“I’m calling because we have reason to believe that you may have been exposed to someone with COVID-19.”
Those words, and the people who speak them, are at the forefront of the virus fight.
Through an unmarked door and down a flight of stairs is a windowless basement room where some of Park County’s most important COVID-19 mitigation takes place. The fluorescent-lit office, filled with a bay of computers and phones, a couch, and Wyoming maps decorating the walls, serves an unassuming juxtaposition to the impactful work taking place in its confines.
Park County’s two contact tracers – Kate Murphy and Julia Tracy – have been making countless phone calls since early July, in their efforts to curtail the virus’ spread locally.
“I like being involved in the response and trying to educate people about what is going on – what’s true, what’s not true,” Tracy said.
There are two groups of people to whom the contact tracers make calls: those who are already confirmed to be infected, and those who may have been infected by another person.
Piecing the two together is a little like playing Sherlock Holmes for these tracers, except the only evidence they have to go off is the information provided in their calls. As they go down the list when tracing, finding more symptomatic people is a clear sign of spread.
“You see the ripple effect,” Tracy said.
When one person infects another, a domino effect can occur throughout a community. How many contacts individuals may make can vary based on their lifestyle, any public events they’ve recently attended and their occupation.
Dr. Aaron Billin, Park County Public Health officer, said most of Park County’s infections have been related to indoor public gatherings such as weddings, parties and bars.
“Some kind of setting where people didn’t seem to be taking precautions,” said Bill Crampton, Park County nursing manager.
Billin said nearly all outbreaks have disappeared since July 4.
Wyoming as a whole has done well preventing infection, with the sixth lowest rate of reproduction for any state, at an estimated average of 0.9 people per infected case.
Tracers are enlisted to ask about the nature of exposure people have had to those infected.
To be considered at risk for COVID-19 infection through contact, one must be within 6 feet or less for more than 10 minutes without wearing a face mask. The type of interaction is also critical, as enclosed spaces, sharing of food or drinks and touching can easily lead to transmission.
“They don’t automatically know unless people give that information (to them),” Billin said.
Placing the calls
Tracy has a positive outlook on her work and said most people have been candid in their conversations, with only a “few disconnected phones.”
“I think I can count on one hand the number of people that were really upset,” she said. “I certainly understand. I’m not going to be able to go work for the next 10 days, what am I supposed to do?”
Those who test positive or are ordered to isolate for the coronavirus have their information referred to the contact tracers who give them a call.
“Just asking, ‘How are you? You’ve just had this positive test, how are you feeling?’” Tracy said.
An isolation or quarantine order comes with a letter by Dr. Alexia Harrist, Wyoming public health officer, threatening legal prosecution if not abided by. Crampton said he sees this order as no different to the fine print included on many legal documents.
Individuals who test positive need a confirmation with a public health employee after at least 10 days before returning to work.
Contact tracers will also provide resource documents from the Wyoming Department of Health and other state services to individuals, and ask them to monitor their symptoms twice a day for the following 10 days. The tracers will typically make at least one more phone call to these people, but also request people to call back if their health deteriorates further. Tracy said many of the people she has spoken with do not start feeling symptoms until after testing positive.
WDH has been keeping a database that tracks the rate people experience certain symptoms like fever, dry cough, shortness of breath, muscle aches, early fatigue and headaches, with the contact tracers providing the state their share of the statistics.
Park County Public Health also is requested by WDH at times to perform contact tracing for sexually transmitted diseases. The COVID-19 contact tracing is merely a new extension of the department’s work, Crampton said.
“Even in public health nursing, you do an assessment whether you really realize it or not,” he said.
The tracers run through their questions organically, flipping back and forth through different sections of their questionnaire packets as the conversation twists and turns. They pose inquiries about symptoms, past medical history, what food or medications they have at home, and the million dollar question – with whom they have been in contact.
When calling possible contacts, the tracers try not to reveal the identity of those who have tested positive, out of respect for those people’s privacy.
“I’ll say, ‘Do you have any idea who I’m talking about?’ And they’ll say, ‘Yep, John Smith called me,’” Tracy said.
She also said most possible contacts have already been alerted they will be receiving a call from the tracers.
“Most people are really pretty concerned about somebody they may have exposed to,” she said.
In its typical duties, Public Health initiates home visitation services, immunization testing and emergency preparedness. Before Murphy and Tracy were hired (with CARES Act funding), full-time Public Health staffers had been performing contact tracing since mid-May with assistance from WDH.
“Adding contact tracing, which is a very time-consuming process, to that put a lot of pressure on my staff,” Crampton said.
Murphy worked with Public Health for more than 25 years while Tracy is a nurse who has volunteered for the department in a few different capacities.
When the pandemic first started, Tracy informed the department she would be willing to participate. After helping with an initial phone bank and some food drive efforts, she was tapped for the tracer role.
“This was just right up my alley,” she said.