Life as a Covid-19 Contact Tracer
What is contract tracing? Kimberly Jocelyn spends her days sharing information with people who have tested positive for the coronavirus and their close contacts who may have been exposed.
Courtesy NYC Track & Trace
Maybe you think you’ve had symptoms of Covid-19 or are just curious if you’ve been exposed to the novel coronavirus. There are expert contact tracers helping to answer those questions and making the connections between people who’ve had the virus and those who’ve been exposed to them. (Effective contact tracing was one of a few key elements in other countries’ successful containment of coronavirus.)
Nobody wants a call from Kimberly Jocelyn, a contact tracing supervisor for the New York City Health and Hospitals Test & Trace Corps. But taking her call and answering her questions could help the country slow the spread of Covid-19 and save lives.
This is the hope and promise of contact tracing, an ages-old method of infection control that is experiencing a resurgence during the current pandemic.
And Jocelyn is one of a growing troop of contact tracers employed all over the globe. These disease sleuths are tasked with interviewing individuals who have tested positive for Covid-19, identifying any close contacts who they may have exposed, and then providing those contacts with information on getting tested and monitoring their own health.
“The way that contact tracing in general works is by breaking chains of transmission between people, by working out who’s been in contact with someone who’s been diagnosed with Covid-19 during the time that they were infectious and asking them to self-isolate at home,” says Isobel Braithwaite, a public health expert at University College London.
This means that they don’t go on to infect as many other people, which is particularly important with Covid-19 since people can be infectious for a couple of days before developing symptoms, and in some cases, they don’t show noticeable symptoms but can still be infectious.”
Contact tracing is a growth industry
In an economy where jobs are sparse, contact tracing jobs are plentiful. As it stands, there are about 66,000 contact tracers in the United States, up from 2,200 in the pre-Covid days, according to the American Medical Association.
And even this isn’t enough. At least 100,000 or more are needed to slow the spread of Covid-19 as social distancing restrictions are lifted and more funding is needed. Much of this is funded by the federal government’s Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020, but more money is still required to hire and train contact tracers. Some countries have national tracing plans in place, but in the United States, these efforts are predominantly local.
Contact tracing works
In the last century, contact tracing has been used to track the spread of syphilis and tuberculosis along with helping control epidemics like the Ebola outbreak in Africa and the 2003 SARS outbreak in the United States.
There has always been a fear that contact tracing might disclose certain private information, particularly sexuality and sexual behavior when tracing STDs. But when you participate in contact tracing for Covid-19 with your state or local health department, your information is secure and kept private.
Jocelyn, a 29-year-old social worker and graduate of the Columbia University Mailman School of Public Health in New York City, says that the contact tracing job found her in many ways. Before, Jocelyn worked with the Centers for Disease Control and Prevention (CDC) and manned a quarantine station at John F. Kennedy International Airport. When she saw a contact tracing ad on Facebook and quickly applied.
Her public health background and experience made her a natural fit. “It doesn’t feel like work because I am so passionate,” she says. “Preventing just one Covid-19 transmission can make a huge difference.”
All contact tracers participate in a three-week training program before they hit the ground. Training includes a Johns Hopkins Bloomberg School of Public Health online course, which covers the basics of interviewing people diagnosed with Covid-19, finding their close contacts, and providing counsel and support. “Contact tracers learn how to respond to different scenarios with scripts, how to overcome bias and incorporate cultural competencies so they can serve everyone,” says Karla Griffith, a spokesperson for NYC Test and Trace.
Courtesy NYC Track & Trace
A day in the life of a contact tracing supervisor
Jocelyn’s day starts by putting on her headphones and logging on via her laptop from her home in Prospect Heights, Brooklyn. She reviews any company-wide protocol or script changes and new data or trends, such as the rise in cases in millennials, before reaching out to her team of 17 tracers and information gatherers to share any new developments.
And then she really gets into the meat of her work. New York State law and the New York City Health Code require laboratories to send positive test results to the NYC Health Department, which NYC Test & Trace Corps receives directly.
It is Jocelyn’s job to reach out to individuals who have tested positive for Covid-19 and those people who they may have exposed. Information gatherers help her collect all of the relevant details. She typically makes about 50 calls a day.
“I say, ‘Hi, my name is Kim, and I’m calling from NYC Test & Trace,’ and make sure that I have the correct person on the phone before proceeding,” she says. “I won’t disclose information unless I first verify who I am speaking with.”
