Verna Laboy received an urgent call late in the night recently from the tearful mother of a 2-year-old boy who’d spiked a fever and was previously considered a close contact of a positive COVID-19 case.
“I just told her what a grandma would tell a young mother — ‘Do you have popsicles? Do you have Pedialyte? Do you have fever-reducing medicine to help your son be comfortable? And then, call your pediatrician,’” said Laboy, who has been working as a contact tracer for the heath department for the past four months.
Fortunately, the boy never tested positive. “(His mother) thanked me over and over again because I took her calls after 10 o’clock at night to calm her and to hold her hand,” Laboy said.
Normally, Laboy leads an award-winning public health initiative, Live Well by Faith, addressing health disparities in the African-American community through their places of worship. But when the pandemic hit, all of the Health Department’s in-person programs were suspended.
So the Health Department decided to reassign her to help with contact tracing.
Contact tracers are responsible for reaching out to all of the close contacts of positive cases and making sure they’re aware of their status and their responsibility to stay in quarantine, said Todd Guess, a senior planner for the Columbia/Boone County Department of Public Health and Human Services, who’s in charge of the contact tracing team.
When people test positive, case investigators interview them to develop a list of their close contacts, including everyone they’ve been in contact with since the two days before their symptoms began, Guess said. Once the list is completed, it’s handed to the contact tracers who immediately begin reaching out to the person’s close contacts.
Case investigation and contact tracing have proved effective to prevent further transmission of the virus, according to the Centers for Disease Control and Prevention. The process works by separating people who test or may test positive from people who don’t.
Fifteen employees of the Health Department are primarily doing case investigation. Another 13 employees within the department, together with two city employees from other departments, are helping with the contact tracing, Guess said.
The Health Department has also recruited 10 unpaid volunteers from the community who have health care or public health backgrounds to work on contact tracing, Guess said.
Many of the city employees can only devote a limited amount of time to contact tracing because they have other responsibilities.
Volunteers are only required to commit to eight hours per week. “Everyone I’ve spoken with has been more than happy to help, but we can’t expect them to do this job in perpetuity,” Guess said. “And we don’t know how long this pandemic going to be with us.”
The CDC recommends 54 full-time contact tracers and case investigators for a county the size of Boone, Guess said. “And we’re just nowhere close to that right now.”
Recently, a proposal submitted to the Boone County Commission for Coronavirus Aid, Relief, and Economic Security Act (CARES) funds to hire full-time employees doing case investigation and contact tracing has been approved, Guess said.
People can apply for one of the positions at www.gocomojobs.com.
To inform and support
Jessica Gladden works in the environmental health division of the Health Department and is usually responsible for restaurant, lodging, child care and pool/spa inspection. These days, she’s putting in an average of four hours a day helping with contact tracing.
Contact tracers usually start the conversation by confirming the identity of the person because they want to protect the private information of a close contact, Gladden said.
Then they talk to the person about the purpose of the call.
“Usually, they don’t tune in until I say ‘COVID,’” Gladden said.
Some of the close contacts Gladden has notified were by no means expecting the call.
“At first, they think it might be a prank call,” she said. “It’s like, ‘No, I’m sorry. This is the city of Columbia Health Department. This is real. I’m not trying to scare you.’”
In many cases, close contacts are shocked or saddened. “So it’s a stressful situation,” Guess said.
Another challenge is confronting rampant misinformation.
“The problem is, they think they know more than you,” Laboy said. “You know, they were hearing, listening to different information from different sources. So they wouldn’t take our information seriously.”
Gladden said she once called a contact who called COVID a hoax. She tried to convince him, but the person just hung up on her. “So trying to get them to stay on the line long enough to collect any kind of personal information is a little tricky,” Gladden said.
On the other side, it’s also difficult and stressful for the contact tracers. After all, they have to tell people they can’t go to work anymore and have to quarantine themselves for 14 days. That’s a serious blow that makes some people very anxious because “that missed paycheck is a big deal for them,” Gladden said.
“You end up feeling really helpless a lot, and nobody likes that,” Gladden said.
Fortunately, contact tracers can refer them to social workers, she said. “They have a whole list of resources and a plethora of ways to help them.”
Even faced with challenges, the contact tracers are still working diligently to inform and support close contacts by accompanying them through the quarantine period.
At the end of the first conversation, contact tracers always ask the person if they want to be checked on every day by text, by phone call or via an automated email, Gladden said. “We can do multiple (ways) if they would like that as well.”
“I think the biggest thing is, nobody wants to go through it alone,” Gladden said.
Even when close contacts choose to receive an automated email, they can check a box to ask to speak to their contact tracer, Gladden said. Often, they’ll get a call within 30 minutes.
Such support does work.
Laboy said she once had a list of some children who had been exposed at a daycare, and one of the kids broke out in a rash on his face. His mother was terrified.
Laboy comforted the mother and gave her some guidance, she said. It turned out that the boy never tested positive for the virus.
When quarantine ended, the mother had kind words for Laboy. “She let me know that she never would have made it through that without me holding her hand,” she said.
A helpful tool
At the beginning of the pandemic, the Health Department did case investigation and contact tracing manually.
Contacts tracers were assigned in an Excel spreadsheet, which was “labor intensive and time-consuming,” Laboy said. “You really couldn’t do any other job. It was like COVID-19 just hijacked all of our work.”
Then in May, the Health Department joined the Research Electronic Data Capture (REDCap) consortium to track contacts through a web-based, automated system, which also made it possible for the department to recruit volunteers who are able to do the work without violating HIPAA.
REDCap was developed by Vanderbilt University in 2004 to help researchers collect data securely, according to its website. Now, it’s being used widely in public health to respond to COVID-19 in a way that ensures data security and privacy.
Guess said REDCap really makes everything easier.
‘A nice way to help’
Gladden said she started doing contact tracing because she saw an opportunity to take meaningful action.
“I don’t have any medical training or medical background. A lot of the first response to this (crisis) wasn’t something I could really assist in,” she said. “So I thought if I did this, I would be able to help people.”
Lori Henderson, a retired pediatric dentist, volunteered and joined the team two weeks ago.
She went through two online, self-paced training modules — one to learn the facts about COVID-19 and the pandemic, and the other to highlight the importance of HIPAA and patient privacy. One Zoom training was held where Guess, the director, walked them through REDCap and let them observe some real calls, she said.
Henderson said she devoted so much effort to the training and contact tracing because she wanted to help, and the work matched her skill set.
“My family has enjoyed being Columbians, and I just feel like I have the time and energy. And it’s a way to help a community that’s given a lot to me and my family.” she said.
Laboy thought of contact tracing as a great opportunity to continue to work with people and keep the community safe in a different way.
“For me, the contact tracers are unsung heroes because many of the tracers right now have been volunteering to help us,” she said. “They’ve come out of retirement to help us, and they’re not getting paid to do this work. They’re volunteering to help keep our community safe.”