it down next to their name, and someone from the public health department would take care of the case.

When De Brauwere calls a possible contact, she must verify her address and demographic information with her file. “It is confidential, so I understand why they would hesitate to share this information,” she said.

In the end, there is little that tracers of contacts can do if those they call don’t want to divulge information.

Schiff believes that the biggest challenge other states can face when building a contact tracer team is the seriousness with which people will take them.

“If people understood that the” contact tracers “were real and collaborated with the public health services, where the information is confidential and private, I think they would be more willing to share relevant information.” She said she was also concerned that it would be difficult for people to trust contact tracers without previous health or public health experience.

All of this will become more evident in the coming weeks as states attempt to staff these plotting stations. In Massachusetts, Partners in Health filled enough positions for their first batch of 1,700 hires and received over 37,000 applications in a month.

In New York, the health service is hiring for its initial target of 1,000 people. Maryland plans to hire at least 1,000 tracers. Washington State has turned to the National Guard and health care professionals, hiring approximately 1,500 tracers to date.

“Anyone can do it if they are properly trained,” said De Brauwere.

In many ways, finding contacts is not much different from working as a librarian: talking to foreigners and giving them advice. “It is listening to people with empathy, talking and helping them make things right by asking the right questions,” she said.

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