Inside the world of COVID contact tracers: Empathy, persuasion, persistence
Photo: Brian A. Pounds / Hearst Connecticut Media
Like many during the coronvirus pandemic, they work alone. But they’re part of a crucial public health effort
Their mission is to speak every day with anxious, uncertain, sometimes-sick people with whom they often become the only daily lifeline in the statewide campaign to beat back COVID-19.
Connecticut’s 85 volunteer contact tracers are sometimes the first to give the serious news to patients that their COVID tests are positive.
Then gently, using diplomacy, empathy and training from the nation’s top coronavirus experts, the tracers try to find others with whom the infected might have spent 15 minutes or more, enough time to transmit the virus.
This kind of outreach is a tried-and-true method to stop the spread of infections, from sexually transmitted diseases to HIV/AIDS. And this new generation of trackers has been crucial over the last few months in the effort to stanch the state’s COVID crisis, its 52,500 infections and nearly 4,500 deaths.
Contact tracing has a new urgency during the coronavirus pandemic, as teams of students in medical programs were recruited to the front lines of tracking COVID, while supplementing other professionals from local health agencies and the state Department of Public Health.
For Tim Klufas of Easton, the son of a doctor, it’s a way to give back after his personal COVID-19 nightmare back in April.
Emily Bean, of Shelton, wanted to get involved in the community as part of her master’s program at the University of New Haven. Now, her daily phone calls have become a personal mission.
Sabiha Tamina, a second-year medical student at Quinnipiac University, got involved in the DPH’s pandemic emergency response after her program was shut down in the pandemic. With skills in interviewing, she quickly became a team leader.
Veronica Sirur-Flores, in an accelerated nursing program at UConn, has been using her bilingual abilities to assuage the fears of infected people whose legal status may be an additional burden at a time of high unemployment in under-served communities.
‘We’re not telemarketers’
The DPH volunteers work the phones about two hours a day, referring to lists of infected people who they remind to self-quarantine for 14 days unless symptoms flare up to the point when they need hospitalization. The tracers also plumb the memories of patients for contacts.
“For the most part, in my experience, people are very grateful,” said Sirur-Glores, 42. “I am Spanish-speaking and most of my calls are to people that are monolingual, so they are very nervous and afraid, but they are very grateful that someone is calling them. The few times that I had to deliver the news of a positive test, they were kind of like expecting the results because they were feeling very sick, or they had a family member who was very sick and they were all living in the same household unit, so they were feeling more grateful, more than anything.”
“You have to explain that you’re not trying to sell anything,” said Klufas, 25, another team leader who is in a UConn public health certificate program. He was “humbled” by his COVID experience of several months back, and now leads a team of volunteers. “We’re not telemarketers. We say we’re really from the state doing this. It’s building the trust.”
They verify patients through their dates of birth, and the nine teams of volunteer trackers are trained to let them vent, but to eventually focus on others they might have spent time with. It’s usually other members of their households and families.
“Sometimes I think they’re just stressing their frustrations to us, which is important,” Klufas said during a recent virtual interview with the Hearst CT Media and Bean, Tamina and Sirur-Flores. “You have to let them talk and listen to the person and see what their thoughts are, and then see what you can do if you’re able to provide them some relief.”’
Some friendly, some mistrustful
The contact tracers say it’s only a small percentage of people they call who refuse to respond; the vast majority cooperate.
“Maybe they’re not 100 percent happy to do so, but they’re willing to participate,” Kulfas said. “Those who completely refuse and are rude and stuff like that, I’d say like they’re maybe 2 percent who are very angry and very upset by it. They are few and far between, surprisingly.”
“I found that even the time of day that we’re calling has a lot to do with how open people are,” said Bean, 23, who will soon become a team leader as well. “When we call during the day, during traditional business hours, I felt like people are more open and more trusting to our process and what we’re doing. On weekend evening calls, people have more distrust.”
Often, patients assume, incorrectly, that the tracers are calling from a testing center. “People think we’re a health care organization, so calmly and comfortably, we go over with people what our role is, to establish that trust,” Bean said.
When the tracers began in June, after training, there was a lag between the nasal-swab testing of potential patients and the results coming in for them.
“So a lot of times we would be calling and we’d be the first people they’d talk to, delivering their test results,” Bean said. “So I think that our role was crucial there, because a lot of people were tested and were asymptomatic and were just going about their daily lives, but tested positive.”
Asymptomatic spread is a major concern of state health workers and Gov. Ned Lamont.
“Yes, there is a lot of hesitation,” said Tamina, 25, “There is a lot of mistrust, but sometimes I have had experience where they have been very amiable. They actually just pass the phone along and you end up tracing all of them because that’s their contact, right? It’s their household.”
The tracers describe their roles broadly — to make sure the contacts don’t have symptoms and if they do, to help them find the right resources. “Once you start having that conversation with them,” Tamina said, “and they see that you’re not just calling for a statistic or to place blame, for the most part it ends up being better than not.”
