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From the Front Row: Behind the scenes with CPH contact tracers

Published on August 20, 2020

The following is a transcript of an episode of From the Front Row: Student Voices in Public Health, the University of Iowa College of Public Health’s student podcast. This episode features a discussion between College of Public Health students Emma Meador, Nate Savage, Rebecca Nyangufi, and Olivia Denkinger on working as contact tracers with departments of public health in the fight against COVID-19. This episode was published on Aug. 20, 2020.

Steveland Sonnier:
Hello all and welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Steveland Sonnier and before we dive into the episode today hosted by the excellent, Emma Meador, I just wanted to touch base really quickly on the recent derecho storm that swept through Iowa this past week. There are thousands of Iowans that are living in places of residence that their cities have condemned or in tents amid the debris of their homes. Local news organizations have been reporting on this disaster and we still need substantial help to get many people back on their feet. For a list of ways you can help, please visit thegazette.com to search for a list of up to date options for help or to receive help, and check out our show notes for those links. Thank you for your assistance and here with our episode is Emma.

Emma Meador:
We’re back with an episode diving into COVID-19 contact tracing. Contact tracing allows for mapping out disease transmission by figuring out where a case got the virus and who they could have potentially spread it to. Contact tracers aim to contact each individual in their region or county who has tested positive for COVID-19. They interview the case on the progression of their illness and symptoms and additionally, any possible close contacts they could have had, either in the community, at work, in their home, or through social gatherings.

Emma Meador:
These tracers then contact each of those close contacts and provide guidance and recommendations that the CDC has laid out for self isolation. To get a closer look into what the work of contact tracing entails, I sat down with three other University of Iowa College of Public Health students who are currently contact tracing to discuss its importance and impact. Well hello and thank you so much for speaking with me today on From the Front Row. I am very excited to get the chance to speak to each of you and hear about your experience as being a contact tracer. To start off, do you want to go around and just introduce yourself, name, age, anticipated degree, and then where you’ve been contact tracing out of?

Nate Savage:
So my name’s Nate Savage. I’m 20. This next year, I’ll be a junior at the University of Iowa. So I plan on graduating with a public health degree, environmental health and then epidemiology, and I’m contact tracing here out of Johnson County.

Rebecca Nyangufi:
My name is Rebecca Nyangufi. I’m 21. I’m going to be senior this year. I major in public health with a minor in social justice on the BA track and I’m interested in community behavioral health.

Olivia Denkinger:
I’m Olivia Denkinger. I’m 21 and I’ll be a fourth year in the public health undergrad program. I’m interested in maternal child health and community health, and I’ve been contact tracing at Linn County.

Emma Meador:
Awesome.

Rebecca Nyangufi:
I forgot, I work out of Johnson County.

Emma Meador:
Awesome. So my first question is what has your experience been like, starting a position like this during a global pandemic?

Nate Savage:
I’ve had a lot of fun this summer. It’s been my first real job, I guess, doing actual public health related stuff, and it feels good making an impact because if you’re a hard worker, if you do get your work done, you are making an impact and helping other people in the community, and it’s been really fun to make connections with the staff. I didn’t have a whole a lot of connections before this, but I’ve met some people I really like, and that I feel like I did some good opportunities with.

Rebecca Nyangufi:
I’d say it’s been a big challenge, but also so rewarding. A challenge simply because we’re constantly learning new things about COVID-19 so you kind of always have to be on the top of your game for when you’re conducting interviews because you’re learning so much new information. You want to be applying the best practices while doing so, but it’s also been so rewarding to be able to apply these things that I’m learning in class in a real world setting. I would have never anticipated as a freshmen three years ago that I would be doing public health work during a pandemic. So in that sense, it’s been a very, very great experience just to get to apply my school content to my professional work too.

Olivia Denkinger:
Yeah. I would say it was scary at first. I didn’t know what I was doing and I didn’t know how to approach the situation, but it was a lot of learning and I really appreciate having that experience, especially during a pandemic where there’s not much that we could have done this summer. I’m appreciative of that.

Emma Meador:
Definitely. And then in your own words, backing up just a little bit, how would you describe contact tracing? What exactly is it you guys have been doing and what is the overarching goal of it?

Nate Savage:
So I’d say, I mean, for Johnson County anyways, each day we get a new case reports and those are the positive cases. Until then, they’ll pull out a survey and then through that, we can kind of see who their possible exposures were and then through that part, it’s the contact tracing part. That’s when we get in touch with those people and say, Hey, you might’ve exposed and basically give recommendations off that, on what they should do.

Rebecca Nyangufi:
I’d say, yeah, it’s the same thing, but just disease investigation and trying to find the starting point of the positive. So if you were hanging out with someone, wait, where could you have possibly gotten it? So it’s kind of interesting and kind of like a mind game.

