Ilana Usiskin said when she picks up the phone to call someone infected with coronavirus, she’ll often ask them to think back over the past few days.
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“Sometimes I even walk people through a day and say, ‘Where did you go that day? Who did you have lunch with? Who did you have dinner with?’” Usiskin said.
Usiskin is a medical student at Yale and one of 90 active volunteer contact tracers for New Haven. Connecticut is working to muster an army of contact tracers full of people just like her: volunteers with a medical background who will reach out to coronavirus patients to learn more about the places they’ve been and the people they’ve been in contact with. The idea is to break the chain of coronavirus transmission in places like New Haven, which has seen roughly 1,700 confirmed COVID-19 cases.
“We ask them who they live with. We ask them the names and phone numbers for their household members,” Usiskin said. “We also ask them about other people. Co-workers, friends, other family members who they don’t live with, who they have been in contact with ... a couple of days before they started having symptoms.”
Health officials then notify those people to let them know they may have been exposed to an anonymous person with COVID-19 and should self-isolate.
As of Tuesday, the city had completed about 850 of these interviews with people who’ve been infected, said Brian Weeks, an epidemiologist with New Haven’s Health Department.
“Contact tracing has been … a very important historical model in terms of addressing and mitigating the spread of an infectious agent, especially one that’s respiratory, like COVID-19, in the community,” Weeks said.
The idea isn’t new. Weeks said before coronavirus, he used contact tracing for Hepatitis C or foodborne illnesses. But the system isn’t perfect. Weeks said people can refuse to participate, they’ll duck out of phone interviews before they’re done or their contact information is wrong.
Still, state health officials say contact tracing will be a crucial part of Connecticut’s reopening strategy. State epidemiologist Matt Cartter told reporters during a conference call last week that the ultimate goal is to do contact tracing for every confirmed COVID-19 case in Connecticut.
“We will start when we have the system up and operational,” Cartter said. “As we gain experience we’ll have a better idea of the percentage of people we identify who are willing to participate in contact investigation.”
To achieve that, Connecticut officials say the state will ramp up to around 800 contact tracers -- recruiting hundreds of academic volunteers in addition to about 300 contact tracers currently working at state and local health departments.
The state said that number can be adjusted if needed.
Jennifer Kertanis, health director for the Farmington Valley Health District, said most local health departments have staff trained to do contact tracing, but historically, the money wasn’t there to support it.
“Even with things like tuberculosis and other diseases for which we might do contact tracing, we sometimes have to, during normal non-pandemic times, rely on state support to do that,” Kertanis said. “Because our funding in local public health has been lacking.”
Kertanis said the regional health district, which serves 10 towns in the northwestern part of the state, has been doing contact tracing since the beginning of the epidemic with the limited resources they have.
“That has meant rapidly training a cadre of staff, shifting them from their regular assignments to do this,” she said. “And if and when testing increases, we will have to ramp up that support far more than even what we have now.”
In a position statement last month, the National Association of County and City Health Officials said at least $3.7 billion in federal money would be needed to support a nationwide contact tracing effort.
Gov. Ned Lamont said Monday he believes the federal government will reimburse Connecticut for its contact tracing efforts. And the federal Department of Labor has said it will cover some contact tracing costs.
“Right now, my understanding is it will be a COVID-related expense,” Lamont said.
But he said figuring out those expenses will take time. And Lamont said he’s “still getting direction” about how that money will flow.
Lori Freeman, president of the National Association of County and City Health Officials, said it isn’t just money that’s needed to make sure contact tracing works. It’s also ramping up ancillary supports for people being asked to isolate, like access to food or mental health services.
“When you’re working with really vulnerable populations that may not have the opportunity or ability to isolate or shelter in place for a number of reasons,” Freeman said, “unless you have a place to send that person to isolate, then the virus is going to spread.”
Volunteer contact tracer Paulina Luna, a medical student at Yale, said when she reaches out to do patient interviews in New Haven, people are generally open, especially if they’ve been self-isolating away from family and friends.
“They really appreciate the chance of talking to someone who’s not just calling them to get information from them, but … allowing them to share their experience about the symptoms that they’ve had,” Luna said. “They just seem really happy to be able to talk to someone who is spending time with them, even just through a phone call.”