The phone rings. It’s a number you don’t know, but you answer it. The person says you may have the coronavirus because someone you were around tested positive.
And then your mind goes blank for a minute while you process the news. What you are not likely to think at that moment is, who is this county employee who called me?
That was a detective of disease, following the telltale trail of an invisible elusive and deadly adversary. That was a person doing the hard, detail-oriented work to stop one case from spreading rapidly through a community.
Utah’s estimated 1,200 coronavirus gumshoes are responsible for unraveling the path of the virus from person to person with the goal of stopping it in its tracks.
“Testing and contact tracing,” Dr. Angela Dunn, the state epidemiologist, said recently, “are crucial to any public health response, and especially to a pandemic response.”
It can be a labor-intensive effort, but with no reliable treatment or vaccines for COVID-19, testing, tracing and isolation is really the only strategy available.
Once a patient tests positive for COVID-19, the contact tracers go into action, trying to help the patient reconstruct their last 48 hours — the window of time when a person was most likely to be infecting others before symptoms set in to prompt the test.
Did you go to work? Did you go to the grocery store? How much time did you spend with friends or family? Did you get coffee or go to the park?
The investigator gathers the names and contact information of those who have had close contact — within 6 feet for 10 minutes or more — and co-investigators contact each person on the list, notifying them of the possible exposure.
The potentially exposed individuals are encouraged to distance themselves from others and get tested, even if they haven’t developed symptoms, to determine if they have been infected and to keep them from infecting others.
The state then conducts “active monitoring” of those contacts, following up with them every day either by text or phone to ask if the individual has a fever or other symptoms. If they do develop symptoms, investigators don’t wait for lab results. They assume the individual is positive and that starts the process again, documenting the new patient’s interactions and contacting a new group of individuals.
“It starts a cascade of a new investigation,” said Tara Scribellito, a nursing supervisor with the Salt Lake County Department of Health.
“Each one of these cases are so individualized,” she said. “We can get one case where a husband and a wife and that’s the family, they haven’t had exposure to anybody else and then you can get a family that has 15 people living in a household so all of those people are exposed and you can get multiple people who end up ill from that.”
Here’s an example, one Scribellito said she has seen several times, of what the trackers can uncover: Say “Ted” works in an office cubicle surrounded by other cubicles and attends multiple staff meetings.
He has no known contact with a confirmed COVID-19 case but notices a couple co-workers with a little cough and sniffle. A few days later, he develops symptoms, tests positive and isolates at home.
The tracers then come in and identify his close contacts and isolate the exposed individuals, starting the follow-up monitoring.
They find that the person in a staff meeting who sat next to Ted got mild symptoms and tests positive, giving investigators a new branch of the tree to trace back. It can happen again and again until they are able to follow the source as far as they can.
Typically Salt Lake County’s infectious disease program operates with 10 nurses, two supervisors and a bureau manager. Right now, Scribellito said, there are more than 130 staff members who have been brought in from other divisions and trained to assist in the contact tracing efforts.
Statewide, local health districts have 900 contact tracers. The state health department has provided 50 more, and 200 additional state workers have been reassigned from other agencies. Fifty more have been provided from various health systems, bringing the total to 1,200 people on the coronavirus trail.
In order to reach hard-hit minority communities — the state’s Latino population, for example, has nearly five times the rate of cases as white residents — the county has investigators who speak Spanish, Thai, Laotian and Chinese. Translators also can be brought in from refugee organizations or through a phone service to help with the outreach.
Last month the state signed a $2.75 million contract with software development company, Twenty Holdings, which converted a location-based social networking app to a tool intended to help contact tracers.
The Healthy Together app records the user’s location and, if they test positive, would allow contact tracers to get a more complete picture of where they might have come into contact with the virus.
So far Scribellito said she hasn’t encountered any cases where someone who tested positive had been using the program.
In the coming weeks the investigators will start going back even further, Scribellito said, trying to identify contacts for a full seven days prior to symptoms instead of 48 hours. This gives officials a chance to nail down where the patient might have come into contact with the virus.
Oftentimes that is already known, say because a family member or co-worker tested positive. About 85% of transmission comes either from a member of the infected person’s household or from a social interaction.
In those instances, tracking the origin back can give officials a more complete picture of how the disease has spread and areas that might need special attention.
“It helps us piece things together,” said Ilene Risk, the manager of the Salt Lake County bureau of epidemiology. “We can identify an outbreak or cluster we weren’t even aware of.”
Dr. Sankar Swaminathan, director of the infectious disease division at the University of Utah, credits the contact tracing efforts for much of Utah’s success so far in combating the virus.
“We’ve been relatively fortunate in not having had a lot of cases and having had few deaths. I think part of that is … contact tracing and isolation,” he said. “The public health department has been doing a great job identifying cases and testing and then isolating and testing contacts.”
Now, as we move toward easing social and economic restrictions, the work these detectives do tracking down the origins of infections, identifying problem spots early and stopping the spread will be more critical than ever.
If you get one of those calls, thank them for the work they are doing for all of us.