Before the pandemic, Lauren Carter was working in a pet store as she pursued her doctorate in physical therapy.
Since June, she has been a contact tracer. Health officials have identified contact tracing as a key strategy in stopping the spread of COVID-19 and other infectious diseases. With the number of cases skyrocketing across the country, the U.S. Centers for Disease Control and Prevention advised health departments to focus their efforts on patients who tested positive in the previous six days so that their contacts can be advised to self-quarantine.
It can be frustrating work; Pennsylvania officials said that during a recent week, tracers were able to reach fewer than a quarter of new cases, often because people just don’t want to answer the phone if they see an unfamiliar number on their phone.
But the tracers persevere; Carter says she’s even getting more cooperation these days as cases surge and more people understand how tracers can help.
Working from home, Carter calls people who have tested positive for COVID-19, or who may have been in close contact with someone who has tested positive, and advises them how to proceed to prevent the infection of others.
Carter, 18, works for the Montgomery County Office of Public Health, through VNA Community Services, a visiting nurse association. She took a six-hour course in contact tracing through Johns Hopkins University, another two-hour course on Train.org and then further training to learn about potential scenarios and review possible scripts.
We spoke to her recently about her job.
Who are the people that you call?
We call people who have tested positive, people who have been exposed to a positive individual, or even someone who lives in a house with a person who has tested positive.
Every day, when someone gets tested, a report gets sent to the state, and the state sends it to the counties. We divide the work and start calling positive people. We gather their household information and develop a list of close contacts. A close contact is someone who has been within six feet or less of a positive individual for 15 minutes or more, with or without a mask. And then we call those people. We’ll notify them of the potential exposure, tell them that they need to quarantine, and recommend that they get tested.
If we learn that someone was at school or at work when they were able to infect others, we reach out to that employer or school to inform them that someone has tested positive. From there, we’ll work together to identify close contacts and clean and disinfect the school or workplace.
What is people’s initial reaction, usually?
It depends. More recently, I’ve been fortunate enough for everyone to be very forthcoming with information and willing to speak with us. When we first started, no one wanted to participate. Some were rude and didn’t want to provide any information or help us. Now, they hear us and they say, “Oh, a contact tracer. Let me help you.”
When people test positive and they haven’t been provided with information from the testing site, they are eager to work with us. They want to know more about what they should do and how they should help.
As for people who might have been exposed, people who are close contacts, it could be news to them. It could be hard for them to understand why we’re calling. It’s hard when you know someone and they didn’t inform you of your exposure.
We do not give out the name of the person who might have exposed a contact. That’s confidential. We just give the date when they were exposed and go from there. We give them information about what quarantine is and information about getting tested and monitoring for symptoms.
Quarantine is necessary if you’ve been exposed to a person who has tested positive. It should last 14 days from the last day of exposure. (The CDC revised its guidance Wednesday to note that some quarantines can be cut to seven or 10 days.) During that time, you cannot go outside your house or apartment, aside from seeking emergency medical attention and getting tested for COVID-19. If you live in a single-family dwelling, you are permitted to go out on your own property to get fresh air, but you should wear a mask and maintain social distancing from neighbors or just go outside when the neighbors aren’t out.
But if the person has symptoms, they need to isolate rather than quarantine. Isolation is for a minimum of 10 days, and it’s preferred that you isolate away from household members – have your own bathroom and have meals brought to your door.
If you live in a household with a person who has tested positive, you need to quarantine during that person’s isolation, and then for 14 days after their isolation ends. It is essentially a 24-day quarantine for that household.
We always make sure to explain it thoroughly and see how we can help. At the VNA, for instance, we also have a navigator program that can connect people with specific resources tailored to them, such as activities for children during quarantine or isolation, or mindfulness and yoga exercises for teens and adults. We can connect people with food and even some medical assistance. We have information about renters’ assistance, mortgage assistance, and other financial help. When you’re quarantined, you might not be able to work. Just ask and we will do our best to find a resource that fits an individual’s needs. We help so your quarantine can go well.
What surprises you most in the conversations you have with the people you call?
A lot of people aren’t really informed about the virus, or they have misinformation. It’s always surprising, and kind of upsetting, that people don’t have a greater knowledge about the virus.
One common misconception is the difference between isolation and quarantine. It gets very mixed up. A lot of people think that if they’re in quarantine, they’re just monitoring themselves for symptoms, and they continue going out into the world.
Even a lot of people who test positive, if their symptoms go away and they’re feeling better, they’re still going out. But they are still infectious and able to infect others. That’s very unnerving.
We call people to follow up, and sometimes we can hear that they’re in a car or outside. And we say, “Remember, you’re in isolation or quarantine, you need to be inside a household.”
You are only permitted to leave the household to seek emergency medical services or to get tested. We always recommend that people go directly to the testing site and not make any pit stops at food stores, gas stations, etc. If they absolutely need gas, we recommend that they pay at the pump and wear gloves or, if they don’t have gloves, to use hand sanitizer before and after getting out of the car. And to always, always, always wear a mask, and make sure it covers their nose and mouth.
What is the most important thing people should know about contact-tracing?
That we’re here to help. The information is confidential, and we’re not judging anyone. We just want to make sure everyone can enjoy their lifestyle as safely as they can. It helps so much if they cooperate with us. The goal is to end the spread of the virus so we can all get back to normal.
Has your experience as a contact-tracer affected how you respond to the pandemic and the safety measures you take?
Yes. I am immuno-compromised. I wear three masks when I go out – an N95, a surgical mask and a reusable cloth mask. I usually pick up groceries at the curb instead of going inside.
At home, we do not bring our outside shoes inside. We leave them outside the door or in the garage and spray them with disinfectant. We also clean and disinfect our groceries, any deliveries and any take-out orders.
Being on the job and hearing more about how people have been out doing things has definitely limited my desire to go out and see family members or friends. It’s all through Zoom for us.
Health officials have learned a lot about how the virus is spreading. Even when someone is just going to the grocery store and has no other contact with outside world, they could still test positive. As contact tracers, we want to make sure we can stay safe, because if we get sick, we can’t do our job helping others.
I just wish everyone would do their part and practice social distancing and make sure to wear their masks at all times when out in public. Even if you’re just out taking a walk, please, please, please wear your mask.
I know some people might find it to be uncomfortable when they’re running or walking. Also, when you’re wearing a surgical mask and it gets moist from heavy breathing, it’s not as effective. But it’s still important to wear a mask when we can, to make sure we’re protecting no only ourselves, but everyone.