When someone is sick with COVID-19 or suspects they may be, the Centers for Disease Control and Prevention says they should isolate themselves in a single room at home. One Durham parent took it a step further.
Worried about infecting children under the same roof, the parent moved into a car parked outside, despite the North Carolina summer heat. The kids delivered food and drinks there.
Katy Roys knows this because she is a contact tracer, a public health worker who finds and coaches people at risk of spreading the coronavirus. This time-tested outreach helped reduce deaths during the HIV/AIDs outbreak in the 1980s, SARS in 2003, swine flu in 2009 and now COVID-19.
Here in Durham and around the world, tracers have front-row seats to ways the new coronavirus disrupts lives.
“You can read everything about coronavirus in the newspaper and reports, and it’s another thing to call people yourself and see how they’re doing,” said Edwin Lee, who like Roys became a county contact tracer while training to be a physician assistant at Duke University.
A dangerous illness
During Lee’s first week tracing in May, he called a Hispanic man who had recently tested positive for the virus. Like Lee, the man was in his twenties. “I feel horrendous,” was the first thing he said.
On paper, the young man had no known chronic illnesses. During an interview the day before with another contact tracer, he reported a fever, cough and slight chest pain.
But on the phone with Lee and a Spanish interpreter, the man was struggling to speak, pausing mid sentence to catch his breath. In response to Lee’s scripted questions, he said he had significant chest pain, chills and fevers.
“Hearing his voice and how sick he sounded, I just told him to hang up and call 911,” Lee said.
It was only his second or third day on the job and Lee wondered whether he overreacted. When he asked a nurse on the county health department staff, she was more concerned with whether the man called 911.
Contact tracers have observed that some Hispanic residents can be reluctant to do so, Lee said, even though new cases of the coronavirus recently were mostly detected among Latinx people in Durham County.
“If he didn’t call 911, this was certainly a person that we would have sent someone to do a welfare check on. But thankfully, he did,” said Lee, adding the man was admitted to the hospital.
Public health detectives
On the the third floor of the Durham County Human Services Building downtown, tracers each day check a whiteboard for their duties, grab case files from a basket and get to work making calls, the students said.
Some on the job have medical backgrounds, some are health department employees pulled from jobs with lower demand during the pandemic, including restaurant inspectors.
Much like detective work, contact tracing requires creativity to fill in gaps. When Lee pulled a file that described a woman who fainted at a local business while trying to pay a bill, he had to figure out who else she may have exposed.
“We had to make a lot of phone calls,” said Lee.
The first obstacle was finding the store’s telephone number. Despite having a physical location, the business did not have a listed phone number. So Lee dialed a restaurant in the same shopping plaza.
A hostess answered but declined to walk only several yards to tell the store manager that the health department was trying to get in touch. When he called a nearby retail store, a helpful employee agreed to deliver the message.
But even after connecting, the situation was murky.
The first employee Lee spoke to said employees weren’t adhering to social distancing protocols that day, a payday, because it was busy. That suggested several people might have been nearby when the women dropped to the ground. Then a manager said the store was adhering to social distancing protocols and there were at most two or three customers in the store.
After six to seven hours and over a dozen calls, including four to the same person, Lee and coworkers determined none of the customers required their help. All of them, including the woman who fainted, were wearing surgical-grade masks, they learned.
To protect people’s confidentiality, tracers do not publicly disclose names or any information that could identify individuals they work with. Contact tracing can get personal quickly.
Roys recently opened a case whose file listed an adult patient’s parent as a designated contact. When Roys called the parent, she learned patient and parent no longer lived together and no longer spoke. Still, the worried parent asked to be updated on the patient’s status.
When Roys reached the patient, she mentioned the parent’s concern. The patient told her not to talk to that parent again.
“At the end of the day, if the patient says they don’t want us to contact their parents anymore, we don’t. We can’t,” she said.
An expanding need
Local health departments collaborate with the state Department of Health and Human Services with contact tracing. More than 1,500 full-time and part-time staff support contact tracing efforts at the local level across North Carolina, 398 of which are contact tracers hired through Community Care of North Carolina, according to Kelly Haight Connor, communications manager at DHHS.
“As cases continue to increase we know we need more and continue to ramp up hiring,” she said in an email.
Roys and Lee entered contract tracing after enrolling in a Community Health course created by Quincy Jones, an assistant professor in the Department of Family Medicine and Community Health. The Duke class is a service-learning elective that allows students to help with the COVID-19 response in Durham County.
Had the pandemic not happened, Roys and Lee would have likely learned about this work through textbooks and in the classroom. Now they see the importance of what the health department and contact tracers do in a public health crisis, they said.
“They play a huge role in the control of communicable diseases and outbreaks like COVID, and their work is essential in guiding a safe transition into normal operations,” Lee wrote in a reflection assigned by Jones, his instructor.
And it’s likely they will be needed for the foreseeable future.
“I think it’s even more important now that things are opening up, that contact tracing is happening. Because there’s going to be a lot more exposures,” Roys said.
9th Street Journal reporter Bella Caracta can be reached at isabella.caracta@duke.edu
At top: Katy Roys and Edwin Lee outside the downtown Durham County Human Services Building. Photo by Henry Haggart