Imagine picking up the phone and hearing that you’ve been exposed to COVID-19.
As a medical student and contact tracer for the San Francisco Department of Public Health (SFDPH), I make these calls all the time.
My goals are straightforward: convince people to get tested and to avoid potentially transmitting the virus to others; provide information and resources to help them safely self-isolate; and perhaps more important, humanize the process.
I first began contact tracing with the SFDPH in April, just weeks after the greater Bay Area received its shelter-in-place orders. As an MD-PhD student at the University of California, San Francisco (UCSF), School of Medicine, I was still engaged in clinical care, but I wasn’t allowed to see COVID-positive patients. I was desperate to help address the pandemic, and contact tracing allowed me to contribute.
Contact tracing — which the Centers for Disease Control and Prevention calls a key strategy for combating COVID-19 — works in several ways. For one, it helps prevent disease spread by getting people who don't know they’ve been exposed to quickly get tested and self-quarantine.
Combined with other public health measures, contact tracing has been used effectively against diseases like Ebola and syphilis. It demands a lot of legwork, though, and requires tracers to earn the trust and buy-in of those they call.
With every person I reach, I hear how scary COVID-19 is and how difficult it can be to self-quarantine, especially given the financial strain of the pandemic.
“My father-in-law is in the hospital, and we all have stopped going to work since we were exposed. We have to leave the house soon because we’re going to run out of food, and I don’t know how we can afford it when none of us can work.”
For many people, it’s impossible to quarantine without outside support, and I find it incredibly gratifying to connect them to wraparound resources like emergency food deliveries, cleaning supplies, medical advice, and social services. Without these, contract tracing programs aren’t likely to succeed.
“My husband was diagnosed last Sunday, and he’s been sleeping in the garage. I’ve been coughing since Tuesday, and I’m trying to stay away from my mother-in-law, but we only have one bathroom, and the kids don’t know to stay away from her.”
When people live with someone with COVID-19 and can’t safely isolate in their homes, we can help them or the infected person with temporary housing in a hotel provided by the city. The hotels are staffed with nursing care and social workers and provide food and essential services on-site to help patients through the illness.
“I feel really overwhelmed and scared, and I don’t know where to begin.”
COVID-19 can leave people feeling vulnerable. I find that calling people and offering guidance — or sometimes just a listening ear — can help them feel supported and less alone in their struggles.
“Why do I need to get tested? I don’t have any symptoms.”
The public is exposed to thousands of contradictory messages about COVID-19, masks, testing, treatment options, vaccinations, and asymptomatic transmission. I’ve found that people trust the department of public health to provide accurate medical information, and sharing that information is part of the service tracers provide.
With every call, I hear how difficult it can be to self-isolate or quarantine, especially given the financial strain of the pandemic. For many people, it’s impossible to quarantine without outside support.
The SFDPH carefully prepares tracers for our work. After serving as a tracer for a few months, I helped recruit and train additional UCSF medical students to make calls. Like me, these students went through a rigorous training program that included practical sessions on how to motivate people to change their behavior and educate them about COVID-19 transmission.
The need for public buy-in to contact tracing is only growing. During the shutdown, nearly everyone I called was sheltering in place and knew they were exposed before I called. They could tell me all their contacts because they lived with them. Shelter-in-place gave us time to expand and help train tracers throughout California. Our test positivity rate crept down. And San Francisco moved forward, and reopened, and we all held our breath. And for a month or so, it seemed like we were going to be okay.
Then things started to change. By this point, I was contact tracing, coordinating UCSF medical student tracers, and helping with COVID-19 testing run by UCSF and a private center called the Chan Zuckerberg Biohub. I noticed that our hospital floor had begun filling with patients with COVID-19 and that our intensive care units were getting full as well, and I started to worry.
COVID-19 can be isolating and can leave people feeling vulnerable. I find that calling people and offering guidance — or sometimes just a listening ear — can help them feel supported and less alone in their struggles.
I can remember the exact moment it hit me that things had changed. I saw one of my Biohub colleagues opening an enormous bag of COVID-19 tests and neatly arraying them. “Are those new samples?” I asked. “No,” she replied, “These are the positives from today and yesterday that we need to further sequence.” I felt ill as I looked at the hundreds of samples. I knew that each represented a person who was infected. I knew that each of them had roommates and families and colleagues and friends whose health was on the line. And I knew that it was urgent that we reach them as quickly as possible so that they could take steps to protect themselves and others. So, I did what I could do: I volunteered to help reach as many of the contacts of those cases as I could.
The United States has tens of thousands of new COVID-19 cases every day, and more than 170,000 people have died from the disease.
Yet, I’m hopeful that we can turn the tide. Contact tracing will be critical to those efforts.
Allison Wong is an MD-PhD student at the University of California, San Francisco, School of Medicine. She has been making contact-tracing calls since April and trains other students to do so as well.