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Contact tracers fight the pandemic, one phone call at a time

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

The county Health Department uses social media to brief residents on differences between contact tracers and phone scammers. This lesson was posted on Twitter.

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

Best of 2020: Reporting

Reporters with The 9th Street Journal had plenty to cover this year and all rose to the occasion. They published more than 140 articles on the pandemic, demands for racial justice, high-stakes elections and far more.

Some articles stood out due to the heft of the subject matter and the depth of the reporting. As the year draws to a close, we share some of that best reporting here.

Hospital bill collectors

Six months after an intruder raped a Duke University student in her campus apartment, bill collectors started calling her about unpaid Duke University Hospital charges. Victims are not supposed to be charged for sexual assault exams. But rules have loopholes, Cameron Beach reports here.

A Durham crisis

Hundreds of people were evacuated from Durham’s oldest public housing community due to unsafe conditions last winter. Housing authorities in other North Carolina cities take better care of their properties, Caroline Petrow-Cohen explains here.

Tracking COVID-19

After the pandemic struck, the world learned how important contract tracers are. These public health sleuths encounter suffering that is hidden from most of us, Bella Caracta describes here.

Once a homicide

After a judge discredited police evidence in the case against a Durham teenager, prosecutors dropped charges accusing him of killing his father. Months later, a medical examiner revised the cause of the man’s death, Ben Leonard discloses here.

Families in the dark

When the new coronavirus started spreading, federal officials banned visitors from nursing homes. Intended to protect the vulnerable, the move isolated residents from family members at a time of great danger, Victoria Eavis documents here.

Follow the money

Durham officials boasted of giving aid to small businesses this summer. But for weeks, they did not know who received the funding, Ben Leonard reveals here.

What is Swing NC?

Trying to track the origin of a $53,000 donation to a congressional candidate shows how the campaign finance system is a messy tangle, Michaela Towfighi finds here.

COVID-19 in jail

Darrell Kersey’s death was the second COVID-19 fatality linked to the Durham jail that was not disclosed to the public, Dryden Quigley reveals here.

Repairs gone wrong

For months, public housing residents were forced to live with a rodent infestation where their children play outdoors, Charlie Zong documents here.

At top: 9th Street Journal reporter Rebecca Torrence interviews a Durham resident during early voting at Duke University’s Karsh Alumni and Visitors Center. Photo by Henry Haggart

Best of 2020: Reporting

Reporters with The 9th Street Journal had plenty to cover this year and all rose to the occasion.

They published more than 140 articles on the pandemic, demands for racial justice, high-stakes elections and more.

Some articles stood out due to the heft of the subject matter and the depth of the reporting. As 2020 draws to a close, here is some of our best reporting of the year:

Hospital bill collectors

Six months after an intruder raped a Duke University student in her campus apartment, bill collectors started calling her about unpaid Duke University Hospital charges. Victims are not supposed to be charged for sexual assault exams. But rules have loopholes, Cameron Beach reported.

A Durham crisis

Hundreds of people were evacuated from Durham’s oldest public housing community due to unsafe conditions last winter. Housing authorities in other North Carolina cities take better care of their properties, Caroline Petrow-Cohen explained.

Tracking COVID-19

After the pandemic struck, the world learned how important contract tracers are. These public health sleuths encounter suffering that is hidden from most of us, Bella Caracta described.

Once a homicide

After a judge discredited police evidence in the case against a Durham teenager, prosecutors dropped charges accusing him of killing his father. Months later, a medical examiner revised the cause of the man’s death, Ben Leonard disclosed.

Families in the dark

When the new coronavirus started spreading, federal officials banned visitors from nursing homes. Intended to protect the vulnerable, the move isolated residents from family members at a time of great danger, Victoria Eavis documented.

Follow the money

Durham officials boasted of giving aid to small businesses this summer. But for weeks, they did not know who received the funding, Ben Leonard revealed.

What is Swing NC?

Trying to track the origin of a $53,000 donation to a congressional candidate shows how the campaign finance system is a messy tangle, Michaela Towfighi found.

COVID-19 in jail

Darrell Kersey’s death was the second COVID-19 fatality linked to the Durham jail that was not disclosed to the public, Dryden Quigley exposed.

Repairs gone wrong

For months, public housing residents were forced to live with a rodent infestation where their children play outdoors, Charlie Zong reported.

At top: 9th Street Journal reporter Rebecca Torrence interviews a Durham resident during early voting at Duke University’s Karsh Alumni and Visitors Center. Photo by Henry Haggart