Contact tracers are fighting COVID-19

MORE THAN A TRACE

SDSU-trained contact tracers are working hard to help stop the spread of COVID-19 in San Diego — and delivering food, resources and reassurances to the most vulnerable families in their communities.

By Padma Nagappan | Illustration by John Herr | Photographs by Sandy Huffaker

January 22, 2021

Abigail Lopez called a woman who had been in close contact with someone who tested positive for COVID-19, to advise her to quarantine for two weeks. The news was the last straw and the woman broke down, crying.
 
The single mother of three children earned money cleaning houses and had already lost clients who didn’t want to let her inside during the pandemic. Struggling to make ends meet, she desperately needed money for that month’s rent. Two weeks without work would hurt mightily. And now there was the added stress she might have the novel coronavirus.
 
It was the kind of heartbreaking but all too familiar situation contact tracers like Lopez encounter on a daily basis as they make calls to try to stem the spread of COVID-19: overwhelming need, job loss, high anxiety. 
 
Lopez, like the woman she called, identifies as Hispanic and speaks fluent Spanish. She was able to form an instant rapport with the woman, assure her and connect her with local resources for rental assistance. As she continued to check in on the woman during the quarantine period, she realized the difference she was making in her life. “She had someone to talk to, to unburden herself and to find the financial support she needed,” Lopez says. “A lot of people are really grateful when we call them.”

 

Student Abigail Lopez

“A lot of people are really grateful when we call them.” —Abigail Lopez

Crista McAfee

“When you’re gathering data, it can be so cold, but if you turn it into a conversation, it can be more friendly.” —Crista McAfee

A Model Program

Lopez is one of dozens of tracers in the Communities Fighting COVID! contact tracing program, a partnership between SDSU and the County of San Diego Health & Human Services Agency (HHSA) that began in June 2020. The university received a $3 million contract to recruit and train contact tracers from the very communities they will serve — Latinx, Black, Tagalog- and Arabic-speaking. Most are bilingual and receive training as community health workers. 
 
“When health workers really understand the nuances of cultural aspects they can relate better to people,” says Hala Madanat, interim vice president for research and innovation at SDSU and a leading public health expert. “Our community health worker tracers are able to make connections and establish trust with the people they are calling, which is effective in getting people to follow the advice to quarantine.” 
 
Madanat and Corinne McDaniels-Davidson, director of the SDSU Institute for Public Health, conceived of the program, in close partnership with Nick Macchione, director of HHSA. In the early days of the pandemic, it was clear to them that minority populations would be disproportionately impacted by the coronavirus. They designed the program to address socioeconomic concerns, language barriers, and, in some cases, inherent distrust of the health care system amongst San Diego’s diverse communities. It now serves as an open source model for organizations partnering with the county on tracing and education efforts.
 
The training program for the tracers incorporates advice from a community advisory board drawn from each of the four communities, and was reviewed by public health faculty. Tracers receive 12 hours of training split over three days via Zoom and reading material. They also receive ongoing training as the situation with the virus and local cases evolves.
 
The county sends the tracers lists of people to call on day one and then check in with a week later for those that are high risk, which is 60% of the calls, and again on day 15 as a final follow-up. 
 
On the calls, tracers advise contacts to quarantine and assess them for symptoms. They then send them a daily symptom log to maintain for self-reporting, and quarantine instructions. 

Empathy and Trust

Lopez applied to be a tracer because she was drawn by the opportunity to make a difference within her Hispanic community, which has been deeply impacted by the pandemic. Latinx residents are three times more likely than white residents to become infected with COVID-19, and they account for 61% of local hospitalizations, according to county figures. 
 
Even so, Lopez, a recent college graduate living in Escondido, has been surprised by the high number of cases referred to the program. On average, she calls 10 new contacts a day, in addition to the families she is following up on as well as connecting those in need with local resources. Each case involves several family members, making for a busy workload. She also goes into the community for home visits about eight to 10 times a week to contact people who don’t answer the phone and to drop off food for people in need. When COVID-19 cases surge, home visits increase to several a day.
 
Like Lopez, Crista McAfee felt being a tracer was her calling. She has faced many personal health issues and relied on her family, friends and neighbors to get through those testing times. She wanted to help her African American community in the same way. 
 
“Many Black people have a deep distrust of the government and believe that the government and medicine has failed them, given their long history of unfair treatment and ignored medical issues,” McAfee says. She is also aware the current wave of unrest fueled by social injustice compounds their suspiciousness.
 
McAfee begins her calls saying she is with SDSU and can provide resources to help them navigate the upcoming quarantine period. 
 
