Depending on the estimate, the U.S. needs between 100,000 and 300,000 contact tracers to help fight COVID-19. Some say these new jobs could be an opportunity for some of the millions of Americans who've been laid off or furloughed.
Tair Kiphibane manages the contact tracing operation for Salt Lake County, Utah. She started working as a contact tracer almost 15 years ago, and she says there's an art to cold-calling people about scary diseases.
"Everybody does it a little bit differently. I just like to get to know them first, but not to spend too much time because I may lose their time and attention," says Kiphibane, who's in charge of the county's contact tracing team.
In the past, she's called people to tell them they may have been exposed to diseases like HIV, measles, Ebola. She's a pro at diving quickly into personal territory – "Who do you have sex with?" kind of personal.
For COVID-19, what she and her colleagues primarily need is a person's memory.
"Sometimes we ask them to pull out a calendar, credit card history, bank statements, things like that to help jog the memory," she says.
For someone who was diagnosed with COVID-19, they need to know when the person started having symptoms. Then, starting with two days before symptom onset, they talk through what happened each day, says Kiphibane, "from the minute you get up to the minute you go to bed." Where have they been, who have they seen?
Then, it's time to call the people they were in contact with – ASAP – to warn them, give them instructions about how to quarantine, and ask about their contacts, too. And on and on down the line.
"We trace as far as we can, up to infinite generations," says Kiphibane.
It's a delicate operation. You have to build trust with total strangers – quickly.
And, Kiphibane explains, wording matters. When giving instructions about how to isolate or quarantine, she'll say "I need you to do this" instead of "I would like you to do this." "We have to be direct because we have a very important message we need them to do. And this is serious," says Kiphibane.
And the stakes are high.
If contact tracing is done well, she says, "We can conquer this. We can stop the spread of COVID 19 … and we can reopen America again."
Kiphibane is a public health nurse by background. But she says you don't need a health background to do a good job.
"There might be various learning curves for everybody, but I think that anybody can do it," she says.
Public health experts seem to agree with her. People like Lisa M. Lee.
"It is a challenging job, but we can train lay people to do this – and we should," says Lee, an epidemiologist and bioethicist with Virginia Tech who started out a contact tracer with Colorado's state health department.
"It was, I must say, the most humbling work of my career," says Lee, whose career has involved (in no particular order) writing a textbook about public health surveillance, chairing the Obama administration's Bioethics Commission, and working for the Centers for Disease Control and Prevention.
Lee says a good contact tracer is someone who's curious, has a desire to help, "and really importantly, is a person who can exercise good communication skills using empathy."
They have to honor confidentiality, use basic software to keep track of the info they're getting, and help connect people with what they need – whether that's a COVID-19 test, or groceries to get them through a two-week quarantine.
"There are many people right now who are out of work whose skills would be very transferable into something like this," she says. "There are people who are good communicators or people who know how to access and advocate for resources. There are people who have initiative and are curious and who do want to help. These are all people we can train to do this."
Not that states can afford to be too picky.
"This is urgent," says Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials, or ASTHO, which recently released a free online course in how to do contact tracing. "This isn't something we're going to put into place in a year. This is something we need to put in place in the next few weeks or at least by the summer."
There's talk of smartphone apps in development – namely, one from Google and Apple – that could do a sort of automated version of contact tracing, using Bluetooth technology to ping phones that have come within a certain distance of COVID-19 cases. Even if such apps work swimmingly, Plescia says, "There is going to be a lot of need for human-to-human contact. We're going to need to hire a lot of people to do a lot of this work because that's just going to be the nature of it."
The Johns Hopkins Center for Health Security cited $17 an hour as a benchmark for compensation in a report on contact tracing. Massachusetts is paying its contact tracers $27 an hour. Its job description highlights a "positive attitude" and "ability to show empathy to distressed individuals" as top qualifications.
Researchers with George Washington University, in collaboration with ASTHO and the National Association of County and City Health Officials, released an online calculator showing how many contact tracers each state will need. It shows that, collectively, Mountain West states need more than 6,000 contact tracers – about half of them in Colorado.
As NPR has reported, it can be hard to get a grasp on just how many contact tracers each state has, as the teams can exist at the city, county and state level.
Idaho's health department said contact tracing is up to the local public health districts, which normally have "23 epidemiologists who regularly do contact tracing," though some districts are adding staff or training volunteers from the Medical Reserve Corp. Nevada's health department said it planned to train volunteers with Battle Born Medical Corp, plus members of their National Guard.
Utah's health department has added at least 100 new contact tracers to its team by training department staff; Salt Lake County has also reassigned staff in the health department. The Salt Lake Tribune has reported that 20 soldiers with the state's National Guard are also helping with the effort. Amelia Prebish, contact tracing lead for the state, said the statewide total by the end of April was "somewhere in the hundreds."
Wyoming doubled its contact tracing workforce – from five people to about 10 – by reassigning health department staff. "We have also received help from many county public health personnel and tribal staff," a health department spokesperson said.
Colorado's health department recently hired a couple dozen epidemiologists for the job, for a total of 56 by early May. Adding contact tracers at the county and city level, the state's epidemiologist estimated Colorado had about 300 contact tracers in total in early May – still more than 2,000 short of its estimated need.
Plescia and his colleagues are encouraging health officials to get creative about where to find new contact tracers. They recommend in a report that states employ three layers of contact tracers, ranging from trained lay people to experienced epidemiologists and health care professionals. Within the contact tracing workforce, the organization distinguishes between "case investigators, who interview people diagnosed with COVID-19 and then figure out how many people they might have come in contact with while contagious, and contact tracers, who notify and follow up with these contacts." For the latter, Plescia suggests university students or school teachers, especially over the summer. Librarians could also be good candidates.
"Another interesting group I've heard about is the YMCAs that are in every community. A lot of them have been furloughed because of the stay at home orders," Plescia says. "Those are the kinds of places that a state could go."
Bottomline, he says, it's urgent to get new people on board. Lots of them.
California has been getting attention for its efforts to build its contact tracing workforce. According to a survey by NPR, it's one of just nine states – none of them in the Mountain West – that are on track to hire enough contact tracers, and it's getting there in interesting ways. For example, this month San Francisco's contact tracers welcomed about 20 of the city's librarians to the team.
Jessica Jaramillo, who currently manages libraries in San Francisco's South West District, is one of them.
"I kind of jumped at the opportunity to do this because it's hard for me to think of a better use of my skills in this moment," she says.
Those skills include interfacing with the public and asking questions to find out what information they need.
"And then disseminating information – that's what we do all day long," said Jaramillo. "My favorite part of my job is interacting with people and giving them something that they want and need."
Like the time she convinced a patron to try reading a new author – and they loved it. Or the time a woman came in after she'd gotten diagnosed with an autoimmune disease.
"She was like, ‘I'm just so scared because I think I don't really know how to manage this and it seems kind of insurmountable.' And so we found some information and some books," says Jaramillo. A few weeks later, her daughter came back to tell Jaramillo how much it had helped.
With the libraries closed, Jaramillo went through about 20 hours of training in contact tracing, and started making calls in early May. She and her fellow librarians-turned-disease-detectives have helped make appointments to get people COVID-19 tests. They've helped arrange for grocery delivery to help contacts quarantine. They've walked people through cleaning methods to keep infection from spreading among family members.
Now, Denver is recruiting staff from the city's libraries – including librarians – for its contact tracing team, too.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.
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