In Kansas, contact tracers listen to the fears of the exposed in race to contain virus

Each day behind closed doors in a handful of Wichita offices, they pick up the phone and start dialing.

On the other end of the line are the latest people to test positive for the coronavirus in Sedgwick County and those who came close to them in the days before their symptoms began.

The questions are the same, even if the answers are not. Did you go to any large gatherings? Were you at work? Were you around other positive cases?

During the course of any given day, the 14 investigators who make up the county health department’s contact tracing team interview roughly 10 newly positive residents and tell their closest contacts to go into quarantine.

At times, they’re breaking the news to someone that they have COVID-19. Empathy is key, said Kaylee Hervey, the county’s epidemiology program manager, who occasionally makes calls herself.

“We do take as much time as they need to really talk through their fears, their concerns, talk about how it could potentially impact their work, their family, their social time,” Hervey said.

Across Kansas, similar scenes play out daily. Statewide, hundreds of people receive positive test results each day. Ideally, all of them need to be interviewed immediately along with their close contacts.

Contact tracing is widely viewed as a key metric for reopening society. While COVID-19 testing has dominated public attention, tracing is the other side of the coin — how test results are used to stop the virus from spreading.

The importance of robust tracing will only grow as restrictions are lifted. Personal interaction will proliferate as people begin to venture outside the home. The result will be both more contacts and contacts that are more difficult to trace.

“The stay-at-home order helped a lot with this but since that’s starting to open up, our next best line of defense is to identify all contacts and then get those people into quarantine as well and also test them,” Hervey said.

Tracing remains a personal affair. Investigators must coax honest and complete answers out of people to be effective. Major tech companies, including Apple and Google, are developing tools to assist, but their efforts have raised privacy concerns.

For the foreseeable future, Kansas counties will continue to bear the brunt of the tracing burden. In the past, that hasn’t been a problem. Other diseases that call for tracing, such as tuberculosis, are often quickly contained by local health officials.

But the breadth of the coronavirus pandemic will tax local resources in the weeks and months to come. In response, Kansas officials are assembling a 400-volunteer contact tracing force to assist the counties. About 200 people have been brought on so far.

Hervey expects the burden on her team will soon increase. Kansas began reopening on May 4 and the virus’s 14-day incubation period means she’ll soon have a better sense of what to expect.

If it came to it, Hervey estimates her team could trace contacts for up to 40 cases a day in Sedgwick County.

“We’ve luckily have never had that happen,” she said. “Knock on wood, it won’t.”

Contacts fearful

In some instances, a single positive case results in a huge number of contacts.

One recently confirmed case had 200 contacts, Kansas Department of Health and Environment Secretary Lee Norman said Wednesday.

In January, officials prepared to reach out to more than 400 people when a student in Lawrence was thought to possibly have the virus. It turned out to be a false alarm.

Julie Swann, a North Carolina State University professor who has worked with the federal Centers for Disease Control and Prevention, said COVID-19 tracing “dwarfs what has been done before in terms of scale and in terms of the number of governmental agencies that are likely to be involved.”

The task is compounded by the need for contact tracing to operate on two separate levels — investigation and counseling.

“The investigator side of that role needs to help the individual think through the different settings that they’ve been and the different people they’ve been in contact with over a period of, say, five days,” Swann said. “The counselor is working with them and being empathetic and convincing them to participate in this and having to do so in a culturally-sensitive way.”

Sedgwick County employs a two-tier system, with case investigators paired with contact tracers.

The case investigators call those who have tested positive and interview them, usually for 30 minutes, Hervey said. Most of the time, the person already knows they’ve tested positive, but if they were tested by the health department the investigator may also be informing them of their positive status.

The investigators try to obtain at least a broad picture of the person’s movements during the two weeks before they developed symptoms. They pay extra attention to the two days before symptoms began, however.

Investigators will ask about every close contact during that period, which health officials have defined as anyone who was within six feet of the individual for 10 minutes or more.

The list of close contacts is turned over to the contact tracers, who call them and ask whether they’re having symptoms. They’re also told to quarantine. Sedgwick County has also begun testing every close contact, regardless of whether they have symptoms.

About 80% of the time, the contacts already suspect they’ve been exposed, Hervey said.

Still, people are concerned, sometimes fearful. In quarantine, the basic tasks of everyday life like grocery shopping become logistical puzzles.

“They’re worried about their jobs. They’re worried about being able to care for their families,” Hervey said.

Investigators and tracers will refer people to agencies that can help, she said.

Tech could aid tracing

A national contract tracing plan developed by top public health experts suggests Kansas may remain short of the tracing capacity ultimately needed, even with the 400 volunteer tracers Norman has promised.

The proposal, from the John Hopkins Center for Health Security, calls for the hiring of 100,000 tracers nationwide. Relative to its population, Kansas would need about 800 additional tracers.

“In order to save lives … the United States must implement a robust and comprehensive system to identify nearly all COVID-19 cases and trace close contacts of each identified case,” the report, released April 10, says.

The additional tracers could be “strategically deployed” to areas with the greatest need, the report says.

Kansas, with fewer than 3 million people, hasn’t suffered anything approaching the outbreak seen in population centers like New York City, but the state’s cumulative case number is on a sharp upward trajectory.

Swann said having 400 tracers available when 800 may ultimately be needed is “not so far off,” given that the state could hire more people later.

“That’s something as states start to think about this they’re going to have to figure out ‘well, how many people do we need to hire and how to organize them? All those kinds of things,” Swann said.

Some Kansas counties are moving to expand their tracing operations. Sanmi Areola, director of the Johnson County Department of Health and Environment, said the county needs more resources for tracing.

The county health department has five staff members who do case investigation and contact tracing, plus it has trained about 30 additional staff members who may be pulled from their regular jobs as testing increases. If more are needed, Areola said the county would rely on volunteers, such as school district nurses.

“We’re going to need to really enhance our capacity beyond what we currently have,” Areola said.

Norman is holding out hope that technology will eventually ease the tracing burden. Smartphone apps have already been developed that can track when people come into proximity with each other based on the location of their phone.

“It would be a particular benefit, for example, to receive a text when somebody that that person had come into contact with has tested positive,” Norman said. “I personally think it’s a good idea.”

Samuel MacRoberts, general counsel and litigation director at the Kansas Justice Institute, said serious privacy and constitutional concerns exist with using cellular data to track citizens, even during a pandemic.

“The public is appropriately skeptical about the potential for government misuse and overreach,” MacRoberts said.

Norman acknowledged privacy concerns. He said the technology should be “safe, private, works and is helpful.”

Still, Hervey said technology can’t replace the “human element” of contact tracing.

“A lot of people want to have that personal contact,” she said. “To have somebody reach out them, to have somebody to talk through their fears and anxieties with.”

The Star’s Sarah Ritter contributed reporting

This story was originally published May 9, 2020 at 5:00 AM with the headline "In Kansas, contact tracers listen to the fears of the exposed in race to contain virus."