Laurel Stang and LeeAnn Palazzo can never be certain how people will react when they call.
“You get a variety of responses ranging from shock, anger, fear, acceptance, depending on the news,” said Stang.
She and Palazzo, both registered nurses (RNs), are contact tracers based in Regina. All Regina contact tracers are RNs. Stang, a communicable disease nurse supervisor, has been with Communicable Disease Control for 18 years; Palazzo, a public health nurse supervisor with Specialty Immunization, Travel Health Centre, began contact tracing in March of this year. Although their two teams have different focuses, they have worked closely together to prevent the spread of COVID-19. At the onset of the pandemic, their teams showed their versatility by merging to increase public health’s capacity to contact trace.
Generally, when you get a phone call from a contact tracer, it’s either because you have tested positive for COVID-19 or you’ve been in contact with someone who has.
Contact tracing is an essential public health tool in the control of COVID-19. The process of tracing the contacts of someone who has tested positive for the virus helps break the chain of transmission.
The role requires not only strong detective skills, but the ability to identify people’s needs, connect them with the right services and establish a trusting relationship.
“It’s really challenging,” said Palazzo. “You need a patient, calm voice and you need to be a good listener to get the details. You also need to learn how to calm a client down who may be upset or anxious while still relaying a lot of information.”
Stang added, “You need to be inquisitive, but in a kind fashion. You have to know when to probe and how to ask questions without jeopardizing the relationship. You need to get people to tell you what we need and we need to show the individual we care about them.”
Laurel Stang said a key part of her role is to be inquisitive.
The work of contact tracers begins when a Regina medical health officer notifies them of a new case and provides details such as the infected person’s name and health card number.
The Regina contact tracing team immediately gets to work filling in the blanks. Under the province’s Public Health Act, 1994, contact tracers have access to databases that allow them to find the contact information of people who have tested positive for a communicable disease.
“First, you have to figure out where is the person located. It’s very much an investigation,” said Stang.
Once they contact the person, they ask them to indicate the date when they first noticed symptoms and provide the names of the people they’ve had contact with, along with all of the places they’ve been, starting from 48 hours before the point of symptom onset. Contact tracers may need to cut a wider swath if the person is asymptomatic. They provide the affected person with instructions on self-isolation, which begins immediately.
“We have to also do mental health and some of the social work assessments and be able to do referrals to appropriate services if someone needs more support. Do they have food needs? Do they have shelter needs? Are there multiple people in the house? Are they able to self-isolate? Do they have a separate bathroom? If they need a phone we provide a phone. If they need minutes, we’ll provide minutes.”
Stang said contact tracers aim to reach the person immediately after receiving the notification although sometimes it may take a little longer.
Depending on the case, contact tracers may link into other teams or services to support the person who has tested positive as they self-isolate. This can include contacting the self-isolation assist team, made up of social workers and nurses who go to people’s homes to help address their needs, Regina’s testing and assessment centre, primary health care networks, the emergency department, the environmental public health team, infection prevention and control staff and employee health services.
Next, they call all those who were in contact with the person who tested positive for COVID-19, including those who were in contact during the 48-hour period before the infected person began showing symptoms.
“You try to put a bubble around the contacts as quickly as possible to stop further spread,” said Stang.
Close-contacts are also instructed to go into immediate self-isolation for 14 days from the date of exposure. Some people are shocked or angered by this news.
In part, that’s because “we can’t tell the contact who the case is and we can’t go back to the case and tell them about the contacts,” said Stang. “All I can tell them is that they were exposed. This is necessary to protect people’s privacy.”
Non-close contacts are also called. They are advised to self-monitor for signs and symptoms of COVID-19 for a period of 14 days. This includes taking their temperature twice daily. They are not restricted from attending work or school but are asked to avoid crowded public spaces and vulnerable people. They are to call the public health team if they develop symptoms and immediately self-isolate.
LeeAnn Palazzo said being a good listener is an essential tool of the contact tracer.
With both close and non-close contacts, Stang, Palazzo and their colleagues talk to the person about their exposure date, review their medical history, review COVID-19 symptoms and how to take their temperature, tell them who to call if they get sick (HealthLine 811; physician or nurse practitioner, 911 if emergent), explain how to take care of themselves, and make clear how long the period of self-isolation and self-monitoring is.
Stang, Palazzo and their colleagues call those who test positive for COVID-19, as well as their close contacts, each day while they are in self-isolation. COVID-19 test results may also be relayed at this time.
“If you start to get symptoms, we’ll support your health and help you get tested in a safe manner, including arrange for transportation, if necessary,” said Stang.
Non-close contacts are called a second time on the morning after their self-monitoring period ends.
Stang and Palazzo will arrange for a home visit when people who are self-isolating can’t be reached by phone or need additional support.
Their work and that of their fellow contact tracers is almost exclusively done over the phone.
“It varies from 100 to 200 calls a day, and is sometimes more,” said Palazzo. This also includes calling back those who test negative for COVID-19.
Much depends on the number of contacts who need to be called. The number varies widely, but is generally between five and 20 contacts per case, but can be more depending on the situation.
When some areas of the province experience higher volumes of cases, Stang and Palazzo – along with contact tracers from across the province – sign onto the provincial online contact tracing system. This World Health Organization outbreak management tool, put in place by the Saskatchewan Health Authority at the onset of the pandemic, enables them to contact trace in another jurisdiction and support their colleagues across the province.
In most cases, the team is able to contact those involved, even if it means working long into the night.
The workload of contact tracers is directly impacted by how carefully the public follows public health measures, said Palazzo. As a direct result of COVID-19, her team of contact tracers has expanded its services from weekdays to 12 hours a day, seven days a week.
“What the public does is very important,” said Palazzo. “Following public health measures, like washing your hands, staying home when unwell, and social distancing, works. They’re there for a reason. They reduce our contacts and they reduce cases.”