SCHENECTADY — The state is enlisting thousands of contact tracers to reopen society.
But what are contact tracers and how is their work critical to easing the restrictions keeping people at home?
“It’s really like being a detective,” said Claire Proffitt, supervising public health nurse at Schenectady County Public Health.
Tracers monitor those who test positive for the virus and guide them throughout the 14-day isolation period, checking on symptoms through daily phone calls.
Key in containing the virus’ spread is also methodologically tracking down everyone who may have been exposed to that person.
Contact tracers serve as the boots on the ground, notifying and interviewing each contact to alert them to their risk of infection, steering them toward testing sites and other services.
More than 30 tracers — retired doctors, registered nurses, nurse practitioners, PhD candidates, epidemiologists and college undergraduates — work out of a salmon-colored building on Nott Terrace in Schenectady.
The call center buzzed on a recent weekday morning as a whiteboard displayed call status and the word of the day:
Anosmia: No sense of smell.
SOLVING THE PUZZLE
Public health nurse Sarah Tice starts her day with a list of state-provided positive diagnoses.
Then the investigation starts.
Tice calls the patient, steers that person toward their primary care provider and then gathers information on whom they may have exposed.
The investigation spiderwebs from there.
Investigators go back 48 hours prior to onset of the symptoms and follow a basic script:
What are your symptoms and when did they start? Where do you work? Did you use public transit to get there? Who did you interact with? When did you get home? Did you visit with anyone or go anywhere else?
“It leads you in a lot of different directions,” said Lauren Stairs, a public health education coordinator.
Central in determining at-risk people are those who have been in close contact with an infected person, which the CDC defines as someone who has been within six feet for a “prolonged period of time,” or at least 10 minutes.
Potential positives are referred to the county’s communicable disease department.
One of the more insidious aspects of the virus is that for many, it presents as asymptomatic, allowing it to spread silently throughout the community.
Once tracers locate a contact, they tell them to stay home for 14 days or until their test results clear.
The goal is to draw a picture, close the loop and prevent transmission.
“We want to make sure we are getting the most truthful responses,” Tice said. “This is the essence of contact tracing.”
People aren’t untruthful as much as they’re stressed and forgetful after their life has been abruptly upended, tracers say.
“There’s often a lot of emotional stuff to work through at the same time,” Proffitt said.
And many families are already navigating challenging circumstances, from caring for newborns to Stage 4 cancer patients.
One positive case can generate hundreds of phone calls.
“It’s not resource-intensive, but time-intensive,” Proffitt said.
The process often felt hopeless at the beginning. Cases didn’t connect, and for every puzzle piece found, a handful didn’t fit.
But that’s changing as investigators refine their skill sets and patterns begin to take shape.
One emerging trend is entire families are testing positive.
While perhaps unsurprising, tracers are impressed by how working-class families are trying to self-isolate, which can be tricky for those without the luxury of sprawling homes and refinished basements.
“We’ve heard of really creative ways on how to partition those spaces,” Proffitt said.
The city’s aging housing stock has one unforeseen benefit: Two-family homes typically contain a third bedroom off the back of the kitchen with direct access to a bathroom, making it easier to isolate the sick person from healthy family members.
“We have had to move people out to an alternative setting, but hasn’t happened as much as it should,” Proffitt said.
Early in the crisis some counties opted to issue alerts in an attempt to locate patrons of businesses where employees had tested positive, including bodegas and fast food restaurants.
Schenectady County opted not to do so, making the decision only after rigorous internal discussions.
Officials ultimately decided alerts tend to generate more panic than leads.
“You can be inundated with the ‘worried well’ calling you,” Proffitt said.
Issuing alerts is typically used as a last-ditch effort.
One scenario would be if surveillance footage reveals an employee coughing on hot dogs and serving them to customers who can’t be tracked down through the interview process.
But issuing an alert for a mask-clad grocery store stocker with limited contact with the public may not be advisable.
“The benefit is small and negligible and you’ve created fear,” Proffitt said. “Putting out press releases gives the impression of possible danger. These are hard decisions, but we feel comfortable with the way they’ve happened here.”
Like any other positive case within the county, personnel performed contact tracing at Bellevue Cafe, whose owner reportedly died of the virus last month.
Prolonged contacts were notified and the business shut down for deep cleaning and to ensure that the staff was healthy when it became operational.
The Capital Region is not among those cleared to gradually reopen on today.
But tracers acknowledged talk of reopening elsewhere paired with warm weather and a restless public will inevitably draw people outside and into risky situations.
“As the valves open up, we’re going to see spikes in cases,” Proffitt said.
Tracers will have to strategize on how to adjust to spikes, ramping up and down and deploying resources as necessary.
But staff members already have experience in tracing as part of their routine seasonal work, monitoring influenza and other infectious disease outbreaks.
“We’re good at having that flexibility,” Proffitt said.
The goal is to steer people into making the right decisions, and to reinforce that social distancing is effective at slowing the spread.
“I try not to get bogged down in the details of individuals doing it wrong,” Proffitt said. “We monitor the best we can, and realize this isn’t going to be done perfectly.”
BUILDING AN ARMY
Contact tracing is among the seven metrics guiding when regions can reopen.
Regions must have 30 tracers per 100,000 residents.
Ranks across the eight-county Capital Region will be bolstered as part of the effort by the state and former New York City Mayor Michael Bloomberg to hire anywhere between 6,400 to 17,000 tracers.
The scope, said Gov. Andrew Cuomo, is unprecedented.
“We’ve put together armies before,” Cuomo said last month. “Never a tracing army. But we can put together people, we can organize, we can train and we can do it.”
Tracers working remotely will text with people throughout the duration of their quarantine or isolation to monitor their symptoms.
Carrie Dunn-Herrera, a county public health systems administrator, said discussions with the state are ongoing.
The Bloomberg School is working with the state Department of Health to develop an online curriculum with a training program and an online exam that must be passed to complete the program.
Johns Hopkins University sent training modules to counties earlier this week.
“We haven’t tried the training module yet, but we’re excited there is one,” Dunn-Herrera said on Tuesday. “We’re hoping to get as many people as possible to take that training.”