MPH Webinar: Contact Tracing and Student Involvement

Katie:

Hello, everyone and thank you for listening to our webinar on contact tracing, hosted by the Regis College Online MPH program. This is an important topic that’s affecting all of us right now, and so we’re glad we’re taking the time to discuss it today. My name’s Katie, and I’ll be the moderator of the webinar today. So let’s get into our introductions and meet the people that will be speaking with us today.

Dr. Beatty:

So, hello. My name is Dr. Frazier Beatty. I’m the MPH Program Director and Assistant Professor at Regis College. Tell you a little bit about my background. I’ve been in public health for about 20 years, working in higher education for about 10, working in a number of public health departments and working with a number of epidemiology students. So this is a area of interest, research, lots of research in epidemiology, and so we’re looking forward to discussing more with the webinar.

Dr. Burke:

Hello, my name is Laura Burke. I am the Dean of the School of Health Sciences at Regis College. My background is in epidemiology. My area of research has been cancer epidemiology with a focus on genetics and nutrition. I came to Regis and started the Public Health program there about 10 years ago.

Sarah:

Hi, good morning everybody. Buenos dias. My name is Sarah Weintraub. I am a nurse. It didn’t start out that way. I got my BA from Clark University with majors in psych and Spanish, and then I actually joined the Peace Corps in Ecuador, rural. I did a health education and outreach, where I actually met my husband, who’s from Ecuador. We have two beautiful children, so biased. And then I got my BSN from UMass Boston in nursing, and I’ve been working for the past 15 years at Children’s Hospital Boston and in Waltham public schools as a school nurse for the past three years. I decided to get my MPH, which I’m very passionate about. So this is my first semester actually in the program.

Katie:

Great. Thank you. And so now we got through the introductions, let’s go in and talk a little bit about contact tracing. So Dr. Beatty, could you tell us a little bit about what contact tracing is, how it works and why it’s important to us right now?

Dr. Beatty:

Sure. So contact tracing is a critically important tool used in public health response, especially in pandemics. So public health officials have long used this tactic to break the chain of transmission of infectious diseases, and so it limits the spread of infection. So historically, contact tracing is a disease control measure that has been used [inaudible 00:03:04] and the professionals use key strategies to stop the spread, and like COVID-19, … cut down the transmission within the community.

Dr. Beatty:

So how it works. So in case investigation, public health staff work with patients and they recall everyone to whom those patients or persons have contact, who been in close contact, with during the timeframe that they’ve been infectious. And then it’s important to stop the spread of COVID because again, it will shorten the timeframe of transmission. So we’re getting a lot of information from CDC about the infectious, while you’re infectious, so that, we’ll get more into that, can be 14 days and it could be longer, but that’s the importance of contact tracing as it relates to COVID.

Katie:

Great. Thank you for that. So now if we get in and talk a little bit about what Massachusetts is doing and what the schools and students are doing, Dr. Burke, could you tell us a little bit about this?

Dr. Burke:

Yes, of course. So the Commonwealth of Massachusetts has placed a high priority on contact tracing as part of their plan to get control over COVID-19 in the state. So Regis College was approached by the Massachusetts Department of Public Health to be part of a group called the Academic Public Health Volunteer Corps. And students, faculty, and alumni from the school, from Regis, have volunteered to participate in this. They get involved in a number of different areas from contact tracing, to working with local state, local departments of public health, to do communication efforts, to serve them in any way that the Department of Public Health needs.

Dr. Burke:

More recently, Partners in Health has taken over running community tracing in Massachusetts, and our students continue to be part of that. So they have applied for positions with Partners in Health and received it across the undergraduate and graduate programs.

Katie:

Great. Thank you. So now that we’ve heard [inaudible 00:05:39] what contact tracing is and what states like Massachusetts are doing, we have Sarah, who’s our Online MPH student who is working for the state doing contact tracing. So Sarah, could you tell us a little bit about your experience as a contact tracer? Maybe tell us how you got involved and what it’s like working as a contact tracer right now?