Olivia Denkinger:
Yeah. I think it’s always a challenge a little bit to jog people’s memories because you’re looking at such a long period of time that they could have been exposed to somebody. So having to ask, Hey, where have you been in the last 14 days? It makes people think pretty hard about who they’ve been around.

Emma Meador:
And I think it’s been really interesting too, just being able to take all of the recommendations and guidance that the CDC has laid out for public health departments and taking that information into our investigations to help us reach our overarching goal of finding all of those possible contacts and exposures that the case may have had because I know we have to look back 40 hours prior to their onset of symptoms, and then while they’re symptomatic, anyone they would have been in contact with for six feet or less for 15 minutes or more. So just taking all the information that is provided for us to be able to find all those contacts, and then moving onto my next question. Have you guys noticed any common misconceptions or things people may not understand about contact tracing?

Olivia Denkinger:
I think sometimes when I talk to potential contacts on the phone, they can be a little bit confused why they’re being contacted because they haven’t been tested. So they assume because they don’t have COVID-19, I’m okay. I can keep going to work. I can keep hanging out with my friends, whatever it may be. So I think there’s a little bit of a misconception or confusion over, even though you may have never been tested or you might not currently be infected with COVID-19, you have been exposed to someone. So for those 14 days after that exposure, you could develop symptoms at any point in there. You could become contagious with COVID-19 at any point in those two weeks. So yeah, I would say I think sometimes people are just confused why they’re being contacted if they haven’t been tested or assume that they don’t have it because they’re not showing symptoms.

Rebecca Nyangufi:
Yeah. Also going off of that, some people will be in contact with someone on day one and they get tested the next day and they’re like, well, I tested negative so I’m good, and it’s like, no, this is an incubation period. So that’s another misconception and other people find it like you’re invading their privacy. So it’s like, I don’t want to tell you how to live your life, but this is a way to be safer. So yeah, the whole issue about that too.

Nate Savage:
Yeah, I would just kind of say it’s kind of on an individual responsibility because I feel like a lot of people will think the whole community will do stuff to protect everyone, but if you have been a contact and whether you did test negative or whatever other explanation you might have, it’s best to follow the recommendations that you were given because you’re not just putting yourself at risk, but other people in the community too.

Emma Meador:
Yeah, definitely. I think those are all really great points you guys have brought up. I think also just something I’ve found is that sometimes when we’re calling cases, they feel like we’re judging them or mad at them for being in the position they’re in, but that’s not the case at all. This virus isn’t discriminated whatsoever. It will infect anyone and we’re really just contacting them because we want to help and we want to stop the spread of this virus because it really is just not doing any good and it’s just causing so much pain and harm. So really the goal of what we’re trying to do is just to help this outbreak.

Olivia Denkinger:
You bring up a really good point there, Emma, too because I think a public misconception is that the only people testing positive are people that are constantly hanging around 20, 30 people every single day, and while there certainly are people that test positive that are in large social gatherings, there’s also people who simply are catching it because they go to the grocery store. I have talked to numerous people who have no contacts other than the people that they live with and somehow they’ve still tested positive and are showing symptoms. So I think that’s another kind of misconception is who can get COVID-19 is frankly, anyone.

Emma Meador:
Yeah, I think that’s… Yeah. Thank you for bringing that up. That’s a great point, and then moving forward just a little bit, how do you think this job has helped prepared you to enter the field of public health as a future public health professional?

Olivia Denkinger:
I’m really interested in working with people on a one-on-one basis, and so I think this has challenged me a lot to develop interview skills, which is something we practice in a couple of my previous public health classes, but it takes a lot of practice to get an understanding of the person that you’re talking to while asking them sensitive information about themselves and their condition. So I would say, I think just that patient care, learning how to speak with other individuals about their health problems. That’s been a really, really valuable skill for me to work on.

Nate Savage:
Yeah. I agree with Olivia on that one because you do tend to the skill you sharpen as you go along, but being able to communicate effectively with strangers because we are passing on important information and sometimes you got to build a connection, whether it’s a casual tone you’re talking in or some common ground or something, but it is best to connect with them. That gives you more information on what you need to know.

Rebecca Nyangufi:
I think another thing that I learned is how to handle sensitive information and because the stuff that you tell these people, when you can be released is really important because obviously, if you give them the wrong date, then they might be still infectious and be out there. So just having to be careful with what you’re saying and how you’re saying it to people. That’s something that I’ve valued with this experience.

