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Lisa Abramson, contact tracer: A lot of my family members and friends had been affected by this terrible disease. And I really wanted to help out in some major way.
Dr. Sanjay Gupta: That’s Lisa Abramson, a contact tracer in New York City. She’s one of the disease detectives now charged with tracking down anyone who may have interacted with a person infected with the coronavirus.
To help stop the spread, Abramson reaches out by phone to people who have recently been diagnosed with Covid-19.
Abramson: You ask some of the questions, you know, have you contacted anyone or have you had sex with anyone? We often ask them to, you know, if you can pull out your cell phone and look at your calendar to see where you were around that time so that we can get the accurate information.
Gupta: Contact tracers in the United States rely on people trusting them enough to give honest information to those kinds of questions.
So it can be a very difficult job.
There’s no one federal agency overseeing the contact tracing efforts, so exactly how it works varies from the state to the local level.
And even though contact tracing has been used to contain a variety of diseases over the decades — from smallpox to HIV — it’s never been done in the United States at the scale now required to tackle Covid-19.
So are we up to the task?
Syra Madad is the senior director of the special pathogens program office at New York City Health and Hospitals. She was featured in the Netflix series “Pandemic,” which remarkably was released this past January — a month before news of Covid-19 became well known in the United States.
Madad has been instrumental in guiding the largest public health care system in the country through this outbreak. She’s now helping train what she hopes will become an army of contact tracers in New York City.
Dr. Syra Madad, senior director, system-wide special pathogens program, New York City Health and Hospitals: We’ve never done this before. It’s obviously taking an army of people to be able to, you know, strategize and then move forward with this current strategy, that is a core public health tenet.
You know, public health has been doing this for, for decades. You know, obviously for foodborne illnesses, for infectious diseases, sexually transmitted diseases, so this is not something new.
If you — even if you look at smallpox, you know, it was eradicated in 1980 not because of immunizations, but because of really rigorous contact tracing.
So it works, but it has never been used to this type of magnitude.
Gupta: A lot of people are becoming familiar with this term “contact tracing” over the last few months. But can you break it down?
Can you just give an example of what it might look like if someone is tested and their results come back positive? What happens in a situation like that?
Madad: When you get that call, they’re gonna ask you, “Basically two days before you were diagnosed with Covid-19, tell us where you’ve gone to and who you’ve come in contact with.” So you want to figure out who those close contacts are and then follow up with them and, you know, and see have they been exposed and then provide them various counseling resources.
And I think one thing that’s very unique here in New York City is actually providing them wraparound services. So letting them know that, you know, if you need to get food, if you need to get anything, we’ll help set that up. So that way you don’t have to leave your home because, again, as soon as you leave your home, then you’re risking, you know, transmitting the disease to other people.
The other thing is if you can’t stay in your home, for those types of scenarios, we have isolation hotels in New York City. So if you can’t safely isolate at your home, then they’re going to put you up voluntarily, if you want to, in an isolation hotel or a quarantine hotel where you’re going to get food and all those various services and health checks for whatever period of time that you’re infectious.
Gupta: If I did get a call from a contact tracer that said there was a concern because I’d come in contact with somebody who was now suspicious for having Covid, would I be told who that person was? Is that important?
Madad: No. So you wouldn’t be told who, who that particular individual is. They will let you know that you’ve been exposed to somebody that has, you know, confirmed Covid-19 or, you know, high likelihood of having Covid-19. So they would not provide any information on the actual index case.
Gupta: Who are becoming contact tracers? Can anyone apply to do this?
Madad: So anyone can apply. But you want to make sure they have some sort of a science or medical background — that’s certainly preferred. But I think it’s also important to note that when people, when people think of contact tracers, they think of people just over the phone. And that’s actually not just the case.
There’s actually multiple layers to contact tracing. So you have an individual that’s making the calls. Then you have other individuals that are monitoring. So those people that are being quarantined for 14 days, you’re gonna get a call, presumably every day, depending on what state you’re in, to say, “Hey, are you OK? What are your signs of symptoms?” So you have other people doing that.
But then you have individuals that some people don’t have phones. Some people you can’t reach by phone for whatever reason, so you have a different workforce that are still contact tracers but they’re going to go out in the field.
So if they can’t reach you x number of times, then they’re going to deploy somebody to go out to your home, and they’re going to knock on your door and going to say, you know, “Sir, ma’am, you know, you’ve potentially been exposed to somebody that has Covid-19. We’ve been trying to reach you.”
And so you want to make sure you’re providing information, whether it’s going to their homes, slipping the letter underneath their door, trying to get in contact with them as much as possible.
Gupta: That’s, that’s fascinating. Can you walk us through the training process a bit?