“I let them know that I’m African American and I’m concerned about the rates at which our community is dying,” McAfee says. “That puts them at ease, they are then more open to communicating. When you’re gathering data, it can be so cold, but if you turn it into a conversation, it can be more friendly.”
 
Some young folks call her ‘Auntie Crista’ and she scolds them because they’re not taking the health guidelines seriously. Older adults are often grateful to speak with someone who is Black, she says. McAfee finds it’s important to meet each person where they’re at. 
 
One particular family stands out in her mind. A young man had been living with his 100-year-old grandmother until she tested positive for COVID-19 and was hospitalized. He moved in with his aunt’s family but, to keep them safe, had to isolate himself in their garage, which had no access to running water or a bathroom.
 
While visiting the family, McAfee observed how stressed the aunt was, pulled in different directions between her elderly ill mother and her nephew who had no place to go. Through a county program for those unable to quarantine safely in their living situations, McAfee arranged a free hotel room for the nephew, which solved a lot of the family’s problems.
 
“What a blessing it was to bring relief to this woman and her family,” McAfee says. “You could see it in her face. It’s the best feeling in the world to have a work day like that.”
 
When she made the follow up call on day 15, she learned the grandmother had recovered and was back home and cooking for everyone. The nephew said he was grateful for all the help — the free hotel room program comes with three meals a day, internet access and daily nurse check-ins — she arranged. Afterward, McAfee broke down crying, moved by their story and their palpable relief, before calling her program manager to share the happy news. Moved by the impact her work is having, McAfee, who took communication courses at SDSU in the past, is now considering pursuing a degree in public health. 

Embodying SDSU Values

McDaniels-Davidson oversees the day-to-day operations of the program and acts as liaison with the county. She helped build the training program and revises it as the program evolves, offering ongoing training to tracers to keep them up-to-date on the latest COVID-19 research.
 
McDaniels-Davidson and her team vet tracer candidates for their willingness to serve their community, their knowledge and familiarity with the barriers their communities face, and their communication skills and empathy. “Our tracers are able to de-escalate situations when contacts are upset, and persuade them to comply with quarantining,” she says. “This isn’t just a job for them, the help they offer feeds their souls.”
 
Designed and launched to answer the need of the hour, the contact tracing program harks back to the values SDSU embodies. “SDSU at its core is about community,” McDaniels Davidson says. “This program exemplifies that in a way that gets to what we are about — we are here to teach, we are here to do research, and improve the lives of San Diegans.”
 
In a pandemic, it’s crucial not to lose people to follow-up, Madanat emphasizes. As the SDSU program proved its effectiveness, the county shifted contacts who failed to respond after three attempts to the university, which deploys health workers into the community for home visits. Tracers like Lopez make home visits for such cases, and they have a success rate of 100% in some communities, and about 80% with others, for getting people to quarantine. 
 
“These are people who would have been lost to tracing,” Madanat says. “But we were able to reach them because we have people who are linguistically and culturally concordant.”

Overwhelming Need for Basics

Over and over, Lopez and other contact tracers see some common problems with which their community members struggle. The need for food comes up so often — because people can’t go to the grocery store during quarantine or don’t have money to buy food — that the tracers came up with the idea of organizing a food drive. 
 
SDSU program managers and faculty helped them make it happen by fast-tracking the approval process, and spreading the word via outreach to public health faculty and students, through SDSU social media channels, and also via the county’s own tracers and employees who donated food. They raised more than $2,400 and hundreds of pounds of dry and canned goods. As a result the tracers are able to do food drops for families in need.
 
Other community members need financial assistance to pay rent, or they may be too scared to go to a clinic because they’re undocumented or lack medical insurance. 
 
The majority of Lopez’s calls are with women, many of them single mothers who worry about missing work, securing food and keeping their families healthy and safe. “We see how much pressure they face daily,” Lopez says. “They constantly worry about providing for their families if they fall sick or lose their jobs.”
 
Not everyone is receptive to the tracers. Some rebel against the idea of quarantining, which adds new stress to an already stressful time for families, Lopez says. 
 
One father of two didn’t want to quarantine because he needed to work in-person. Lopez convinced him of the necessity by drawing on the health communications training she received, and then helped him apply through CalWORKs for public assistance.

“The program taught me how to make people comfortable, especially when they have language barriers,” Lopez says, “to help them take care of themselves.”

“These are people who would have been lost to tracing. But we were able to reach them because we have people who are linguistically and culturally concordant.” —Hala Madanat