After having first-class treatment for his Covid-19 diagnosis — a chartered helicopter ride to the hospital, cutting-edge therapeutics administered in a six-room presidential suite complete with crystal chandelier — Trump’s first statement to the American public was not that he was humbled by the virus that his administration had downplayed for months, it was this: “Feeling really good! Don’t be afraid of Covid. Don’t let it dominate your life.”
“Feeling really good”? “Don’t be afraid of Covid”? “Don’t let it dominate your life”?
In my hundreds of hours training and acting as a volunteer contact tracer for the San Francisco Department of Public Health, it is unimaginable to me that the president of the United States would promote this message about this insidious virus.
The CDC reports more than 200,000 Covid-19 deaths and well north of 7 million cases and counting in the US. Each of these individuals had a life, loved ones, goals, and dreams for the future. I know this because I speak with them for hours at a time, every week. Families across the nation are being pushed to their mental and physical limits by the weight of this pandemic. Whether it is the everyday stressor of risking infection each time you leave the home, or the financial stressors brought on by the recession, or the deep pain of losing a loved one and not being able to hold their hand in their final moments, our country is in a state of collective trauma due to this virus — and government apathy toward our pain and suffering only deepens the wound.
Since the beginning of the pandemic, I have served as a contact tracer for my local Department of Public Health. Every shift, I am assigned a list of people to call who are close contacts of a Covid-19-positive case (whether they know it or not), or people who are Covid-19-positive themselves. The idea is to try to get people who have been exposed to isolate and, hopefully, contain the spread. When I’m getting ready to make calls, I sometimes find it disorienting to look at the list of names and imagine that the person on the other end of the line, perhaps for the first time in their life, might have to reckon with their own mortality.
There is a little dance we play as contact tracers. Due to HIPAA, we are not permitted at any time to share privileged health information, but contact tracing requires that individuals be notified of exposure to a confirmed case. It is almost like playing a reverse game of Clue, where you as the tracer know the time, the place, and the person, but you are never allowed to say it directly. Each call typically goes as follows: I notify the person that they have been identified as a close contact of someone who is Covid-19-positive, meaning that they have been exposed to the virus. I then conduct a brief interview to piece together the sequence of events, as well as a picture of how they are feeling at this time, and then I connect them with testing and other services, if possible and if needed. The shift ends with documentation, documentation, and more documentation.
All of this has provided me with an unusually up-close picture of what many Americans are living through right now. It was near the end of my shift about a month ago when I called Rose (names and identifying details have been changed throughout to protect people’s identities, and represent a composite of several people), a high school principal and mother of three. By the time I was able to reach her on the phone, her partner and one of her children had tested positive for Covid-19. She is well-connected in the Bay Area and has private health insurance. Yet she was unable to get herself or her other two children tested. The reason? Minors are not allowed in most, if not any, of the public testing sites in San Francisco, meaning that she couldn’t bring her children with her to be tested. Adding yet another layer of complication, her health insurance would only cover a testing site hundreds of miles away, impossible as she doesn’t have a car.
“So, if I can be completely honest with you, I’m basically between a rock and a hard place. I need to be tested and I need to have my children tested, but what am I supposed to do — get an Uber and possibly get the driver sick?” she asked me. “I can’t just leave for three days out of the blue like this. Can you help me, please?”
I felt that sinking feeling knowing how I was mostly powerless to help her. I felt for this woman and for the many women like her I’ve talked to in this pandemic whose duties to work and family have only multiplied. “I will do everything I can, Rose, I promise you. I’m so sorry to hear that you are going through this,” I said.
After I had counseled Rose to start isolating from her infected family members and reminded her that she was now under quarantine, I called our 1-800 number for tests. Even with the internal extension codes reserved for tracers, it took me two and a half hours, three transfers, and minutes of pleading to obtain her the single spot reserved for adults and minors in the city of San Francisco. There was no confirmation email or code for her slot, so she would have to take my word for it.
If this is the barrier to testing for someone with relative privilege and the learned ability to navigate systems, how can we expect testing to be anywhere close to universal for everyone, including the uninsured and those who are marginalized by the health care system? Answer: It isn’t, and that may be purposeful.
