‘You just see the stack rising.’ Pierce County contact tracers try to slow COVID-19 spread
Normally, David Carr is a chemical dependency professional — meaning he works for the county providing counseling to residents coping with addiction.
It’s a job Carr is well suited for, he says, because he’s good at talking to people and he enjoys helping.
Recently, however, Carr, 53, has spent his work days doing something different.
On a Tuesday morning earlier this month, Carr was stationed at his new post — wearing a mask and manning a telephone — preparing for another shift working as a case and contact investigator for Tacoma-Pierce County Health Department.
While the health department always employs a small team of disease investigators to help limit the spread of communicable illnesses like tuberculosis or norovirus, the coronavirus pandemic has necessitated an expansion of these efforts, aided by funding allocated through the federal CARES Act.
At the outset of the coronavirus pandemic, the county employed 10 disease investigators, according to Tacoma-Pierce County Health Department spokesperson Steve Metcalf.
Currently, there are 27 case and contact investigators working for the county, not including support staff. In total, the county has trained “about 94 investigators, made up of staff and volunteers, who are available as caseloads increase,” Metcalf adds.
Metcalf says there’s a long-term plan to employ 180-200 case and contact investigators if needed.
“The size would be scalable based on a surge in cases,” Metcalf says.
The important work these contact tracers conduct now takes place on three floors of what Tacoma-Pierce County Health Department refers to as its “overflow building,” which is a nondescript office building across Pacific Avenue from the department’s main headquarters.
Here, since May, the county’s case and contact investigators have gone to work trying to reach residents who have tested positive for COVID-19 and those they’ve possibly infected.
Metcalf describes contact tracing as “one of the most effective tools public health has to identify COVID-19 activity in our communities and stop the disease from spreading.”
“Until we have a vaccine, we’ll lean heavily on contact tracing to help keep Pierce County residents healthy and safe,” Metcalf added.
Carr is one of many local people who have stepped up to help with the county’s COVID-19 contact tracing response.
Like roughly half of the county’s expanding team, Carr says he was “activated” for the position, or pulled away from his normal chemical dependency work at the health department to help fill the emerging need.
Carr is happy to help.
“Contact tracing is just like counseling. It’s helping people through a difficult situation,” Carr says.
“I help people. That’s what I do.”
Making contact
Every morning, according to Kelsie Lane, a brand new stack of confirmed COVID-19 cases arrives.
Lane, who typically performs restaurant inspections for the county, has served as a team leader in the health department’s case and contact investigator unit since May. Expecting her first child, Lane said she plans to continue the work until November.
When the new cases arrive, Lane and her team of contact tracers get to work.
The first objective, Lane says, is to make contact with the person who has tested positive for COVID-19 within 24 hours of receiving the case.
Over the phone, the county’s contact tracers provide people with instructions on how to effectively isolate, and help connect them with services — like rental assistance, child care or a spot in the county’s temporary care site — to make the voluntary isolation feasible.
Most people are aware of their test results, Lane says, though occasionally a contact tracer breaks the news. These conversations can be particularly difficult, she acknowledged.
“We know that it’s scary for people to receive a phone call from the health department,” Lane says. “It’s trying to find a way to have that conversation with somebody and put them at ease. It can be a pretty delicate balance.”
Next comes what can often be the more difficult part, the investigation. During the initial phone call, Lane says, county contact tracers work to identify anyone the infected person came in close, unmasked contact with, particularly over the two days prior to showing symptoms.
Scratching names and hopefully phone numbers on a case contact list, a collection of relatives, coworkers and acquaintances hopefully emerges, she says. If possible, these people will be contacted by phone within 24 hours.
If a potential COVID-19 hot spot emerges — like a restaurant or place of work that can be traced to more than two cases — the information is forwarded to the health department’s facilities division for further investigation, Lane adds.
