By Joslin Coggan
I worked as a contact tracer and case investigator in Colorado during the months of July and August 2020. I was hired along with around 350 other contact tracers, and we initially went through two weeks of training. While working, I would call individuals who had been exposed to a known COVID-19 positive case and give them instructions to quarantine or isolate. Additionally, I would work with the individuals to identify the people they had recently been in close contact with. Contact tracing efforts are used as a tool for reducing the spread of COVID-19. By identifying contacts and notifying individuals of exposure to the virus, there is an increased likelihood people will be able to quarantine and reduce the spread.
On the Job
I spent the majority of the time as a case investigator, calling individuals who had tested positive for COVID-19. Most of the individuals had already received their positive test result by the time I spoke with them, but there were occasions when I was the first to tell them of the positive test result. The interview was completely voluntary, a fact that was restated at multiple points throughout the call. At any time, the interviewee could stop the call or chose not to answer a question. The shortest interview I had was thirty-five minutes and the longest was approximately two and a half hours, but the average time was forty-five minutes. While we were provided with a script as a guideline for our conversations, we were encouraged to build a rapport with the individuals. I believe maintaining a rapport helped build trust and increased the individual’s willingness to participate in the interview.
The first part of each interview was spent collecting or confirming personal contact information such as address, phone, email, and birthdate. Most of the people I talked to did not object to sharing this information. In the next section of the interview, I would ask if the individual had experienced specific symptoms which may be characteristic of COVID-19. After going over symptoms, we went through a list of chronic conditions, which may be used to identify individuals at increased risk for experiencing more severe symptoms of the virus. All of the information gathered was stored in a secured web application on state computers.
Next, I would calculate the approximate time of exposure and days needed for isolation based on their positive test date or onset of symptoms. I would ask individuals if they were willing to share the names and contact information of the people they had been in close contact with during the window of infection. Identified contacts would be entered into the system in order to be notified about possible exposure to COVID-19. The identity of the individual who tested positive with COVID-19 was not shared with the contacts.
There was a section of the interview that asked about race and ethnicity. This was an open-ended question, and the contact tracer was not supposed to suggest answers or make assumptions. I believe this section demonstrated how race has been arbitrarily defined and does not have a universal definition. The people I talked to would reflect on their race in different ways, and the answers they gave did not always fall under one of the boxes I could check on the application. Some individuals would share with me the immigration stories of their ancestors and how this had shaped their identity. Others described their race as their country of origin. I believe varied answers related to race highlight how society and institutions commonly subject people to categories which do not always align with personal identity.
In addition, the contact tracing program heavily emphasized the importance of health equity and cultural sensitivity. During the two-week training, we engaged with modules that discussed how to provide equitable care and conduct culturally sensitive interviews. There was also the option to use trained translator call lines, so interviews could be conducted in the preferred language of the interviewee. Culture plays a significant role in how people have experienced the pandemic. Beliefs about family, employment, and health all shape how individuals respond to and navigate social distancing and public health mandates. As a result, listening to people’s beliefs and learning more about the details of their lives and cultural context were often important aspects of the conversation, which assisted me in connecting households with specific resources and information.
Updates to the Program
Since my time as a contact tracer, cases in the United States and Colorado have greatly increased. When I was working, Colorado was experiencing 150-400 COVID-19 cases a day. In the fall and winter, cases rose and there were periods when the state was experiencing over 3,000 cases a day. I recently met with my former team lead to hear how the program had evolved. In the past few months, the program has updated the software used to store the information gathered from interviews, which has helped streamline data entry. Despite the dramatic increase in cases, the contact tracing program was still able to conduct thorough, and similar in length interviews.
One valuable addition has been the creation of a branch dedicated to health equity. This branch aims to ensure that people of different backgrounds and cultures are delivered information in a way that promotes understanding. Cultural navigators may be present in calls to help facilitate sharing and understanding of information.
Additionally, Colorado launched the use of exposure notifications. When turned on, exposure notifications alert an individual when they come into close contact with a person who has tested positive for COVID-19. Exposure notifications do not collect or share personal identifiable information and alert the individual to general exposure. This software may aid in the contact tracing effort by notifying individuals of exposure before being contacted by a traditional contact tracer.
Reflection on Contact Tracing
Working on the Bass Team has prompted me to consider the efficacy of traditional and digital contact tracing. Through Bass, I have primarily researched digital contact tracing apps and exposure notification systems. Digital contact tracing has several advantages including speed of notification time. Additionally, some people may be more comfortable using a digital app than sharing contacts or speaking with a traditional contact tracer.
However, I believe barriers to use and low participation make digital applications and exposure notification insufficient as the sole approach to contact tracing. Based on my work as a contact tracer, I believe the personalized, traditional approach has several benefits including forming a connection and building trust while sharing valuable information. I spoke with individuals who would have faced several barriers to using digital contact tracing. First of all, not everyone has access to a smartphone, which would make it challenging to rely on a digital form of contact tracing. In these instances, traditional contact tracing is a better option for notifying the individual of possible exposure and providing quarantine or isolation instructions. Additionally, traditional contact tracing allows individuals to be connected to resources and information which may assist in keeping themselves, family, and community safe.
Moving forward, I believe the best approach is one that uses a combination of traditional contact tracing, exposure notifications, and digital applications. Implementing a variety of methods may increase the likelihood of identifying and alerting possible contacts to slow the spread and reduce harms from COVID-19.