Wendy, now a contact tracer in New York State, shares her experiences thus far.
I am a contact tracer. It's a job that's been around since before the days of Typhoid Mary, but it's brand new to the common lexicon. So how does it work?
I applied for the position last May when Governor Cuomo announced that one metric for re-opening New York State was hiring 30 tracers per 100,000 residents. That's a lot of tracers, but historically, contact tracing has proven to be a critical factor in containing the spread of disease. And it's a labor intensive job. NYS has hired the requisite number of tracers, but very alarmingly, some states are seeing a shortage of applicants, and in others, the number of new cases has grown so fast that contact tracing can't contain the spread of the disease.
After submitting my application, which included a resume and a brief essay on why I was applying for the position, I had a remote interview in which I was asked about my work and volunteer experience; we also discussed my ability to relate to and empathize with diverse members of our community. I then moved on to the next step which was completion of the six hour Johns Hopkins COVID-19 Contact Tracing course. While I'd been reading voraciously about the virus and considered myself fairly well informed for a lay person, I loved the course! It included information about transmission, incubation periods, symptoms, ethics, and isolating and quarantining (did you know that isolating and quarantining are not one and the same?). It also included segments on apps for tracking the virus -- not being used in NYS at this time -- as well as many videos modeling calls to cases and contacts (which are also two different things). And all importantly, it included a section on privacy and confidentiality, a topic that has returned repeatedly over these past interesting months.
Once I was certified in the course, I was hired to join a team to help stem the spread of the virus. Our team consists of roughly 15 contact tracers and a community support specialist who all report to a supervisor; the supervisor ensures that we have seven day a week coverage, 12 hours per day, and troubleshoots issues that arise, anything from software glitches to addressing questions and issues which come up during our conversations with contacts. Contact tracers connect contacts with the community support specialist when they need help; the support specialist in turn works with local health departments. So far, what I've encountered in this area is families who are unable to get food during quarantine because they have neither access to delivery services nor nearby friends or relatives to shop for them. But community support specialists are trained to work with local health departments to connect contacts with a broad range of social services including mental health care, delivery of medication, housing, COVID testing, and more.
In addition to making calls, there's ongoing education. A lot of it. Confidentiality. Travel advisory policy. Essential workers. Using the software. More confidentiality. Call demos. Cultural awareness. Connecting to a translator. Depending upon content, the education is provided by members of the NYS Department of Health, often epidemiologists, but also those experienced in contact tracing for previous outbreaks (eg measles) or by experts in the software which guides the work flow.
So what's it like? It's a very rapidly changing environment. If you’re looking for a writ-in-stone playbook, this isn’t the job for you. As contact tracers report back on their experiences with calls and with the software, everything is fine-tuned. And then we repeat. More fine tuning, more new learning. It’s challenging to digest, but at the same time, I've found it fascinating to watch a new venture evolve and adapt and improve in real time, and the deep well of patience and supportiveness among everyone connected with this process has been an inspiration in a time that feels so divided in almost every other realm. Our group, which has never met in person, perhaps never will, has coalesced into a team that's rowing together pretty much in synchrony.
So about the calls. I've talked to people in cluster outbreaks, to returning travelers, to people who've been loose with their safety protocols, to people who were simply in the wrong place at the wrong time. I'd braced myself for anger, for contacts yelling at me, or refusing to speak with me. But so far, that hasn't happened. Of course, some people see me coming on their caller ID and choose not to answer the phone. But surprisingly to me, that isn't the norm. People have been unfailingly polite and many express deep gratitude for the work we're trying to do. We’re dealing with human beings, so by definition, each call has its own tone and rhythm. I find that the elderly often are talkative; perhaps this springs from loneliness, perhaps from a sort of wisdom that makes them want to connect. I feel as if I’ve walked midway into a novel as I learn about the richness of their lives. Sometimes people are in a hurry, and I do my best to finish our interview with military efficiency. Sometimes the contact isn't terribly concerned about the virus, but most of the time, I hear at least a little fear. This often comes out in a burst of questions before we end our call. Once, a contact and I found a reason to laugh together. And on one occasion, a contact's situation brought me to tears. On that one, I waited until we ended the call but then I gave myself a moment to weep before composing myself and dialing the next person on my list.
Way to go Wendy. This is important work.ReplyDelete
I’m SO proud of you Wendy!ReplyDelete
Your work is priceless and as always, I am pulled in by your writing! Keep at it, BFF
Interesting, informative. And moving. Thank you for doing this work.ReplyDelete
Thank you. I had no idea how intensive the training is. You're doing great things in service of New York and, in my view, in service to the American people.ReplyDelete
Interesting ... I'm left with a couple of questions.ReplyDelete
* what's the timeline? when someone takes the test, how long does it take in your area to get results? How long after that is there an attempt to contact the case and develop the list of contacts? How long from the list creation to start making calls to the contacts?
* I expect as contact tracers, you are encouraged to avoid the politics of the virus in the community. But do you get unsolicited indications of whether people react to the diagnosis or tracing as "acts of God" or natural calamity that couldn't be avoided, or "acts of humans" which ought to have been handled better (whatever they consider "better")?
I can't answer your first question definitively; my guess is that the speed of results is somewhat dependent upon where you get the test but again, I don't know and it's obviously an important question. I was tested myself about a month ago and I had the results within two hours, but that may not be the norm as I went to my private doctor, not a state testing site. As you seem to be getting at, time is of the essence with contact tracing. When someone tests positive, the testing site must report it to the county DOH immediately (similar to measles or rabies whereas some other diseases such as Lyme disease have more lenient reporting timelines). The local DOH attempts to contact the case that day to develop a plan for isolation and to identify contacts; theoretically, the contacts could also be contacted that day, but in my experience, the contacts I've called have appeared in the records the day after the case is reached. I haven't heard a lot of references to politics on the calls I've made except for an occasional expression of gratitude for the way Governor Cuomo has managed the situation here in NY. So far no mention of "acts of God" or "could have been handled better." What I've found interesting is that people are extremely well informed about symptoms, quarantining, and the like; while I know we're all steeped in this, some people are really trying to make ends meet and get through the day, but they're still quite knowledgeable.Delete
Excellent piece, Wendy. And even more excellent work!ReplyDelete