Health detectives track down the threats
Contact tracers are key to preventing new surge of COVID-19 infections
Health investigator Mackenzie Bray smiles and chuckles as she chats by phone with a retired Utah man who just tested positive for the coronavirus.
She’s trying to keep the mood light because she needs to find out where he’s been and who he’s been around for the past seven days. She gently peppers him with questions, including where he and his wife stopped to buy flowers on a visit to a cemetery. She encourages him to go through his bank statement to see if it reminds him of any store visits he made.
Midway through the conversation, a possible break: His wife lets slip that they had family over for Mother’s Day, including a grandchild who couldn’t stop slobbering.
“Was there, like, a shared food platter or something like that?” Bray asks. “There was, OK, yep … sharing food or sharing drinks, even just being on the same table, it can spread that way.” Suddenly, with a shared punch bowl, the web has widened, and Bray has dozens more people to track down. She is among an army of health professionals around the world filling one of the most important roles in the effort to guard against a resurgence of the coronavirus. The practice of so-called contact tracing requires a hybrid job of interrogator, therapist and nurse as they try to coax nervous people to be honest.
The goal: To create a road map of everywhere infected people have been and who they’ve been around.
While other countries have devised national approaches, a patchwork of efforts has emerged in the U.S. where states are left to create their own program.
Bray normally does this type of work to track contacts for people with sexually transmitted diseases. She is now one of 130 people at the Salt Lake
County health department assigned to track coronavirus cases in the Salt Lake City area.
The investigators, many of them nurses, each juggle 30 to 40 cases and try to reach everyone the original person was within two metres of for10 minutes or more. They stay in touch with some people throughout the 14-day incubation period, and calls can take 30 minutes or more as they meticulously go through a list of questions. Some estimate as many as 300,000 contact tracers would be needed in the U.S. to adequately curtail the spread. While some states like Utah say they have enough contact tracers, others are hundreds or even thousands of people short.
The contact tracers often find themselves in a tangled web of half-truths and facts that don’t match up. Language and cultural barriers arise that require interpreters and taxing conversations that leave the investigators wondering if the person understands what they’re trying to do.
They land on occasion into complicated family dynamics, where people are reluctant to tell the truth.
Investigator Maria DiCaro found out days into a case that a father was sleeping in his car because he and his wife were separating. The man had stopped returning DiCaro’s calls, and that key information came from his child.
“I get people that lie all time,” DiCaro said. “I try to get as much information from the beginning, but it’s just not always the case. And time is one of those things you can’t take back when you are trying to prevent and, you know, do these contact tracing investigations.”
Each call is an exercise in good cop, bad cop. She needs people to co-operate, but no one is legally required to answer the questions. Usually kindness works better than strong words. Some people lie because they’re scared, or they forget an outing. Construction workers, housekeepers and others without paid sick time may gloss over symptoms so they can get back to work. Some immigrants without documentation brush off testing because they fear it could lead to deportation.
“People sometimes think contact tracing is black and white but there is a lot of grey that goes into it,” said Bray, who often thinks about her parents and 97-year-old grandmother as she works to help stop the spread of the virus.
“Our worst fear is that we push too hard and we lose someone. It’s not just their health on the line, it’s the people around them.”
No matter the tension, Bray and DiCaro give frequent reminders of why it all matters: “Thank you for what you’re doing. You’re helping the community,” DiCaro says during one call.