Emma Meador:
Yeah. Thank you for bringing up those points, guys. I think that they’re great. I would definitely agree that this job has helped me prepare to enter the field of public health in the aspect of better being able to communicate and talk to cases, speaking to them in a way that makes them feel comfortable explaining their situation and sharing that information that might be kind of sensitive, and then also being able to communicate to them all of the guidance and recommendations that the CDC or the WHO or the Iowa Department of Public Health has laid out in a way that is really easy to understand, because you do talk to people from every age group, demographic education level.

Emma Meador:
You have to be able to talk to anyone, and I think that’s so important, and then not only are we talking to cases, but I know I also have to talk to healthcare professionals in the hospitals and doctor’s offices because we have to see if they have been notified of their diagnosis before we interview them. So really, you’re not only getting to improve upon your communication skills with cases, but also just healthcare professionals within every aspect of the healthcare system, and then going off of what we just talked about, what do you guys think has been the most rewarding part of contact tracing so far, and then also, what has challenged you the most so far?

Nate Savage:
It’s always rewarding to pass on important information that people need to know. It’s not always the best when the person’s caught off guard or surprised, but it is nice knowing that you are, I guess, making an impact, but I’d say some of the most rewarding things is identifying an outbreak early, whether it’s at a graduation party from a high school senior or some family gathering or something, being able to identify that early and just try to limit it as much as possible. I find that to be kind of something fun to work on.

Olivia Denkinger:
Yeah, I would definitely agree. I think we’re connecting the dots between different cases and see where a little outbreak has happened and then being able to catch those contacts early is relieving, but also very rewarding because you’re like, Oh, we caught that right before it turned into something larger, but I also think I thought the opportunity to talk to a lot of people who were just very thankful for what, Linn County specifically, just because that’s where I’m working, all the efforts that they’re doing right now to make reopening the city and stuff safe for everyone involved. I think talking to those people is always rewarding because it’s kind of that, there’s just a lot of gratitude for this work and I think that’s very cool to experience.

Rebecca Nyangufi:
Yeah. I would say it’s also rewarding seeing everything that we’ve been working in classes, and we always see hypothetical situation or things that happened in the past, but actually having this happen and we’re the one on the front lines, then it’s rewarding to be the person to say I did this, and you’re working with the people in the community and they’re suffering. You’re trying to help them through this situation, but wait. Did you also ask what was challenging?

Emma Meador:
Yeah.

Rebecca Nyangufi:
Yeah. And it’s challenging, especially when you have a case of a two-month-old and stuff. I just get personal. I feel for a lot of people so it’s just really challenging when you get really difficult cases.

Emma Meador:
Yeah. And I think going off that a little bit too, something that’s been really challenging for me too is to put away any sort of personal beliefs or biases or perceptions I have when I’m talking to these people and really just putting forward my professional voice and head so I can gather the best interview I can because sometimes people will be calling that, believe that the virus is a hoax or that it’s not real, and I know that getting upset with them or arguing with them is not going to help anything whatsoever so I really have to put away all of those views I have and just focus on being the best contact tracer I can be and really just doing whatever I can to gather the best information possible. So I don’t know if you guys are run in to that at all, but I know that’s something that’s been really challenging for me.

Nate Savage:
I have. I actually was surprised, I feel like, with… I have felt that most the community or people I’ve talked to, they’ve been more cooperative than I thought coming in. I thought I would receive more backlash, but they have been pretty cooperative, but I do agree with you on that because some cases are challenging to try and talk to not have your opinion be too much in it, but really, all I can do is just lay out your best advice and health recommendations and then they can choose to do with the information as they please.

Olivia Denkinger:
Yeah. I’ve definitely had a couple of cases like that and I think I’ve seen both ends of the spectrum where it’s people who don’t believe anything that I’m telling them and are very upset that they’ve been contacted and that the state’s even doing anything right now about this, and then I’ve had the opposite end where people don’t think that we’re doing enough. So either way, it’s challenging and also draining, I think, to have those conversations because like you guys have both said, there’s really nothing I can do other than give our professional recommendation that’s coming from the state and give them those guidelines and allow them to do what they choose to do with that information, but it’s definitely challenging because obviously, we’re all very passionate and care about responding to COVID-19 in a way that is helping our communities, and so sometimes to feel like other people don’t understand that or don’t believe in that, it gets frustrating over time.

Emma Meador:
I agree. It definitely can be frustrating sometimes, and I think through all those difficult conversations and understanding how people have different views and different opinions, we’re able to grow, not only as a student, but a person and just an individual in the field of public health, and then going on to the next question, what is one thing you thought you knew about contact tracing and/or COVID-19 going into this job and then later realized that you were wrong about, or have you had any sort of perception change?

Nate Savage:
I kind of touched on this a little bit briefly in the previous question, but I did. I was expecting more people to get mad at me on the phone. I have had some people get mad at me on the phone, don’t get me wrong, but I have also had people who gave some rewarding comments or thank me for my work and I wasn’t really expecting to hear that coming into this job.

