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A crash course in contact tracing: What it’s like to track Covid-19

Volunteers and paid contractors alike are investigating coronavirus by telephone.

A person in a face mask and telephone headset sits at a laptop computer.
In Brussels and around the world, contact tracers work to track Covid-19.
Laurie Dieffembacq/BELGA/AFP via Getty Images

For two hours every day, 27-year-old Claire McGlave calls up sick people. She asks them how they are feeling now and when they first began to feel unwell, which McGlave uses as a starting point to tabulate every single person they may have been in contact with since they started shedding Covid-19. The patient on the other end of the line offers up the phone numbers of their friends and family, and McGlave repeats the process for anyone who was potentially exposed to the virus. The message throughout is simple: Stay inside and help flatten the curve. This is called contact tracing, and it’s becoming one of the fastest-growing industries in America.

In Massachusetts, where McGlave lives, the governor’s office has hired 1,600 contact tracers to help connect the dots within the state’s 53,000 confirmed coronavirus cases. That number of tracers is on the low end compared to other state efforts. California intends to hire 10,000 tracers, and New York Gov. Andrew Cuomo wants to raise an “army” of people making these phone calls. The goal is to replicate the success seen in countries like South Korea, which famously curbed the spread of the coronavirus early with comprehensive testing and aggressive isolation measures for those who contracted the illness. The salary isn’t bad either: New Jersey intends to pay its contact tracers between $20 and $25 an hour. But while this legion of full-time contact tracers will saturate the workforce, a huge portion of the labor is still being conducted on a purely volunteer basis. McGlave is one of those volunteers. She earned her master’s degree from the Harvard School of Public Health last year and has been working the contact-tracing phone lines for her local government since March.

McGlave says she’s happy to volunteer her public health expertise because disadvantaged communities around the state simply aren’t getting the resources they need. The job has brought her much closer to the economic carnage of this pandemic. McGlave has been forced to tell people that they need to remain isolated for two weeks, even when they’re desperate to go back to work. These are the patients suffering the most, she says, those who could never afford to stay home.

McGlave knows that the United States is working from behind. As many as 20 percent of New York City residents might already have Covid-19 antibodies, hinting at widespread community infection that, at about 1.67 million people, supersedes the 1 million confirmed cases nationally. But McGlave thinks any contact tracing is better than nothing. If she can keep one person out of the hospital, it’ll all be worth it. Read our conversation below.

How did you start contact tracing?

I graduated in December with a master’s from the Harvard School of Public Health, and in the beginning of March, the governor convened a volunteer public health volunteer corps. He emailed all the current students and alumni saying we needed a big force of people if anyone was interested. And the students created this organization overnight. They recruited 2,000 people from institutions all over the state. They dispatched us. We basically got randomly assigned to towns and cities in need. We’re in groups of eight to 15 depending on the size. I answered the email because I’ve been working so hard to finish school, and this huge public health incident was happening right outside my door and there was nothing I could do about it. It seemed like a cool opportunity.

What are you doing for money right now?

I’m really lucky because I’m working at the School of Public Health. I started in February as a data scientist. The volunteer work is a pretty natural bridge. I work with data all day, but I really like talking to people. It’s nice to have that contrast.

What was the boot camp like to pick up your contact tracing skills?

This group trained 600 students in two weeks. We had confidentiality training, because you’re looking at people’s health records. We did an online crash course about why contact tracing is needed and why we do it. Each team has its own setup for coordinating volunteers. We could get anywhere from five to 30 cases a day. We have to figure out who’s gonna take each one, who needs a Spanish speaker. It took a bit to get the coordination logistics down.

When you get assigned a new case, what are your first steps to figure out who they’ve been in contact with?

It really varies day to day. I’ve had days where nobody answers the phone, and days where five people in a row will pick up. The general idea is we introduce ourselves, we say we’re from their local board of public health and that we know they’ve tested positive for coronavirus. We want to chat about how they’re feeling now, if they have any symptoms. At the beginning of the call, we do a bit of socializing. Some people love to talk, and other people are a little more private, which I totally understand.

We try to talk through the timeline of when they should be isolating at home versus quarantining at home. It’s pretty complicated. You want to isolate until three days after you have no symptoms or fever, and then you start your two weeks of quarantine. That takes a little bit of time to explain. Once we’ve established the plan, we ask them about who they’ve been in contact with two days before they started showing symptoms. As far as we know right now, that’s when people start shedding the virus. We ask if they were at work, if they were already at home, if they’ve been to the grocery store. And if they do list people, even in the same household, we reach out to them and do the same process.

These conversations are tricky. We don’t want anyone feeling like they did something wrong because they went to the grocery store. Because of our public health training, we’re aware of the social determinants of how they were in a position to be infected. Maybe they didn’t have access to child care and had to go into work. You have to be sensitive about those issues, and because we actually live in these communities, we know how to talk to them in an effective way.

