So You Wanna Be a Contact Tracer?

Last week brought good news and bad news when it comes to New Mexico's COVID-19 contact tracing efforts. On the bright side, the state will be receiving more than $77 million in federal funds for testing and contact tracing. On the other hand, Gov. Michelle Lujan Grisham says the state remains very short on actual contact tracers: it needs at least 670 people and currently has approximately 100. For now, the state is waiting on federal guidance on how to proceed.

In a nutshell, contact tracers identify and communicate with people who have been infected and those with whom they were in contact. The practice has been used for decades by health departments for a variety of illnesses, including tuberculosis, sexually transmitted infections and HIV, and the Centers for Disease Control and Prevention characterizes contact tracing as a key element in controlling the COVID-19 outbreak.

I wrote last month about digital contact tracing—apps to monitor and notify patients and contacts—and the challenges they face. These continue to unfold. As Politico reported last weekend, numerous states are now trying to develop their own apps with little success: North Dakota encountered spotty cell service with its rollout and Utah had to delay its app due to a technical mishap with GPS. New Mexico has yet to fully reveal its plans, although the governor previously said the state would be rolling out a pilot program with software company Accenture.

Privacy issues remain. A late April poll by the Washington Post and the University of Maryland reported close to three in five Americans would be either unwilling or unable to use the COVID-19 system Google and Apple are developing. And of the 82% of Americans who have smartphones, only half said they would use such an app. Just as mask-wearing has become political, so were responses to the survey, with Republicans more resistant to the apps and Democrats more willing to use them.

However digital tracing efforts ultimately fare, the need for actual humans to conduct contact tracing remains pressing. To respond to the need for more contact tracers, Johns Hopkins Bloomberg School of Public Health epidemiologists recently created a free online training course through Coursera. I learned of it from a WIRED magazine article by Megan Molteni, who notes that the US only has 2,200 contact tracers and potentially needs 100,000 to 200,000. Curious about what the job entails, she enrolled in the course. Equally curious, I followed suit. Although I'm not looking for a new job, I had imagined one that requires calling up strangers and asking nosy questions might be in my wheelhouse.

The course begins with a basic primer on COVID-19 by Johns Hopkins Associate Scientist Emily Gurley on the virus' origins, clinical signs and risk factors, followed by quick quizzes on signs and symptoms; diagnostic and antibody tests; intubation and infection periods. Having done little else but read and write about COVID-19 for the last six weeks, I sped through the introduction and, at the risk of sounding boastful about something sort of weird, did quite well on Module 1.

I started fading a bit, though, when I reached the nitty gritty of actual contact tracing, which involves calculating intubation and infection periods with specific people in order to calculate isolation periods for sick people and quarantine durations for healthy but exposed people, and following up with all of them.. This essentially turns into a very grim version of a grade-school math question. As detailed by Gurley:

"Let's assume that you identify a case, and you call them on May 10th. During the conversation with them, they tell you that they became ill on May 9th. So now you know that they were infectious for two days before they became ill, and they will be infectious for at least 10 days after their onset. So that means May 9th plus 10 days equals May 19^th…"

I skipped ahead to watch examples of both basic case and contact calls. In the first instance, a nice young woman named Amy Jones from the Hillside Health Department contacts Larry Murray, 73, recently diagnosed with COVID-19 and checks in with him as Murray, coughing, pleasantly cooperates. In the next video, Drew Evans contacts the impatient Annette Peterson to let her know she had spent time the previous Saturday with someone who was later diagnosed. "Oh my God!" she replies. "Are you sure? No! This can't be happening."

It occurred to me then I was much more likely to be the impatient hysterical person receiving such a call than the calm calendar-wielding person making it.  Nonetheless, I'm determined to complete the course and hopefully others will as well. While Annette's hysteria wasn't that pleasant, it was understandable. But the more people like Drew and Amy—informed and calm—the better.