Rebecca Nyangufi:
Yeah. I didn’t know how many steps it took to get to close a case. We have to do so many phone calls and a lot of… I don’t know. I thought it was just a case investigation and we’d do conduct tracing and then we’re done, but I didn’t know all the steps were taken to just get to close a case so that was interesting to see.

Olivia Denkinger:
Yeah. I think on the same note, it’s the followup process that was new to me or I wasn’t expecting at least, working with patients until they meet our recovery criteria and calling them to check in on their symptoms and see how they’re doing. I guess I kind of assumed that we would do the interview, find their contacts, and then that would be it for the case and so yeah, definitely the followup and the aftermath of an interview was new to me or not what I expected.

Emma Meador:
And I think something else too, that’s really surprised me, and then I just didn’t really realize with all these viruses and outbreaks is that since they are… Well, since COVID-19 is a new virus, we’re continuously learning more about it so recommendations are changing all the time by the CDC. I know for instance, they just changed one of their recovery criteria to 24 hours with no fever versus the three days it was usually. So just you always have to be up to date on the virus and what’s going on and what the CDC has recommended because it is such a new virus.

Emma Meador:
And I know they’ve recently discovered that it’s not just a respiratory virus, which I thought it was, but it’s also a vascular virus and it can affect your blood vessels and can cause blood clotting and oxygen deprivation. So I just think it’s been something I didn’t realize is how much you can learn about a virus and these different outbreaks as they’re happening. I just, it’s stuff you hear about, but you never really have to go through or you never thought you would have to go through. So something that I’ve found.

Olivia Denkinger:
That’s a really great point. I think we’ve learned so much in such a short period of time too, where it almost feels like our information is constantly changing, and I know some people can be frustrated because they feel like the guidelines have changed and who’s coming up with this or whatever, but whatever recommendations we’re putting forward are what the best information we know at the time says.

Emma Meador:
Thank you so much for taking the time to chat. I think this was a great discussion and I wish you guys all the best moving forward. Thank you.

Nate Savage:
Thanks for having us.

Olivia Denkinger:
Yeah, thanks for having us.

Emma Meador:
I hope this interview was able to provide a closer look into some of the ways public health is working in this pandemic. By tracking close contacts and the travel of each case, a probable path of virus transmission is found. In this pandemic, prevention is key and can help prevent further spread of COVID-19 within our communities, and personally, the experience of contact tracing is something I will never forget. Not only has it allowed for me to grow as a future public health professional, but it’s really just opened up my eyes and provided me with an inside look at how a virus can cause devastating effects for families and/or individuals.

Emma Meador:
For instance, when a family member tests positive for COVID, not only do they have to stay home from work and self isolate, but everyone in their family does as well, and with the whole family staying home from work, who is making money to put food on the table or pay the bills, or what if a mother tests positive and has to choose between holding and caring for her young child or not giving them COVID-19? Not only do these positive individuals have to isolate from their friends and work, but from their family as well, and it’s just a position that no one wants to be in or should have to be in, and just seeing the pain that this virus can cause just makes me realize how much more serious this pandemic needs to be taken because just while it may not affect you, it can significantly affect someone else.

Emma Meador:
And with that being said, I think it just highlights the importance of practicing all the preventative measures that the CDC and the Iowa Department of Public Health has advised. By maintaining six feet distance, wearing a mask, avoiding crowds or bars and just practicing good hygiene, this virus really could end, but it just requires the work of each and every one of us because this virus doesn’t discriminate and no one is immune to it. I really just think we should all be doing what we can and what we have the privilege to do, not only to protect ourselves, but everyone around us, and then just to wrap things up. While contact tracing is crucial in a pandemic, it’s just a sliver of the work public health has been putting forth into this pandemic.

Emma Meador:
And I would just like to thank everyone, not only the field of public health, but everyone in the healthcare field and each and every one of the essential workers for just collectively putting their skills together to help fight this pandemic. We appreciate you so much and the work you do does not go unnoticed. All right, that is it for this week. Let us know what you thought about this episode and series at cph-gradambassadoratuiowa.edu. That cph-G.R.A.D.A.M.B.A.S.S.A.D.O.R.@U.I.O.W.A.edu. You can find us on Facebook at the University of Iowa College of Public Health. We’re on iTunes and Spotify as well as the University of Iowa College of Public Health, and thank you to our guests, Nate Savage, Rebecca Nyangufi and Olivia Denkinger. This episode of From the Front Row is hosted by Emma Meador. Steve Sonnier produced and edited this episode. This podcast is brought to you by the University of Iowa College of Public Health. See you next week.