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Contact tracers on front lines of fight to prevent covid spread

Public health nurse Robbie Goolsby grabs a report of a positive covid-19 case in her work as a contact tracer. Public health nurse Robbie Goolsby grabs a report of a positive covid-19 case in her work as a contact tracer.

Boxes of Cheez-Its, bags of peanuts and packages of Oreos and Kind bars sit on tables in the data room and the hot line room at the Department of Public Health, a cheerfully colorful exhibit of junk food marketing that belies the serious soldiering in the war against the coronavirus.

 

The ground floor is also ground zero of the health department’s rapid response work against the virus: inputting test results and other information needed for the county’s dashboard, answering hundreds of hot line calls a day and reaching people who have been in close contact with someone who has just tested positive for covid-19.
“We do lots of cleaning and verifying of data to make sure everything is good for the dashboard that’s published on the website,” said Anita Glance, the department’s preparedness coordinator, as she guided a visitor on a tour of the war rooms. “We are continuing to get notifications, both of testing and positives, 24-7. They come in at all hours, every single day, and we have a responsibility for processing and making contacts with positive cases and do contact tracing.”
In the hotline room last week, four women made calls to people who had tested negative and fielded calls from the public. Public health nurses, health educators and even financial analysts have been repurposed for the pandemic, doing jobs that didn’t exist on March 1.
“Right now there are a lot of people who are wanting to be tested because they were in contact with someone who’s positive,” Heather Masington, a registered nurse, said of the hot line calls. “It does change every week because the needs change but I feel like a lot of the needs right now are people that have experience with somebody that had a contact with a positive. And just a lot of questions.”
“We get complaints about certain places,” she said. “I got one this morning, a tanning salon, they were not following the rules, wearing the mask, cleaning their equipment properly, restaurants that are not following the rules. We take their information down and we pass it up to our director. We listen to them a lot because sometimes it’s just making them feel better. A lot of people are anxious. I had a lady yesterday, for example because there was a person who was positive in the building she lived in and he was walking his dog and everybody was worried because he was outside walking his dog.”
The public health guidance was to steer clear.
“He wasn’t near anybody, he was just walking his dog,” Masington said. “You just try to talk to them, tell them to protect themselves, for them to stay 6 feet apart, for them to wear a mask, for them to do the right thing to protect themselves.”
The hot line is averaging about 80 calls a day per person. One morning recently, the team tallied up their calls at lunchtime. They had answered about 50 each. The hot line team is lucky in one way. They’re the good news team, notifying people that their covid test came back negative.
“Oh, they’re happy,” said Amy Chandler. “I had a lady cry on the phone today. I felt so bad because she was so worried about it.”


Contact tracers are ‘drowning’

The bad news job, notifying someone they’ve tested positive for the virus, falls to contact tracers.
“We contact that person to see their household contacts, others who have potentially been exposed to them for long periods of time, in order to help prevent the spread of the disease,” Robbie Goolsby, a public health nurse, said.
The nurses stay in contact with the people who have been exposed, ask if they want to be tested. The virus is most detectable five days after a contact, so the nurses offer testing at that point.
Six contact tracers are on duty every day, seven days a week. With increased testing, more tests are coming back positive. A few days to a week after the public testing site operates at East Henderson High School, the inbox overflows with new patients for Goolsby and the other contact tracers to call.
“No, we are swamped,” she said when asked if they’re caught up. “As of yesterday, we are drowning. I have been working overtime and so has everybody else.”
Goolsby ticks off the levels of complexity in the contact tracing task.
“Simplest scenario, the patient lives alone, has not had contact with anyone, has only been to the grocery store or out in public as needed,” she said. “That person has no contacts that we have to follow up with. Next scenario, somebody’s been at work, they’ve been within six feet of each other” and potentially exposed many coworkers.
“If it’s a food industry worker the restaurant would have to be notified, so it can get very complicated,” she added. “We can have multigenerational families with mom, dad, grandma, grandpa, several children and grandchildren, and those folks all have to be followed up and we monitor their progress and their symptoms and get them quarantined for the time CDC recommends for household contacts.”
A contact is a face-to-face encounter less than six feet apart, with no mask, for 15 minutes or more. The person who is quarantined with covid-19 must report being symptom-free “without Tylenol or ibuprofen” for 72 hours before they’re liberated from isolation.
“The people I have encountered have been very compliant and very willing to do their part,” Goolsby said. “I’m just very much in awe of how nice people have been when I’ve called. People are just very concerned that they could potentially have been around an elderly person or compromised person.”
If the positive covid patient says that quarantining would cause a financial burden, the public health nurses list the resources that can help: a covid-19 fund the Community Foundation and United Way administer, the Interfaith Assistance Ministry’s food pantry and clothing closet, True Ridge’s programs geared toward the Latino community and other agencies.
“I tell them to check with their HR director,” Goolsby said. “They may have some kind of extra sick leave in place because of the covid crisis.”
Retired as a school nurse, Goolsby is among the reinforcements the health department recruited to handle the massive load of data input, hot line calls and contact tracing.
“Myself and another PRN (on demand) person said, ‘Oh, we’ll come in and we’ll work about two or three months and we’ll help get over the hump and the regular people can take over,’” she said.
Four months later, instead of a hump, there’s a steady rise in cases, growing piles of data to process, questions and face mask violation reports for the hot line crew to field, a stuffed inbox of positive cases and calls to make. The work can be exhausting mentally and emotionally but fulfilling, too, given the literal life and death stakes.
“I think it’s very rewarding just to know you’re helping containment of this terrible disease,” Goolsby said. “And you’re delivering some bad news with some empathy and guidance.”
The most stressful part is being unable to reach someone who has covid-19, despite repeated calls.
“You know they’re out there,” she said, “and they need to know.”
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