Wednesday, July 24, 2024

Massachusetts’ coronavirus contact tracing initiative drew national media attention, including from the CBS Evening News during an April broadcast.

The Covid-19 pandemic has thrust all us into unexpected circumstances that are stretching our capacity for resilience, empathy and grit. For many, the crisis has meant becoming their children’s school teacher or day care provider while juggling a work-from-home “routine.” For others, it has meant sudden unemployment or a desperate scramble to save a small business by offering new products and hybrid service models. And, of course, for health care workers, first responders, bus drivers and those performing other essential jobs, the unchecked spread of this “novel” and lethal coronavirus has exponentially raised the stakes of going to work.

For me, the pandemic presented a unique opportunity to enlist in the ranks of the “army” of contact tracers that Partners in Health and the Commonwealth of Massachusetts began assembling in early April. As the virus started its deadly surge here, I started working as one of the more than 1,200 tracers hired by Partners in Health under its $44 million state contract. With no background in public health, I hadn’t heard of “contact tracing” until suddenly the term became part of the lexicon along with terms such as “social distance” and the “R naught factor.” Call it kismet or luck, I fell into the role and in the process gained a front-row seat on the Covid crisis and a way to feel I was helping those affected.

As the virus gained momentum this spring and the economy shut down, I found myself in limbo, between jobs and with an empty nest. Having recently closed the city councillor chapter of my career, I had been poised to begin a job only to see it placed on indefinite hold. Glumly following the news of massive layoffs and the mounting rate of infection, I was scrolling idly through my Twitter feed late one night during the first week of April when a link caught my eye: “Apply to be a contact tracer.” Curious, I clicked. Less than five minutes later I’d applied by submitting my résumé and contact information. No cover letter was required.

A couple of days later I got an email inviting me to video-record my answers to eight behavioral-style interview questions. Within five days I’d been emailed a job offer and began training online along with a cohort of about 200 other recruits. The process was so quick and impersonal that I was surprised to learn later that the odds of being hired to join the Community Tracing Collaborative were longer than being accepted to Harvard.

I now have an inkling of what it’s like to work in a call center and an appreciation for the challenges of teaching and learning in an entirely virtual environment. For 30 hours a week, from Tuesdays through Saturdays, I was on the phone with people who had recently tested positive for the coronavirus and their close contacts, most often their family members or roommates. I was assigned to a team that focused on residents of two emerging hotspots: Brockton and Chelsea. Both are low-income communities with many essential workers, often living in large, multigenerational households that put them at greater risk for contracting and spreading the virus within their families. Both are communities with high percentages of immigrants and people of color, groups for which the disproportionate impact of this pandemic has become starkly apparent. As of July 1, Brockton had the third-highest case count in the state with 4,225 cases after Boston and Worcester; Chelsea was sixth with 2,944 cases.

While not everyone was willing to answer my calls, and I spent a good deal of time leaving voicemails and logging unsuccessful call attempts in our database, most of the people I was able to reach were grateful, even if initially they were reluctant to share personal health data with a stranger. Knowing many would have privacy concerns, I worked hard to win their trust and gain their cooperation by offering a sympathetic ear and sound information about how to protect their loved ones from getting sick. I thanked them over and over for being willing to try their best to follow our instructions to voluntarily self-quarantine (for possible contacts) or to self-isolate (for positive cases). At the end of each call I praised them for doing their part to stop the spread of the virus. People isolating or quarantining in their homes may feel anxious, lonely or bored, and my daily check-in calls helped them feel heard and supported. One woman I monitored through her lengthy recovery period said she hoped I would keep calling her as a friend. One man I spoke with through a Spanish translator cried as he described how his employer accused him of putting his co-workers at risk even though he self-quarantined as soon as his wife tested positive. Fortunately he never caught the virus, his wife recovered and he was able to return to work after about three weeks.

One big hitch for families where one or more person tests positive is that the two-week quarantine period for household members begins only once the last positive case has completed their isolation period. To complete isolation, the positive case must meet all three of these criteria: 10 days since onset of symptoms, no fever for at least 72 hours without taking Tylenol or such, and a significant improvement in any cough or respiratory symptom. So family members could be stuck at home for several weeks waiting for others to clear isolation. This is a huge ask when it means instructing a healthy person to stay home from work for weeks because a sick family member may have exposed them. And the likelihood of household exposure is high – it is extremely difficult for a positive case to isolate effectively at home unless they have a private bedroom and bathroom and someone can provide them with food and other supplies without entering their room. When children are present it is even harder; how does a single mother isolate from her young children? In some cases we were able to place people in hotels where they could isolate safely, but most people stayed at home and tried to ride it out with the help of friends to deliver food and supplies.