During a recent tracing call, I tried repeatedly to contact a confirmed case to no avail. Finally, on the fourth ring, the phone was picked up by his son, Junior. Junior explained that his father didn’t speak English and passed over the phone to prove it. Although we do have a translation line for times like these, there is often a delay in response, and many languages are not listed. Given it was the final moments of my shift, and I had only limited time to notify his father that he had been exposed to the virus, I was placed in the difficult position that comes with multilingualism. At that moment, I had to make a quick decision about whether or not I could, or should, share the news with Junior to pass on to his father. This is a heavy burden to place on a child, and even more so given the language barrier. As a tracer, I have to do what is best to protect both the patient and the public, which requires me to make these difficult decisions on a near-weekly basis.
Experiences such as these reaffirm the need for a health response that is inclusive of all, including those who are multilingual or non-English speaking. According to the US Census Bureau, more than 40 percent of Californians speak a language other than English in the home; language barriers are not uncommon, yet they are often not accommodated for by institutions. Public health campaigns may not always include a person’s language, and even in the best of circumstances where we are able to include a translator during contact tracing calls, so much vital information gets lost in translation.
This disease is also disproportionately deadly for Black and Latinx patients; in my experience, this is due to a mixture of social determinants of health, preexisting conditions caused in part by the chronic stress of racism in America, and medical racism in the health care system. Our health care and governmental institutions need to do better to address the medical and social needs of every patient, including and centered on those who have been underserved by the health care system.
Even in the minute percentage of times where the initial stages of contact tracing go exactly according to plan, there is still the issue of treatment. Enter Kara, a landscape architect. Young and otherwise healthy, Kara was able to have a Covid-19 test done at a walk-in testing site immediately that revealed she was Covid-19-positive. She was on her fifth day of isolation when I reached her on the phone. Kara told me that, although she wasn’t experiencing symptoms, she was nervous because she had heard the worst symptoms usually come on day eight. Kara is usually paid in cash and is uninsured. If she starts having symptoms, there are no options for her that don’t end in perpetual medical debt and/or financial ruin.
I found myself running a list in my mind of the things I could do for Kara. Each of the possible branches of my decision tree led to possible calamity, whether it was a mountain of future medical bills or an endless stream of applications for the chance to obtain a watered-down form of low-cost health care. There isn’t enough time for Kara — not enough time to look for other options, not enough time to travel from one free clinic to the next, and not enough time to wait for free public health care. She, and millions of Americans, need help now.
The president and his inner circle don’t have to argue, beg, or cajole for a test. They have the ability and the immense privilege to have access to immediate, on-site, daily tests that provide them with a barometer for their own health. Although the Covid-19 test is only a temporary indicator of one’s health status, it allows for decisions to be made that have ripple effects on the rest of the population: whether to isolate, quarantine, or be treated. The President and his inner circle also have the privileges of guaranteed income, access to the highest level of care at state-of-the-art medical facilities, and essentially unlimited remote teleworking — benefits that most of the people I talk to could only dream of.
Unlike Donald Trump’s glib advice to Americans, for so many of the people that I talk to on a weekly basis, this virus is already dominating their lives. I’ve listened as people describe how they’ve lost their once stable jobs due to Covid-19, and how they aren’t certain how they’ll pay for the next week of groceries. How families of eight living in a two-bedroom apartment have had to navigate isolation when a mother tests positive. How that same mother can’t feed her crying infant when she knows she is positive, as there are still questions around whether the virus can be transmitted from mother to child through breast milk. How so many people can describe the event where they believe they may have been exposed — that one busy morning shift at the grocery store where they work, the time they had to take public transit because they had no other option, the first time they emerged from their home after four months of solitude and had a picnic with friends — and the regrets they have. I listen to the fear that is in their hearts.
The fact of the matter is, many of us are afraid of this virus, and rightfully so. It is easy for politicians to sit in gilded towers and spout platitudes about how Covid-19 isn’t that bad and to not be afraid, but I and the thousands of contact tracers and health care workers nationwide know the truth: This virus is deadly. This virus is pervasive. This virus has long-lasting effects beyond what we even know today. Covid-19 is disrupting the lives of everyday Americans, and will continue to do so until there is an effective government response.
Jahnavi Curlin is a dual medical student and Master of Public Health candidate at the University of California San Francisco. During the Covid-19 pandemic, Jahnavi has served with the San Francisco Department of Public Health as a volunteer contact tracer. Find her on Twitter @jahnavi_curlin.
This essay does not reflect the views of the University of California or the San Francisco Department of Public Health but rather are the own personal views of the author.