Sarah:

Yeah, sure. Thank you, Katie. And thank you, Dr. Beatty and Dr. Burke for inviting me to be part of this important webinar. So as I said, have worked for, with the Waltham public schools for the past three years as a high school school nurse. And early, when the pandemic just started, the Mass Department of Health and the Waltham Department of Health, reached out to the nursing department, to my nurse leader, asking for help. The local boards of health were getting inundated. We’re talking about part time nurses being the only public health nurse in the city. And the volume of COVID cases was just worsening, getting more and more.

Sarah:

Each call as a contact tracer is super involved and very time consuming, not to mention when people speak other languages. So I volunteered because I’m bilingual Spanish, and I wanted to really make it easier for the Spanish speaking residents in Waltham to have someone that they could speak to directly and not through a translator, which is sometimes a little bit more impersonal, but we all do the best that we can do. And so that’s how I volunteered.

Sarah:

What is it like being in the front lines? What does it actually mean to contact trace? That’s a question that a lot of people have that I’ve encountered. What actually are you doing? So from my experience as a public health nurse, I was given access, there’s a huge database, and I was given access to the Waltham Public Health patients who were diagnosed with COVID or suspicious of being COVID positive to help support the Waltham Public Health team.

Sarah:

I would be given a case number, which I would look up in the database and I would call … The lab where the … So most people are getting diagnosed with the COVID and tested, a lot of people are getting them through the urgent cares, the drive-thrus, where you just drive in your car. So the lab, actually the lab results go … As soon as the results are in, they actually directly get input into the databases for the state, which then are passed on the same database to the individual towns and cities. So oftentimes, we would find out before even the patients knew. Sometimes we were the first people to inform them that they were COVID positive, sometimes not, but sometimes yes.

Sarah:

So then yeah, so back to the … I got the case number and then I look them up in the system and I give them a call. If the person was available, I have a conversation with them. It’s very detailed, there’s a bunch of interview questions that are expected to be asked from the nurse to the patient, and a bunch of assessment questions. Do you have abdominal pain? Are you vomiting, diarrhea? Are you coughing? Do you have a fever? What’s your temperature today? And as a contact tracer, you’re expected to follow up as much as, as often as every day, but sometimes once a week to sometimes every day, depending on what the situation is.

Sarah:

Oftentimes, the patients were hospitalized. In which case, we had to track down the closest relative, which always actually wasn’t that easy. Sometimes you have to call the lab where they, the urgent care center to where they were diagnosed. And often there were, we ran into privacy issues where sometimes the clinics weren’t disclosing the information to us. So then we just reached back out to the Public Health Department to acquire the proper documentation so we can fax them over the appropriate release.

Sarah:

An example? You guys want … Maybe I could talk about a specific example?

Katie:

That’d be great.

Sarah:

So I had one, it was actually funny. So there were a group of gentlemen that were living, sharing an apartment. Two of the gentlemen had come from the other side of the United States because in their state COVID was spreading more readily than what they thought was occurring in Boston. So we have people flying across the country to avoid COVID, and then unfortunately, one of the people living in the house, in the apartment, became COVID positive. There were two full bathrooms and each person had their own room, but unfortunately most of the roommates ended up eventually testing positive.

Sarah:

So I was in touch with them almost every day, calling each of them individually. So as the primary contact tracer, you have to call the patient first and then find out everybody the person’s been in contact with, which means within six feet for more than 15 minutes. That’s what that means. You have to trace it back to two days before they started having symptoms, any symptoms. So then I was in contact with this group of roommates, and I’m asking them about their symptoms, and they all sort of got diagnosed at different times. Obviously, one would recover and they would be cleared.

Sarah:

So it’s just tricky because we’re talking about such a bigger issue. This example, they were able to have people drop off food to their doorstep, but a lot of people don’t have that luxury. They have lost their jobs, they don’t have the financial means to support themselves, frankly. Or don’t speak the language and don’t understand how to access the systems in place in order to survive. So I know in Waltham we have been reaching out to families in need, who’ve expressed need for support, and we’ve been dropping off groceries safely outside the house and stuff like that. But not everybody, again, has access to support.