It is a confidential process so Jocelyn does not reveal how they were exposed or who may have been the source. Sometimes an infected person beats her to the punch by telling their close contacts before she has a chance to call; that is more than OK, says Jocelyn. Because most of the time she’s the bearer of bad news.
Sometimes the person doesn’t want to hear the news—or anything at all. “That’s OK. I don’t take it personally,” says Jocelyn. “If they are not willing to talk now, they can always give us a call back.” Others are confused about how they may have contracted Covid-19; so the job involves some hand-holding, which she can pull from her social work background and training.
It can be difficult to be on the receiving end of the call, she admits.
Most people, however, are willing to talk. When she calls a person who has tested positive for Covid-19, Jocelyn asks about their health as well as who they have been around recently who may be at risk. This list includes housemates, sexual partners, or people they’ve spent 10 minutes or more in the company of minus social distancing and mask-wearing.
Just remember, warns Jocelyn, there are some things a contact tracer would never ask, such as credit card or bank account information or a Social Security number; and they wouldn’t need to take control of your computer or require you to download software.
There are other tracers who go to homes to contact individuals who can’t be reached any other way. “Community engagement staff knocks on doors to let individuals know they have tested positive or that a contact has identified them to get as much info as possible,” Griffith says.
Cases yield contacts
Most “cases” yield two or four contacts who are then called and encouraged to get tested and isolate until they receive results, explains Griffith.
Exactly how long a person is asked to isolate to prevent the spread of Covid-19 varies, but two weeks from exposure or as long as there are symptoms is typical. It’s a big ask, she admits. “For some, it is difficult to separate because they are caregivers, have jobs, and have a family and may not feel sick,” says Jocelyn. Contacts also receive education and support, including how to monitor for signs of illness.
The relationship doesn’t end here. Tracers also reach out during the infectious period. “Mostly, people are happy to have someone check in on them,” Joceyln says.
Contact tracing road bumps
Historically, contract tracing has played a huge and important role in getting control of diseases, says Len Horovitz, MD, a pulmonary specialist at Lenox Hill Hospital in New York City. “For it to be truly effective in slowing the spread of Covid-19, we need quicker and more reliable Covid-19 testing with a shorter turnaround,” he says. As it stands, it can take up to two weeks to get results back. “Since many people have no symptoms, they could be taking the subway for five or six days before they get called and can’t possibly know who they have exposed.”
Many apps are now being tested and developed to aid the contact tracing process, but it’s still too early to rely solely on these digital trackers, according to a review in Cochrane Library.
There are countries that rely on downloaded smartphone tracker apps for contact tracing using technology from Apple and Google that exchange Bluetooth signals to keep an anonymous list of close encounters. These apps then allow people who test positive to notify contacts anonymously. Apps are not ideal on their own because at‐risk populations may not have internet access or digital technology, the study authors point out.
“Contact tracing apps could potentially detect and notify anyone a person with Covid-19 has had close contact with for long enough to transmit the virus while they were infectious, even those whose name and contact details they don’t know (for example due to time spent in a public place or on public transport),” says Braithwaite.
But we are not there yet. “One of the big challenges many countries seem to be experiencing is in getting enough people in the population to use these kinds of apps,” she says. “Our research suggests that between 56 and 95 percent of the population need to have an app for it to be really effective.”
There are also unanswered questions about whether apps are as effective at persuading people to self-isolate if they’re identified as a contact, she says. In the future, apps may augment manual contact tracing, but until them Jocelyn and other contact tracers are on the job.
- Kimberly Jocelyn, MPH, MSSW, case investigator, New York City Health and Hospitals Test & Trace Corps
- Centers for Disease Control and Prevention: "Identify the Primary Components of Covid-19 Contact Tracing"
- Isobel Braithwaite, public health expert, University College London
- Karla Griffith, spokesperson, New York City Health and Hospitals Test & Trace Corps
- American Medical Association: "Experts: Here's how many more contact tracers U.S. needs"
- National Coalition of STD Directors: "STD Contact Tracing"
- Lancet:"Automated and partly automated contact tracing: a systematic review to inform the control of Covid-19"
- Len Horovitz, MD, pulmonary specialist, Lenox Hill Hospital in New York City
- Cochrane Library: "Digital contact tracing technologies in epidemics: a rapid review"