WINCHESTER — The disease detectives don’t carry guns and badges. They mostly use phones for their investigations.
Leigh Headley and Dawn Hill are trying to contain the coronavirus pandemic one call at a time. The Valley Health System nurses are among five full-time and three part-time contact tracers working the phones for the Lord Fairfax Health District. They spend their days tracking people diagnosed with COVID-19 and the people with whom they may have come in contact.
Headley and Hill work out of the Frederick/Winchester Health Department. The other tracers work from home.
Among their duties are advising people who have been diagnosed that they are required to remain in isolation for at least 10 days after being tested or 10 days after first showing symptoms. People who have not been diagnosed but may have been exposed to the virus must quarantine for 14 days from the last day they had contact with the infected person.
The difference in days is because it takes up to 14 days for someone who may have been infected to show symptoms. Isolation is a stricter form of quarantine for people who have exhibited symptoms of being sick. The goal is to have no contact with other people while sick if feasible. Patients are to stay in one room and use a separate bathroom if possible.
If a case involves an outbreak, the tracers can make up to 30 calls in a day. Besides arranging tests and asking questions about demographics, health, travel and who the person may have come in contact, they also offer support. That includes trying to arrange for ways that groceries and medicine can be delivered to the home and moral support for infected people who feel stigmatized.
Most people are cooperative, but some express reluctance to stay home. Headley and Hill said the reluctance is often because of job concerns or a lack of resources.
Dr. Colin M. Greene, district director, said during past disease outbreaks around the nation, such as tuberculosis, people who refused to isolate themselves were sometimes confined against their will. He said people deemed “a threat to public health” during the current pandemic could theoretically be forcibly confined, but there are no plans to do so. “I would talk to the person and try to reason with them,” he said.
Greene said in some cases, health district staff have dropped off groceries at the home of someone who was infected or quarantining. Hill said she tries to reason with people who are reluctant to isolate or quarantine.
“Is it a financial issue? Is it, ‘I don’t have anybody do to what I need to do.’ Or, ‘I don’t have anybody to take care of my kids,’” she said. “We try very hard to determine why they’re resistant and work to come up with a solution that will help them and the community.”
Contact tracing has helped epidemiologists better understand and contain diseases for centuries. From tracking syphilis in 16th century Italy and yellow fever in France in the 19th century to discovering that Mary Mallon — the asymptomatic cook known as “Typhoid Mary” — was spreading disease in New York in the early 20th century.
“Contact tracing is a core disease control activity,” the Centers for Disease Control and Prevention said on its website. “It has been used for decades by state and local health departments to slow or stop the spread of infectious disease.”
In the midst of the coronavirus pandemic, the need for the health detectives is greater than ever. Through Saturday, COVID-19 had killed approximately 679,000 people worldwide, according to the John Hopkins University of Medicine Coranavirus Resources Center.
With some 154,000 dead, including over 2,218 Virginians, America leads the world in coronavirus deaths. That includes 86 people in the Lord Fairfax Health District, which encompasses Winchester as well as Clarke, Frederick, Page, Shenandoah and Warren counties.
As part of efforts to reduce infections and deaths, contact tracers are being hired nationwide. The Department of Health and Human Services announced in May that it was providing $11 billion to states to expand testing with the money including funds for hiring contact tracers.
Kaiser Health News reported in June that experts say 100,000 to 300,000 will be needed. However, a study in June by National Public Radio found there were only about 37,000 contact tracers in the U.S., up from about 11,000 six weeks earlier.
NPR found just seven states, the District of Columbia and two U.S. territories met the estimated need for contact tracers. Virginia was not one of the states. The study said Virginia has nearly 700 contact tracers, but needs nearly 2,800.
The Virginia Department of Health is seeking to hire up to 1,200 tracers, according to its website. Applicants do not need to have a medical background to be a contact tracer.
While more contact tracers are being hired, their effectiveness has been hampered by the overwhelming number of infections. The New York Times reported on Friday that in parts of Arizona and Texas, contact tracers have only been able to reach a fraction of infected people and that some cities in California and Florida have abandoned contact tracing due to the high volume of cases.
Efforts have also been hampered by testing delays. The longer it takes to get a test or to get the result back, the greater the likelihood of infections spreading.
After lengthy problems developing tests early in the pandemic, the U.S. now leads the world in the number of tests done, according to the John Hopkins center. Nevertheless, testing delays are increasing nationally and locally.
Greene said local delays have increased in the last month. From overnight results or a two-day wait, some results now take over a week.
“It really makes it very hard to effectively do contact tracing,” Greene said, adding that the state is working on ways to simplify testing. “You can’t prevent something starting a week later.”
Headley and Hill also said virus containment efforts have also been hampered by misinformation. They regularly speak to people who try to downplay the virus comparing it to the flu. But the virus is far more deadly than the flu.
Between 24,000 and 62,000 Americans died from the flu between Oct. 1 and April 4, according to the CDC. The approximately 154,000 American coronavirus deaths have come in just five months. At the current pace, deaths will reach at least 300,000 by the end of the year.
Headley said as long as many people refuse to regularly wear masks, practice social distancing and frequently wash their hands, the pandemic will continue despite the best efforts of contact tracers and other medical professionals. She said people who don’t wear masks are being selfish.
“It puts so many people at risk, but it especially puts our health care workers at risk because those are the ones on the front line,” Headley said. “We have to look at the greater good.”