Sarah:

So that’s a big thing, right? So if you’re confined, if you are quarantined, if I call you, as a public health nurse and say, “You have been exposed to somebody … You’ve been exposed to COVID,” so then you have to stay in your house without leaving for groceries, unless it’s for an urgent medical appointment for until I say so. Or if the person has been cleared, then you have 14 days that you have to be quarantined. So it’s not that … Even if the primary COVID person’s cleared, the people who’ve been in contact with that person have to be isolated for 14 days more. It’s tough.

Katie:

So Sarah, so just to clarify, so if you were the primary contact tracer, you were contacting the person who was ill. Were you also in charge of contacting all of their contacts or was there other people?

Sarah:

Yes.

Katie:

Yes, okay.

Sarah:

So the Partners in Health was a fairly new intervention, but when I was primarily calling, towards the beginning, we were doing all of the contact tracing, which means we would call the primary patient, find out everybody they’ve been exposed to, including places of work, and call every single person and open a new case for all of them. So imagine how many, how much time that takes. I would take anywhere between half an hour to an hour with each call. So it’s very time consuming because we care a lot, and also because it’s very important in a public health standpoint to really get accurate information and make sure that I’m communicating what is expected.

Sarah:

And in fact, there were times where I had to remind people that if a public health official tells you are under isolation or quarantine, if you are found to have broken that, there can be legal consequences, you can be arrested. It’s not a joke. There’s a lot of different perspectives out there about, “Oh, the masks … I don’t believe in it.” But it’s really not a question of believing or not believing, it’s actually there are legal consequences if you don’t pay attention to what the public health officials are saying.

Katie:

That’s great. Thank you. Yeah. So to turn this a little bit, if you could tell us a little bit about the types of skills you maybe need for a contact tracer. Since you’re doing your MPH right now, are there things that you’re learning in your MPH that apply to being a contact tracer? Are there things that you’re using?

Sarah:

Absolutely. Yes. First of all, I love the program for Online MPH at Regis because it’s very grounded. It’s real, it’s applicable, especially now, it’s a hundred percent applicable, and it’s a very, very grounded program. It’s very much about getting involved in the community, doing research projects in our communities to help improve the public health situations. So there’s a lot of articles and theories that we’re learning that I didn’t know before, that I wouldn’t necessarily have known which resources, which databases to pull from.

Sarah:

I’m excited to learn more, to get more tools in my bucket, to really … Longterm, I really am interested in decreasing the disparities in our healthcare system. It’s broken, in my opinion. I think that we need a lot of help to fix it, and I’m so excited that I’m in this program because Regis is going to have my back. I feel like it’s a really great program for people who want to really give back to their communities, and understand that, where they’re coming from, from Regis, is in my opinion, the best program that you could find for this type of master’s degree.

Katie:

Great. And I guess going off that, what are your career aspirations after you get your MPH? Do you have a specific goal?

Sarah:

I think since the Peace Corps, to be honest with you, it’s always been a part of my soul, public health. And it’s a little bit off topic, but the healthcare system in rural Ecuador, when I was living there for three years, was rather broken in a lot of ways. It’s improved in some ways, but we’re talking about extreme … Parasites, for example. Things that we just take advantage … The water, right? The water, you had to boil, or you had to, you couldn’t eat raw fruit, you had to peel it. Just basic, basic public health things. And the local health clinics, everyone in my town was afraid of the nurse because she was so mean and she gave shots. That was the representation of healthcare there. I am desperate to be involved in the policy process to try and get more involved.

Sarah:

That’s a huge reason why I chose Regis, because they had a health management and policy focus. I don’t know a lot about health policy, frankly. I am excited to learn more about it, so I can therefore go back in the community, go to my state house, work with my local politicians, in order to really … I want to be part of that change. I love being a nurse though. So I’d like to integrate my nursing and maybe eventually get my feet in the policy arena as well, in the politics of it a little bit more.

Katie:

Thank you. Okay, so if we get into now our Q&A, so we have a few questions that we’ve collected, and so we’re hoping all three of you could help answer some of these questions for us. These questions are really just around contact tracing.