Madad: Sure, so training is extremely important. On top of that core science training that they’re going to be getting, they also need to get training on cultural competency, humility and trauma-based care.
And that’s extremely important because this is — this is a situation where people are going to be scared, people are going to react in different ways. I mean, for myself, I was diagnosed with Covid-19 back in March and I got that call from public health, but it was still very scary for me because I have children at home. I have, you know, my in-laws that are high risk.
I think what is very unique also in this situation, and particularly here in New York City, we have such a large number of individuals that are immigrants. And especially if you talk about it in the context of contact tracing, which is a very manual process, and it really relies on every individual providing accurate information so that we can contact trace and let others know if they’ve been exposed, if they’re reluctant to give that information because they think they’re going to be sent, you know, back to their country or any type of fear, then that completely undermines the entire purpose of contact tracing.
And so if you get that call and someone is telling you, you know, you have Covid-19 or you may have been exposed to somebody that has Covid-19, that’s very fearful and people are going to get scared.
And so you want to make sure that that person that’s providing that information, you know, is trained in trauma-informed care, is trained on cultural competency, is trained on building that trust and listening to people.
Gupta: When you’re thinking about hiring contact tracers, is this a few months sort of deal? I mean, how long a contract are they given?
Madad: This will go well into next year or maybe the year after that or the year after that, until we can safely say that this is something that we can continue to operate in the backdrop of our everyday life without putting more people at risk.
Unfortunately, quite a number of Americans don’t want to get vaccinated. And so while that vaccine is available, you’re still going to have a number of individuals in the population that are vulnerable to this disease because they haven’t gotten infected with it yet.
And so I really do think people thinking that we’re going to stop contact tracing once a vaccine or a therapeutic is available, that’s not correct. You know, we’re going to have to do it well after that.
Gupta: There have been some, you know, reports about companies like Google and Apple designing apps that could help with contact tracing. The concern is that everyone may not have the app. People may not even have smartphones.
But could technology and those sorts of forms work in this country?
Madad: It really will rely on the general public accepting and being able to feel comfortable utilizing these types of technologies. And I think if you look at it, if you educate people and let them know why it’s important, I think people will listen.
I mean, I personally would want to know if I was at a grocery store and I’ve come in contact with somebody that has Covid. I would want to get that alert. I would want to know that, yes, you know, you’ve been in contact with somebody. So that way I can take the appropriate measures to protect not only my family members and my children, but obviously my community. So I think it’s the risk and benefit.
If you look at, for example, Singapore and China, there are very low number of cases where they were not able to trace back to an individual. And that’s not going to be the case here because we’re not utilizing technology. We’re really — it’s a very manual process. And as I mentioned, a very — it’s based on a volunteer system and it’s based on the best information that we have.
So I think here in the United States, we’re not going to be able to, unfortunately, you know, just get rid of the virus. We’re going to continue to see hotspots. We’re just going to have to try to prevent these cases from becoming clusters, clusters from becoming outbreaks and outbreaks from becoming, you know, epidemics.
Gupta: Dr. Robert Redfield, who runs the CDC [US Centers for Disease Control and Prevention], said the United States needs to build a network of some 30,000 to 100,000 contract tracers by September.
Does that number sound right to you? Does it sound feasible to you?
Madad: I think it’s a lowball, you know, given how widespread Covid-19 is across the nation. You know, I’ve seen estimates from a bare minimum of 100,000 to over 200,000. The National Association of County and [City] Health Officials, you know, they estimate the US, you know, tracing efforts will require basically 30 contact tracers for every 100,000 people.
Gupta: You know, you’ve sort of been ahead of the curve on this so I guess in some ways, you may be the perfect person to ask about what you think the next several months are going to hold.
Is this inevitably going to get worse? What do you tell your friends and colleagues?
Madad: Certainly try to stay hopeful, I think. The goal of contact tracing and, I mean, working in a health care and health care delivery environment is making sure we don’t overwhelm hospitals again. ‘Cause I’ve seen firsthand what that looked like. And it’s unimaginable. We certainly want to make sure that we are not in that same situation.
And we want to make sure this contact tracing — we know it’s going to work. I’m not going to say I hope it’s going to work; I know it’s going to work because it’s a tried-and-true measure. So not only do we want to slow for the hospitals’ sake, we want to prevent as much as possible.
Gupta: Dr. Madad, thank you very much for your time and thank you for your work as well. It’s so important. I hope you’re able to care for yourself a bit through all this. I’m sure you’ve been very, very busy. So thank you.
Madad: Thank you.
And if you get a call from an unknown number, consider picking up. These days, it might not be a telemarketer.
We’ll be back tomorrow. Thanks for listening.