Sometimes, the contact lists generated by tracers are long. Other times, they’re short. The goal, Lane explains, is to reach everyone possible, informing them that they’ve come in contact with someone who has tested positive for COVID-19 while encouraging them to voluntarily quarantine.
A frequent concern, Lane says, is employment.
Many people have only recently returned to work as Pierce County moved into Phase 2 of Gov. Jay Inslee’s reopening plan, she says. Now — with a positive COVID-19 test or the discovery that they’ve been in close contact with someone who is infected — they’re being asked to take roughly 10 to 14 more days off, and possibly longer.
“I think a big source of anxieties is work … (and) money. They want to know, ‘How am I going to get through this?” Lane says. “We want to do whatever we can to facilitate them being able to isolate. So whether that’s connecting them with rental assistance resources, or unemployment resources, or just making sure that they have … someone can deliver them groceries. It’s just having those conversations with them, to set them up for success and to make sure they’re going to be able to get through their quarantine or isolation period.”
Though both the isolation and quarantine are voluntary and people are free to refuse, the vast majority understands the importance of complying, Lane says. She notes that her team also attempts to follow up with those in isolation and quarantine on a daily basis.
“We have a lot of people who are awesome and cooperate, who are doing the right thing for the community. It’s wonderful, and we super appreciate it.” Lane says. “Some days are harder than others, but I think overall we have really good success.”
That’s not to say the work is a cakewalk. Occasionally, Lane says, contact tracers reach someone who has no interest in cooperating. Some people are reluctant to provide contact information for those they might have infected, while others simply hang up the phone.
Then there’s the workload itself. There are people staffing the health department’s contact tracing team seven days a week, taking only half-hour lunches and two 15 minute breaks per shift. On average, a contact tracer works two or three cases a day, Lane says.
With the recent uptick in positive COVID-19 test results in Pierce County, it’s necessary staffing.
One recent Monday, 60 new cases arrived at Lane’s office, a dump that she said required “all hands on deck.”
“You just see the stack rising. It’s a little stressful,” Lane says.
“I hope we don’t have too many more days like that. I can’t predict the future, but I hope that.”
‘Every phone call is different’
Like Carr, Abraham Acosta typically works elsewhere in the health department. In normal times, the 48-year-old is a medical assistant in the health department’s STD and HIV clinic.
Acosta’s parents immigrated to the United States from Mexico. He was born in the United States.
He remembers serving as a translator for his family growing up, he says. With a disproportionately higher rate of COVID-19 infections affecting Pierce County’s minority populations, it’s a skill Acosta is grateful to be able to bring to his current job, however long it lasts.
“I’m first generation. I’m the son of immigrants here. I have a big passion for service because of that ability that was bestowed on me at a young age. Being able to speak two languages, Spanish and English, it puts me in a great position to help people that were exactly like my parents … in a country that’s not their own, struggling to get by,” Acosta says.
“Every phone call is different. Everybody’s scenario is different. But an underlying theme … is to be able to diminish that trepidation, and allow the client to realize that this is a human-to-human interaction,” Acosta adds. “It’s very, very important, and for me it’s just another opportunity to be of service to the people of this county, and that’s what drives me.”
Unlike Carr and Acosta, Ron Morris was sitting at home when the coronavirus outbreak took hold.
Morris wasn’t “activated” for anything, he says, except out of retirement.
A former family physician, Morris, 69, worked most of his career in Puyallup and on Joint Base Lewis-McChord.
Morris says his medical background helped him quickly understand the threat of COVID-19, inspiring him to volunteer for the county’s Medical Reserve Corps earlier this year.
Morris’ volunteerism quickly led him to the county’s contact tracing division, where he was hired out of retirement, full-time, roughly two weeks ago.
Morris describes COVID-19 as “the pandemic of his lifetime.”
“I just felt that I couldn’t stay home and work on the yard or work in my woodshop and not be involved,” Morris says.
“I just want to get this over with, so everyone can get back to a fairly normal life.”
This story was originally published July 9, 2020 at 5:00 AM.
