Contract tracing has been around since at least the early 20th century and it remains one of health care's most critical infectious disease responses.
Melissa Graven, McLean County Health Department's communicable disease supervisor, said tracing who infected people have been around is more critical during COVID-19 because hardly anyone is immune.
Interviews have been edited for clarity.
Graven: Traditionally, when we're doing contact tracing, it's with diseases we very much know the disease processes. We know lots about them. We do a lot with STDs, gonorrhea, chlamydia, the community may remember when we've had mumps outbreaks, contact tracing was something we did a lot with mumps outbreaks as well. But the difference is we had a lot less susceptible people because we've got a vaccine. We really were only trying to identify those susceptible people to get them to quarantine, as opposed to nobody has immunity and everybody's at risk, if exposed.
WGLT: The other part of the problem is you have to get them to answer the phone first. What kind of success rate have you had in getting people to answer if it comes up as a contact tracer, or maybe an unknown on their ID when people don't answer the phone unless they know exactly who's on the other end?
Graven: I think that's interesting. It’s a trend I've seen just as a nurse in my 15 years, nobody answers their phone anymore. They want a voicemail or a text message. They'll always respond to a text message or voicemail. Now the callback is the problem. We have seen the callback rate kind of drop down with COVID when they hear it's the health department calling. That's always been kind of a struggle, but I think particularly now when they know what's on the other end of that call, or think they know what's on the other end of that call, they may not want to call back.
WGLT: How often do you have to deal with false information, where people give you a bogus number or they give you something that is not helpful?
Graven: Unfortunately, it does come up, we do have instances in which we were given incorrect phone numbers, incorrect contacts. I will say that we very, we don't get a lot of people giving us names just because they want to get somebody in trouble or, ‘They don't like me so they gave me my name.’ Very rarely have we ever had those instances. It’s more, ‘I'm going to give you a fake name and a fake phone number, so you think I have contacts and send you on a wild goose chase.’
WGLT: How much does skepticism about many of our public institutions play into this? We're just naturally resistant sometimes to want to cooperate because there's an agenda, who knows what they're looking for, what they're trying to do? How much of it is that?
Graven: A good portion of it is that we are a government agency, there is a portion of the community that that has an inherent distrust in government.
State software helps data harvesting
The McLean County Health Department (MCHD) praises a new software program from the state that it's using to to handle contact tracing. Graven said the program comes at no cost to the county, it's been easy to use and it helps the agency harvest more data to develop a targeted public health response. Graven said the Salesforce program also would be useful to track other infectious diseases and food-borne illnesses, but it's not clear if the state will offer access to it after the pandemic.
Falling behind
McLean County has been rapidly hiring more contact tracers in recent weeks, but it hasn't been enough to keep up with a late summer surge in coronavirus cases. MCHD has hired more than two dozen new tracers this summer and plans to bring on about 10 more. Graven said the recent decline in new coronavirus cases has helped somewhat.
Graven: I have heard from some staff telling me, they feel like they can breathe a little bit, knowing that there's more people in house that can help. They are not seeing like 100, 200 cases reporting out every day, they're seeing the 15s and 20s, so they can come into work seeing it's a little more manageable. I don't think any of them feel like we're caught up yet.
The tracers in our program are very Type A kinds of people. They want to be excellent at their job, and they want to get to people as soon as that result comes in as soon as it hits our queue. They do feel a little bit defeated, I think, because they can't get to them as fast as we want to. They're managing their expectations and managing their own need to want to be perfect and make sure every single person gets contacted as soon as possible. That is just not something we're going to change in them, which is a wonderful quality, but it does make for them to feel a lot of pressure. It makes it very hard to turn off COVID, it makes it hard for you to relax knowing there's still so many people call.
WGLT: Is there a point where a virus has spread in the community to such a degree that contact tracing becomes such an uphill battle that it becomes futile. Have we approached that point, or could we potentially approach that point?
Graven: Absolutely. Contact tracing is most effective in the acceleration phase of an epidemic, meaning you are still able to get on cases and rapidly identify them and make contact with them in their contacts and quarantine their contacts.
There's been a lot of things kind of working against us for that, namely, testing and the turnaround of testing. If it takes five or six days to get your test result, and then another one or two days to get to us, we're already kind of behind on that anyway. We're getting you towards the end of your quarantine. But yes, there is an instance in which it is so prevalent in the community that contact tracing doesn't work and that's when you start seeing mitigation efforts coming in.
Role play
WGLT: This role play issue gets to other questions that we hear in the public sphere about the health department's role in managing pandemics, such as schools deciding whether to reopen, such as when Bloomington and Normal adopted their own emergency orders to limit crowds and perform additional surveillance and businesses. We sometimes hear why isn't the health department making these calls or taking [the] lead on them? The health department has the expertise, after all. Can you explain what role the health department plays in these decisions that other government bodies are making?
MCHD Administrator Jessica McKnight: We're definitely here to provide the guidance and that guidance is what we also receive from the Illinois Department of Public Health. That's who we refer to for our guidance, and they refer to the CDC. We’re charged with bringing that guidance to the local level, seeing what's going on in our community and how do we implement that guidance here locally. Even if we are not always out there publicly saying, ‘The town should do this, they should do that,’ we're definitely having those conversations and sharing the guidance with our community partners, being involved in their discussions as they're planning ahead.
WGLT: We're six months into the pandemic with not a clear end in sight. No one has all the answers even now, and certainly nobody did back in March. What lessons has the health department learned since then? (Is there) anything that you would have done differently since we've now learned about the effectiveness of masks? There was a question back in March, being outside was a big difference from being inside, those kinds of things. But anything else on the local level that is more clear now than was back then?
McKnight: I think the only thing that's really clear is that we don't know, and things continue to change. That has been difficult and it's been a lesson learned that it's difficult to instill that confidence in the experts when it appears that they're changing directions, but that's science. That means that we're doing what we should. Looking at the medical field 100 years ago, (it’s) much different than it is now because of what we've learned.
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