As the U.S. experiences record-breaking surges of the coronavirus, communities across California have struggled to contain outbreaks of the virus. But in Santa Clara County, public health officials are offering a model for one possible recourse: building a massive network of contact tracers that’s ready to be activated at a moment’s notice.
Since March, the Santa Clara County Public Health Department has recruited a workforce of more than 1,000 contract tracers: about 350 volunteers, another 350 county employees redirected from other departments, about 150 state workers, about 100 county health workers, and an additional 50 more people hired specifically for contact tracing.
During periods of low community transmission, the county uses only a fraction of its contact tracers, “but we keep the rest of them ready in the wings with regular trainings and rotating days on service,” explained Assistant Health Officer Dr. Sarah Rudman, who leads the county’s contact tracing program. “They’re ready to hit the ground running within just a few days if our case counts really climb again.”
How it works
The contact tracing process is deceptively simple: When the county receives information about a resident who tested positive for the coronavirus, a contact tracer is quickly assigned to reach out to the person, first by text message and then by phone call. If the person picks up the phone, the contact tracer conducts an interview — typically 30 minutes to an hour — to uncover contacts who may have been exposed and to provide information on resources the resident can access during quarantine. Afterward, the contact tracer adds the list of new contacts to a database for her and her colleagues to call and inform of their potential exposure. If the person doesn’t pick up the phone, the contact tracer continues to call twice a day for three days while also sending an email with relevant information and resources.
Of course, it’s rarely that easy, said Constance McComb, an East Bay resident and Santa Clara County native who has volunteered as a contact tracer for the county since late June.
At the pandemic’s peak during the summer, she worked Monday through Thursday, “making a fair number of calls,” taking down names of contacts and trying her best to answer difficult questions. (The most common: When will a vaccine be ready?) Some of the calls lasted only minutes, while others — especially those requiring translation services for Spanish, Punjabi, Vietnamese, and other languages — could take as long as three hours. She has encountered a range of reactions — dismay, distrust, frustration, resignation — that she has had to navigate.
‘Some people are hesitant to share information’
“Some people are hesitant to share information with us, especially about their close contacts,” said McComb, a former lawyer currently taking classes to become a registered nurse. Others balk at the prospect of a two-week quarantine. “The hardest calls are those who are the only ones working in their household. If they don’t go to work, they can’t support their family.”
In response, the county offers a number of support services, including access to motels for people unable to quarantine at home, help with groceries and cleaning supplies, medical and behavioral health services, and assistance with rent and utility bills. Moreover, Rudman and her team have taken steps to ensure that contact tracers align closely with the demographics of the people they’re contacting.
“We have a lot of different strategies to help connect with people who, for very good reasons, might be reticent to answer a cold call from a government group,” said Rudman, who also serves as the STD/HIV controller for Santa Clara County. “We do everything we can to match our clients with folks who speak the same language and have the cultural sensitivity to have this conversation with you. That means making sure that the same communities getting hit by COVID are represented in our workforce.”
So far, those efforts have paid off beyond the health department’s highest expectations. As of Nov. 13, contact tracers have interviewed more than 80% of people they have attempted to reach, totaling more than 44,000 interviews.
More importantly, contact tracing has been proven to help mitigate potential spread: An analysis by the health department in late September revealed that about a quarter of all positive cases were previously identified as a contact. However, because these cases were alerted by contact tracers to their exposure to the virus, they were much more likely to already be in quarantine when they tested positive and almost twice as likely not to have exposed anyone during their illness, effectively breaking the chain of transmission.
“While we would like to do even better, we have done a remarkable job of successfully reaching people,” said Rudman. “At the end of the day, we find that most people want to help — help us, help their neighbors, help their family and household members, help their communities — and it’s only because of very reasonable barriers when they’re unable to do so.”
It has also meant a decrease in McComb’s caseload. She now only works on Mondays and Fridays, making three to five calls per day — though like her colleagues, she’s ready to take on more if and when it becomes necessary.
“It’s a very rewarding job. You’re talking to people, listening to their stories,” she said. “Most of the people I call are so willing to do this. Most people are good, most people are trying their hardest. I’d encourage people to think about volunteering. It makes all of this a little bit easier for everyone.”
Visit sccgov.org/sites/covid19/Pages/i-can-help.aspx to learn how you can volunteer.