When you’re tracking the people the sick person has been in contact with, how much of that work requires poring over public records or other data, and how much of it is purely anecdotal and based on the phone numbers the person is supplying you with?

The way we’ve been doing it has all been anecdotal. We ask people to just list the names. The vast majority of people have been pretty careful, because we’re doing this late in the process. This would’ve been different in February. People usually either say, “Yeah, I’ve been going to my grocery store job,” or, “I’ve been staying at home with my wife or whoever else I’m living with.” Some people have been hesitant to give out their contacts’ information, which I completely understand. But we’re careful to say that when we reach those people, we won’t reveal their identity.

What tone do you strike to put people at ease? I imagine you’re trying to be as disarming as possible. How do you approach those conversations?

We have scripts from leadership. They write out a phone call on how to optimally do it. They gave us some guidance on that. But it’s tricky. The conversation at the beginning is super important to get a sense of where someone is at. If someone is anxious, we can say that we’re giving them tools to help them and their community. But other people don’t seem to care at all and are just mad. We engage in a different way, “Let’s talk this through. I know this is frustrating, I know this is inconvenient. I hear you.” The resources we give out are from the state and have the state emblem on them. I think that helps people understand that this is serious. That’s where social and emotional intelligence comes in. Our first instinct is to email people, but a lot of people we’re talking to don’t have wifi at home. This disease has impacted our population based on where they started. The vast majority of people we’re talking to didn’t have the choice to not go into work.

Has there been anything about a job, where you’re talking over and over again to people who have or had coronavirus, that’s put some of your anxieties about this pandemic at ease?

It definitely has. At first it really scared me to hear people’s stories, especially how long people are waiting to go to a hospital because they’re scared, which I completely understand. The other side of that coin is that people who are staying at home and are isolating are pretty lonely. Sometimes having a conversation with them can be good. To help catalyze all of their worries into some evidence-based strategies to help their communities feels really good. But some of the conversations are hard because a lot of people really need to go back to work and want to know when they can. That’s heart-wrenching.

Are those conversations generally the same? Or do you feel like you’re meeting a new set of anxieties every time?

I’d say there are three archetypes they fall into. “I didn’t get this virus on purpose. I need to go back to work. I need to take care of my kids. It was really scary to get sick.” Almost every person I talk to wants another test. They say, “Oh, you say I can go back in 14 days on this date. I have to go get another test first, right? To make sure I don’t have it?” I have to say, “No, you have to just trust the timeline.” That’s when people get frustrated, and I have to explain that we’re short on tests.

How different are the conversations when you’re calling a contact who might not have gotten sick yet?

It depends. If someone is in the same household as someone who’s gotten sick, they understand the severity of it. They get the seriousness of the situation. People who haven’t gotten sick, they’ll ask if they really have to isolate. I understand that, I’d have the same reaction. So I just talk them through the science of flattening the curve. I also talked about how the contact tracing work really helps us understand when we can relax the physical distancing measures. People get really excited about that. The more we double down on this now, the shorter we’ll have to do this for. But that’s a big ask.

Are you willing to stay on the phone with someone for a long time?

I’ve had conversations that are 90 seconds, and I’ve had a conversation that’s lasted a half hour. That was with a mother with three kids and no opportunities for child care, and no money coming in, and doesn’t have direct deposit so she hasn’t gotten her stimulus check yet. That’s the beauty of having all these volunteers, we have time. We’re only assigned a few cases a day, so I can go on her town’s website with her and look at the food pantry and help her get some diapers. That’s really worth it. It’s pretty shocking, coming from the luxury of working from home and having a full-time job. I feel really lucky leveraging what we learned in school to direct action.

We’ve seen a lot in the news right now about the sheer magnitude of how many people in America have had coronavirus. When you consider how vigilant a country like South Korea was with their contact tracing program and how we’re just now starting to stock up with people like you, are we late to this response?

My mom is also in public health, and when I told her I was going to start contact tracing, she was like, “Oh, a little late, huh? What’s the point?” But I think it’s better than doing nothing, and since we’re so short on tests and on protective equipment, if we can do anything to keep one person out of a hospital bed, that’s more than enough for me. It’s definitely effective, but it would’ve been much more effective if we’d started earlier. We’re also working on distributing this model to other states. We have scripts in many different languages, we have protocols, and we’re going to try to share it so other states don’t have to reinvent the wheel.

You mentioned that you’re a data person in your studies. Has anything about this experience made you want to pivot your career aspirations to something that involves more person-to-person interaction?

It definitely has. It’s invigorated my motivation to work on policy. I really respect the people who are doing the micro person-to-person work. It’s incredibly draining. I’m only doing this for two hours a day. I don’t know how the people who are doing shifts are holding up. My original idea was that I’d do data stuff to make sure other people have the material to create policy. Now, this situation has made me both frustrated and excited to see opportunities where we can protect the most vulnerable people in our population. That could be really exciting.

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