With most of Massachusetts largely shut down in April and May, the virus was primarily spreading within the households of essential workers. Most people were staying home; schools, day cares and businesses were closed; and people were not out shopping and socializing. Many of the patients I spoke with had no outside or unrelated contacts to report. In early June the queue of positive cases and contacts started to decrease dramatically – a good thing – and many of us tracers ran out of new people to call. At the end of June, Partners in Health laid off several hundred of the small army it had assembled and trained over the three months prior. The organization won’t reveal exactly how many people it kept on hand, but my guess is that it’s fewer than half.

As a contact tracer, I was on the beachfront during the so-called first wave of the pandemic. Day One of my training (April 15) was the apex of the state’s positivity rate (28.9 percent), and there were 1,755 new positive tests. The high tide mark came nine days later with 4,946 positive cases on April 24. Through May the queue of new cases and contacts almost drowned us. But by the end of June the number of daily positives had ebbed to 114 and the seven-day average positivity rate was just under 2 percent. Most significantly, there were no Covid deaths on June 30 (deaths typically lag case diagnosis by about a month). Our success in lowering the positivity rate by about 90 percent between mid-April and late June is largely a measure of people’s cautious behavior until around Memorial Day. As the economy reopens, however, we must not become complacent. As we are seeing in states that reopened more aggressively, the virus is opportunistic and will surge again if we relax our guard.

Over the 10 weeks I spent as a contact tracer, I learned a lot about the impact of the virus on people’s lives and livelihoods and the challenges facing our local boards of health and policymakers in controlling its spread. I’m proud that we are trying to become known as “Mask-a-chusetts” but wearing a mask is not sufficient protection unless we also continue to avoid prolonged, close contact, especially indoors, with people outside our family and a very small circle of trusted friends. The criteria we used to trace possible exposure for contacts was 15 minutes within 6 feet of someone who had tested positive. You will not see me at my gym if it reopens next week, or in a movie theater (it’s impossible to eat popcorn while wearing a mask!). Personally, I do not feel comfortable with outdoor restaurant service and will continue to order takeout to support local businesses. I will not risk a salon visit for a haircut or a mani/pedi.

In closing, here are a couple takeaways:

We need rapid, ubiquitous testing. A test result is just a snapshot in time. In many instances, people wait for five to seven days for their test results. That’s way too long. A person without symptoms is unlikely to self-isolate rigorously in the absence of a positive test result, but could be contagious before and during that critical waiting period. Worse, a person may have been exposed just after they were tested, and a negative result could give them false confidence. New research suggests that as many as 45 percent who test positive will never experience any symptoms at all. Initially people without symptoms were denied testing; it’s now possible to get a test if you are asymptomatic, but depending on where you live and your ability to pay, it may not be easy. In practice, most people do not seek out testing unless they know they’ve been exposed or their job requires it. Case in point: I have not had a test.

We are a long way from making testing ubiquitous enough to detect and head off a rising rate of infection within a community. It can even be hard for people you’d think would have ready access to on-demand testing. A physician friend who works at a local hospital wanted to get tested before visiting her elderly parents; her own hospital wouldn’t test her, since she was asymptomatic, so she had to make an appointment to go to an outside test site. Luckily she’s a Cambridge resident and was able to go to the Cambridge Health Alliance drive-through testing tent on Gore Street (since closed), where she tested negative. Most test sites still require an appointment and a referral from a physician, and some charge a fee. The process can be confusing, but here’s a helpful interactive map of test sites.

Make getting tested cool. Sadly, some people resist getting tested because they’ve heard having a long swab inserted deep into your sinuses is uncomfortable. Many people waited several days after their symptoms began to get tested, making it harder for us to alert their contacts in time. A public information campaign could help overcome people’s fears. Remember when Katie Couric allowed her colonoscopy to be televised? Celebrities posting selfies during their Covid tests might help make getting tested cool.

Every household should have a thermometer. I was surprised that quite a few people I called did not have a thermometer, and I’ve heard it has become hard to buy one at drugstores. Fever is a very common symptom of the virus, and knowing when it has been 72 hours without a fever is a criteria for clearing isolation, so having a thermometer is important. When I go to the dentist I get a toothbrush, floss and toothpaste; couldn’t thermometers be given to those in need, or at least sold at cost, through the health clinics and primary care offices?

As much as anything, my contact tracing experience underscored how lucky I am. Not only have I and my family so far remained healthy, but I am not living with the constant fear of losing my home or going hungry. I’m not forced to go to a workplace where my health is at risk to support my family. Nor am I enduring the stress of trying to work from home while having to be teacher, playmate and caregiver to housebound children. Among my many privileges is the one that separates me from most of the people I called: I have the choice to hunker down at home indefinitely with relatively few distractions. When I begin to grow restless and anxious about the future, I try to remind myself how lucky I am.

Jan Devereux is a former city councillor and vice mayor.