Katie:

So the first one, has contact tracing ever been done before COVID-19? Is this a new practice or has it been around for awhile?

Dr. Beatty:

Go ahead, Laura.

Dr. Burke:

Contact tracing has been around for a very long period of time. This is nothing new. It’s done around the world. When there was the Ebola outbreak in Africa, it was done there. It’s been done when SARS was an issue a few years back. So this is not new. This is just one of the tools that public health has to address pandemics and epidemics.

Katie:

And that actually goes into my next question. What would you say to people who have ethics and data concerns around, I mean not just even with the app, but people calling and contacting you because maybe you were in contact with someone?

Dr. Beatty:

Yeah. I think one of the issues, just in general, is that this COVID-19 impacts disproportionately people of color, minorities, and so trust is an issue. Sarah actually mentioned and spoke about it briefly, but it’s a trust issue that public health experts have to be very skilled, just like Sarah spoke about, to be able to even contact and be in touch with the people who they’re trying to reach. Because oftentimes, people don’t trust public health officials or any officials for that matter. So I think that’s an important thing that, I think maybe Sarah, you could speak to a little bit more about how you establish that trust with the community.

Sarah:

Sure, yeah. I’d love to. So I think it’s really important to be real with people. I’m often pretty open with my history, and that I did marry someone who is a first generation citizen here, and my husband didn’t speak any English when he came here. I think that actually makes me a better nurse as well. I think it makes me a better contact tracer.

Sarah:

How do I make connections with people? I truly care about the people. I want the best for our community, for our world, for everybody’s health. I think if you’re straightforward about that and just talk from your heart and let people know that we don’t have all the answers, don’t pretend … I never pretend that I have all the answers. If I don’t know something, I’m honest about that. And I’m honest about that a lot because there’s a lot that I don’t know. But what makes me a great contact tracer and a great nurse is knowing your resources, knowing where to point people, how to connect people, in order to get the right answers. No one’s expected to know everything.

Sarah:

So I think just being real and being honest with people helps. And also, speaking Spanish fluently helps because it’s much easier for families to speak to someone who speaks their language. When you’re talking about a third person, an interpreter, which I understand that if it was any other language besides Spanish, dude, I need the interpreter, but it’s more impersonal, frankly. I think we have to pay attention to hiring more staff of color and different ethnicities and people who speak more languages, frankly. I think that would help.

Sarah:

Does that answer your question?

Katie:

Yes, thank you.

Sarah:

I tend to go on.

Katie:

That was perfect. Okay. Here, a question just about contact tracing in general. How effective is it in busy urban areas versus rural areas? I guess the understanding is that everyone that you’re in contact with now has to be contacted. So how effective is that?

Sarah:

Crazy. So I feel like it would be much easier to isolate yourself in a rural environment, assuming that there’s more space. The biggest issue is space and there’s a huge amount of socioeconomic disparities. And as Dr. Beatty pointed out, a lot of people of color and minorities are unfortunately getting hit hard, frankly, when you live in a small space.

Sarah:

I was in contact with one of my Waltham families this week, who said, “I think my husband has COVID and I’m scared that my daughter’s going to get it. We live in a very small apartment. What do I do?” I was contacting her as the school nurse, not necessarily as her COVID investigator, but just trying to make sure you’re hand washing, make sure that you’re wiping down after you use the bathroom, and make sure you’re using an alcohol-based solution that’s stronger concentrated than 60%, or some type of a disinfectant. We all do the best that we can, but it’s disproportionately affecting people of lower means. It’s not right.

Sarah:

I think it’s much easier to isolate if you’re in a rural situation because there’s more space, but in an urban environment, it’s tricky. Everyone’s doing the best they can. But I think educating everybody on good hand hygiene, wearing masks, the importance of it to protect ourselves and other people, wiping down surfaces and getting tested. So test, trace, treat. Boom. Test, trace, treat. That’s what we need to be doing in order to stop the pandemic.

Dr. Burke:

Can I add something to that?

Sarah:

I’m sorry?

