Officials agree that tracing COVID-19 — where it has been and who it has infected — plays a key role in limiting the spread of the virus, especially as Massachusetts considers reopening certain areas of the economy in the coming weeks.
That’s why the Community Tracing Collaborative (CTC), the nation’s first comprehensive statewide tracing program launched last month in Massachusetts, has received national recognition and inspired similar programs across the country.
Across Massachusetts, however, cities and towns had already been engaging in similar efforts, albeit on a smaller scale.
Lisa White, a public health nurse for the Cooperative Public Health Service — a regional health department run by the Franklin Regional Council of Governments (FRCOG) that serves 13 towns in Franklin County — said public health officials have had practices in place for tracing infectious diseases long before the COVID-19 pandemic.
“Locally, if you identify issues, then you can be effective at stopping the spread of illness,” she said.
The investigation of infectious diseases is a local board of health mandated role, she explained. The Department of Public Health invigorated that role with MAVEN, the state’s database for information on infectious disease. The database informs local boards of health when there’s a positive infectious result in their town.
But the concept of “contact tracing” became popular as a result of COVID-19, which required a larger workforce at both the state and local levels to slow the spread.
“I normally served in that role by myself, but with the increased need due to COVID infections, we hired two additional nurses to our staff,” White said.
To help manage the case load for the county, FRCOG hired Melanie Ames Zamojski, a registered nurse who lives in Turners Falls, to join the regional contact tracing efforts.
“I knew that when this was coming up, (White) would need help,” Zamojski said. “I was more than willing to help out.”
Once public health agents are informed — through MAVEN, a primary care physician or a long-term care facility — that a resident in their town has tested positive for COVID-19, the work of a contact tracer can begin.
The process starts with a phone call to the COVID-19-positive patient, or “index case” — the first call of many the tracer will make over the 14-day period of reaching out to monitor the patient’s symptoms and ensure he or she is following the quarantine or isolation period.
“When did you first start feeling ill?” the tracer asks. “What were your first symptoms? Have you been to the hospital?”
They ask the individual who he or she has been in “close contact” with since 48 hours before the positive lab result or the onset of symptoms. Close contact is defined as being within 6 feet of a person without personal protective equipment for 15 minutes or longer.
If one of those contacts is known to reside in another town, the tracer reaches out to the health agent or representative of that community and informs them of the last time the index case was in close contact with their resident and when they were symptomatic. Case information can also be shared with the agent through MAVEN.
“Even though everyone is doing the same thing, there might be subtleties that I am unaware of. … So we respect each town’s local jurisdiction,” said Jennifer Hoffman, a tracer for Greenfield who also serves on the Greenfield Board of Health.
She added that one of the unique challenges in Western Massachusetts is that not every municipality has a health department.
“So you have to find the people who are taking care of smaller towns,” she said.
From there, the tracer begins reaching out to the list of close contacts to let them know they may have been exposed to COVID-19. In some cases, particularly with respect to household contacts, the index case will ask to handle communicating with his or her contacts.
Hoffman said an individual case often has between one and six contacts.
There are specific questions tracers are required to ask, but that doesn’t mean any two phone calls are the same, said Kelly Dixon, a contact tracer for Greenfield, who also chairs the city Board of Health.
“We do what we have to to get the job done. One call for me could be 30 minutes or longer,” Dixon said, recalling a conversation she recently had with a man who was worried about his wife in the hospital. “Sometimes it’s just a matter of talking to people and letting them voice where they’re coming from.”
The conversation also involves informing the person whether he or she needs to quarantine or isolate, and explains options and locations for getting tested. Tracers also help connect them with services they may need, such as grocery delivery services.
Dixon said that for herself and the two other nurses who work as tracers in Greenfield, there are no days off.
“We work from home every weekend, as COVID does not recognize that it is the weekend,” she said.
For the most part, tracers have found the people they contact to be receptive of the work they are doing.
“People seem pretty thankful to have somebody contacting them,” Zamojski said. “They don’t feel as isolated and alone.”
Hoffman said in general, people are open about who they’ve been around.
“I think at first there’s some hesitation, but I stress that if (contacts) are not aware, they … can spread it,” she said. “I think once people realize the impact of saying ‘Yeah, I had lunch with my coworker,’ there’s less trepidation.”
In Greenfield, Hoffman works with Dixon and a part-time COVID-19-related public health nurse to carry out contact tracing for the city. Hoffman largely manages the long-term care facility case load, while Dixon manages the community case load. The part-time nurse was hired in April as the case load started to increase.
“I think right now we are handling the case loads that are present in our community,” Hoffman said. “If we needed more assistance, we have volunteers on hand that are available to us.”
White said she and her colleagues made more calls to close contacts in the beginning of the pandemic, compared to now.
“In the beginning, say mid-March, when we started really to experience ticking up cases of COVID, people had not been social isolating … because people didn’t know,” White said. “But since people have been working from home and being conscious of social spacing when they are in other people’s presence, the lists have been quite short.”
Still, she expects for the case load to increase as testing becomes more available and social distancing opens up. White said she anticipates having a close working relationship with the state’s program, the Community Tracing Collaborative, if that is the case.
That’s because contact tracing is “absolutely” effective in slowing the spread of the virus, she said.
“I think all the work that’s been done in Massachusetts has been amazing,” Dixon said. “Here in Franklin County, in particular, the work that’s come out of the EOC (Emergency Operations Center) and FRCOG has been pretty stellar.”
Mary Byrne can be reached at mbyrne@recorder.com or 413-772-0261, ext. 263. Twitter: @MaryEByrne