How 20,000 will train to be pandemic sleuths
In order for California to reopen its economy, Gov. Gavin Newsom has made it clear that active coronavirus cases need to be tracked aggressively.
To make that happen, thousands of newly trained civic workers, acting as pandemic detectives, will be required to follow the spread of the disease through widespread contact tracing and case investigation.
Last week, Newsom announced that he has tapped UCSF and UCLA to partner with the California Department of Public Health to dramatically scale up the state’s efforts with a new workforce training program that will recruit up to 20,000 individuals, including librarians, environmental health officers and city attorney staff not working their usual jobs at the moment.
The new UCSF Pandemic Workforce Training Academy opened May 6 with an $8.7 million state contract.
Based on a model UCSF developed with the San Francisco Department of Public Health, the program will work
“Contact tracing is working in other places. The science is showing that it works.”
Dr. Mike Reid, an assistant professor of medicine at UCSF who is leading the training effort
with the state’s 58 county health departments to identify and employ a multitude of civil servants and volunteers to interview people who are newly infected, investigate existing coronavirus cases and make contact with people who have been exposed to the virus.
“If we move beyond shelterinplace, we need this resource,” said Dr. Mike Reid, an assistant professor of medicine at UCSF who is leading the training effort along with colleagues at UCSF’s Institute for Global Health Sciences. “The scale gets big quickly.”
The new program builds on UCSF’s initiative to provide free statewide COVID19 testing analysis and results, which began in April. In three weeks leading up to the state contract announcement, the UCSF team trained 240 contact tracers. That number will now expand significantly.
“I am glad that my time is being put to good use, especially with the libraries closed,” said Jensa Woo, a librarian at the San Francisco Public Library’s Merced branch, who is now working as a contact tracer for the state.
Contact tracing is a longstanding tool of public health to battle infectious disease outbreaks. It helped stop outbreaks of measles, HIV and Ebola, but due to a shortage of testing supplies it was not effective in controlling the initial outbreak of the coronavirus in the state in February and March.
UCSF’s program involves training workers to interview people who are newly infected, investigate those cases, and make contact with people who have been exposed. The process is designed to protect the privacy of people who are infected and those who are at risk of becoming ill — names and dates of contact are not revealed along the chain.
People who are close contacts of the initial case and considered at high risk of becoming infected will be asked to quarantine themselves and be monitored over 14 days.
“Contact tracing is working in other places,” Reid said. “The science is showing that it works.”
The online academy is built around a 20hour program, broken up into 12 hours of synchronous learning and eight hours of individual sessions, which will train workers to communicate with the state’s diverse population.
A sample of the training program, supplied to The
Chronicle, reveals a variety of instructions for the remote workers, including trainees conducting practice calls with actors; listening in on real contact interviews by health care professionals; and finally conducting their own calls under supervision.
The primary duty of the new contact tracers will be to convey potentially upsetting, complex health information in a way that’s sensitive and clear.
“One of the first things we ask about is their preferred language, just to make that conversation more comfortable,” said Lucia Abascal, who trains contact tracers for UCSF.
The tracers collect information about individuals’ living situations, to assess if the patient is able to selfisolate. If the person is homeless or living in a crowded space, tracers will refer them to municipal public health departments that will help them find better accommodations.
“Overall, people have been receptive and grateful,” Woo said.
The trainees also receive instruction on ensuring that people who are being asked to quarantine are well supported with food and supplies.
“Asking people to quarantine at home is a big deal,” said Reid. “Part of that conversation is, ‘Are you able to quarantine at home? Are you able to get food? Can we support you to stay somewhere for two weeks?’ ”
The program follows up with automated texts to monitor if they develop symptoms.
“If they have symptoms, we want to connect them for testing very quickly,” said Dr. Susan Philip, deputy health officer for the San Francisco Department of Public Health. “This whole system is dependent on being able to test people who become symptomatic.”
As part of the initial rollout of the training program in San Francisco, UCSF trained a dozen city attorneys, 24 librarians, five assessors, nine retired clinicians and 11 medical students; in addition to 44 internal staff members.
“Testing is the backbone,” Newsom said. “But the tracing component requires a workforce, requires an element of coordination and collaboration. Building on the existing county supports and building capacity through this virtual academy will, I think, substantially help aid our efforts.”
UCSF will initially train 10,000 repurposed state workers. After the first phase is complete, Newsom will reexamine needs with the California Department of Public Health and local health departments to examine the need to train additional people. It will be up to the state and the counties to determine whether to hire more experienced people, students or volunteers.
The goal is to conduct contact tracing for every single case in the state.
“If we ever want to move beyond shelter in place, we have to have the capability that enables us to do that,” Reid said.
The United States will need at least 100,000 contact tracers to prevent future outbreaks once social distancing measures are lifted, according to the Johns Hopkins Center for Health Security, a nonprofit organization focused on research of infectious diseases.
Other public health experts say that number may need to be even higher.
“Done effectively, these strategies will help to break the chain of transmission and enable people to return to a more normal life,” said Dr. George Rutherford, an infectious disease expert at UCSF who will be the principal investigator on the state contract.