Dr. Burke:

I’m going to add something to that. I agree with Sarah a hundred percent, but I also think we need to emphasize the social-distancing that needs to take place.

Sarah:

Absolutely. I apologize for not mentioning that.

Dr.  Burke:

No. So we’ve seen a lot of our super spreading events have been in churches, at social events, at [inaudible 00:25:51] across the country, and so where people are in tight areas. So in addition to what Sarah just said so well, we need just to add to that the social-distancing. That’s a crucial part to controlling this disease.

Sarah:

Absolutely.

Katie:

Definitely. Definitely. Okay, so I have one more kind of a broad question. So if contact tracing is successful in tracking this disease, what short and long term impacts you see when it comes to lockdowns throughout the US? Do you see that particular states might benefit more than others?

Dr. Burke:

So I’ll start, but I hope that Sarah and Frazier will join me in this. Contact tracing is one tool we have. It is just part of our approach to dealing with this pandemic. As Sarah said, we need to emphasize contact tracing, we need to emphasize social-distancing, hand washing. There are a number of things that are in place. When we can get our testing up to where it needs to be in the population, that will contribute to it.

Dr. Burke:

We have not hit herd immunity, which is crucial for the control of this. And since we are not, just a small number of people in the population with the disease can set off another outbreak in a community. So we need to keep that in mind as well. Until there’s a vaccine, an effective therapeutic program, testing, this is just one key piece to the whole approach to this pandemic. I don’t know if Frazier, if Dr. Beatty or Sarah want to contribute.

Dr. Beatty:

Sure. Certainly. Absolutely correct. I think we need to use all of the tools and the resources that we know about, social-distancing, certainly. But when your particular state … I think you mentioned about states and various areas, when your particular state may open back up, you still have to practice those tools that you know about. Because if you don’t and you let your guard down, it could increase the numbers again. The numbers could go up again. And some states are already seeing that as a result of people letting their guards down.

Dr. Beatty:

So it’s a community effort. Everyone has to do their part. I think that’s why it’s so important for people like Sarah to educate and get their information out there. Because there’s still people that don’t know that you should wear a mask or you should wash your hands. Even with this age of technology and all of the things that are on social media, some of the people don’t have access to social media. I know in particularly, elderly people don’t, are not on Facebook. And so you think “There’s so much information out there,” but there are still people that don’t know. They read the newspaper and there might not be an article in the newspaper. So it’s a community effort.

Sarah:

Yeah, absolutely. I think in Waltham they’re also having a program to get Chromebooks out and they’re buying up mobile hotspots even, for students who can’t afford or don’t have access to internet access. And I know that Comcast was offering free installation services through June 30 as well. I apologize if I’m forgetting other internet companies, but that’s just one of the ones that I heard of. But even understanding what those resources are and getting access to them is so complicated. So many people don’t speak English. And if you don’t have access in the first place, imagine for … Even for me to sort of figure out, “Okay, what do I have to do? How do I contact Comcast? How do I get in touch with the school to get my Chromebook?” Even to do those things is complicated. And for someone who doesn’t speak the language, it’s even more complicated.

Sarah:

I think the more that everybody’s sending out the same message, word of mouth, when you trust, when you’re communicating with people in your family and peers, it’s important that everyone’s spouting the same message about social-distancing, and about if you have symptoms, get tested, respect and listen if the public health team in your city or town is telling you to isolate or quarantine. And yeah, it’s unfortunate we don’t have really a treatment yet, so it’s scary. Nobody thinks it’s going to happen to you until it slams into you or it affects someone you love. I know so many people who have lost loved ones because of the COVID, and it really hits home when you know somebody or it’s somebody in your family. And then you’re like, “Oh my gosh.” We have to do everything that we can to prevent the spread. It’s just that simple.

Katie:

Definitely. Definitely. Thank you. Okay, well we’re just about at time, unless there’s any other points the three of you want to make or anything else? No? Okay. Well, thank you, Sarah, Dr. Beatty, Dr. Burke, for joining us today, sharing your knowledge and experience of contact tracing. And thank you everyone for listening to this webinar, we hope it was helpful and informative. Thanks.