Making a difference
Many patients and contacts live alone, and tracers are sometimes their only daily human contact.
“This is such an odd disease,” Tamina said. “If you have symptoms and you’re not dying, you’re supposed to stay at home.”
“I do remember a lady that I could tell this person was very, very anxious about the call, about the whole situation,” Sirur-Flores said. “She didn’t want to disclose symptoms. She didn’t want to disclose any contacts. I tried different techniques to listen and I was able to get a little bit of information in about the length of quarantine and how to quarantine and things like that.”
The person eventually accepted the daily calls. “Of course she didn’t provide any contact information,” Sirur-Flores said. “You can tell that some people are just having a very tough time.”
While the coronavirus pandemic paralyzed the state for months and has devastated much of the hospitality, dining, entertainment and bar industries, when COVID hits home, some people forget the public health protocols.
“One person I contacted, they had a person in the household test positive but they said ‘Oh, they lived in the basement, they did this, this and this, but we want to go to Maine and see my grandparents.’ And I said that you really shouldn’t do that because even though you don’t feel sick, you’ve only found out two days ago that they tested positive,” Klufas recalled. “They said ‘Oh, we didn’t think about it that way.’ Later I said okay, I’ve made a difference today.”
‘The opportunity to educate’
At the end of individual interviews, the tracers ask patients or contacts if they have any questions. The responses are an indication of their overall knowledge.
“It really gives you a sense of their world view,” Bean said. “So it’s a good opportunity if they’re asking you a question like: ‘Oh, now that I tested positive, I’ll just get through this and I’ll be safe and I’ll never get it again.’ That’s the opportunity to educate them and say it’s not true, you still need to be practicing all of these recommendations. You still need to stay safe.”
“They might ask questions as far ‘as I wonder who I was exposed to?’” Tamina said. “But for the most part, people were aware of it. They know it’s something serious and ‘maybe I should isolate.’” She said that some patients don’t want to invade the privacy of potential contacts, but the tracers protect everyone’s identities. “Contacts who have been called are more like: ‘OK, thanks for letting me know. I’ll make sure I’ll be quarantining to be safe.’”
Sirur-Flores recalled an adult who was feeling sick and a child in the house tested positive, but the mother was going to send other children away to relatives in attempt to dodge the outbreak.
“She didn’t realize they were already exposed, so it was going to be worse because it was going to spread to the other household and the other family,” Sirur-Flores said. “So through that contact tracing she was able to talk out loud, think about the repercussions, and contact her health care provider. I definitely see a big difference, especially people keep thinking that if you have been exposed and you have a negative test, you’re safe. You may still be infected when you are leaving the household.”
In another case, Sirur-Flores was able to speak with a child who disclosed some symptoms that their father hadn’t known about. “Kids don’t always have the right words to express how they feel, especially if they are little ones, five, six, those ages, you know, before school-age,” she said.
When Klufas and Tamina started in the program, the list of daily calls was huge. But infections statewide declined and the daily positive rate has stayed at or below 1 percent for months, the caseload has become easier to manage, they said.
Laurie Ann Wagner, a project manager with the state Department of Social Services who heads the contact-tracing program, says the volunteers have gone above and beyond in their efforts.
“The commitment, the work ethic, it blows my mind,” Wagner said. “And our team leaders take it to a completely different level. It’s like a part-time job and they are doing it as volunteers because they are committed to the mission and it has just been an amazing experience.”
In all, there are more than 725 contact tracers, including local health departments and the DPH. In August, Connecticut has averaged 96 new cases a day.
“Now we’re at a very manageable level, and some days there are very few calls to make, which is impressive,” Klufas said. “The first day, we had like a giant list every day. But just because we’ve ramped it up so much, we’re able to manage it and actually reach every person every day within 24 hours of them entering into the system.”
“Sometimes when you’re doing a case or contact, you can see it working before your eyes, too, which is quite amazing,” Klufas said.
He remembered one patient on a weekend night who got very upset. “He was probably the meanest person I’ve talked to on the phone while doing this, and then I just said I was sorry he feels this way, I was understanding. Obviously he was going through a lot and it’s hard to be in someone else’s shoes and see if there is like a work problem, family and how it affects them,” Klufas said. The patient disconnected.
But an hour later, the man called back.
“He said ‘you know, I was just thinking about this and I’m really sorry, and you were so nice to me and you really changed my view on this,’” Klufas said. “He said ‘I just wanted to apologize at how rude I was. You didn’t deserve it. You didn’t do this to me. I just wanted to thank you for what you’re doing. You’re right, we’re all in this together.’”
It made Klufas’s Saturday night.
“You get those moments that are really impactful that shows you this works, and you’re able to make a connection with people and cause some change,” he said.
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