Observations

COVID-19 Contact Tracing

Part public health nurse, part detective

I’ve been a public health nurse for 30 years, so I’ve always understood that the role focuses less on face-to-face patient care and more on administrative work. That effort never felt as important to me as bedside care, but it’s been a different story since the emergence of COVID-19.

This is how my job has changed during the pandemic.

Stay at Home!

I work for the health department in Bergen County, N.J., which recently assigned me to COVID-19 contact tracing. My task is to call county residents who have tested positive for the 2019 novel coronavirus to try to determine where they’ve gone and whom they might have exposed.

On a recent call, a very cheerful middle-aged man told me that on the day before he developed “only a slight fever and cough,” he’d delivered a dresser to his daughter across the river; gone to the supermarket, a deli, a drug store and Starbucks; and then joined a friend for lunch and 18 holes of golf. Later, they’d picked up their wives and had dinner at a nice restaurant across the state line.

When I asked if he’d notified his friends of his positive test results, he laughed and said, “Oh, you should try to get them on the phone. They’re really busy.”

So was I, trying to verify cases, track contacts and hopefully limit exposure to this highly contagious infection.

Commuter Contagion

New York City hasn’t become the epicenter of the U.S. COVID-19 pandemic simply because it’s crowded. Tri-state residents just don’t stay still. If you’re unfamiliar with my state, Bergen is directly across the George Washington Bridge from Manhattan. Housing costs are somewhat lower than in New York and the offerings are more varied, including everything from suburban houses with big yards to high-rise apartment buildings. Consequently, our area has a large commuter population.

Bergen had the state’s first confirmed COVID-19 patient: a healthcare worker who lived here, but worked in New York City as well as in New Jersey.  As the New York figures began to ramp up, so did ours. Soon, Bergen County, with almost 1 million people, accounted for half the cases in the entire state of New Jersey, which has a population of 9 million.

Cancelled Vacation

I’m a per diem nurse for our regional health department. On Tuesday, March 10, I returned to my office from a blood pressure clinic at a senior center only to find TV news satellite trucks blocking the street and newscasters milling around trying to get statements. Our county had just registered New Jersey’s first COVID-19 death hours earlier.

Three days later, still not understanding just how fast the scene was changing, I was packing for a vacation trip to Florida. We were planning to leave the next morning. By evening, we’d decided it was a bad idea and cancelled our flight.

During the following week — my vacation — New Jersey Governor Philip Murphy followed New York Governor Andrew Cuomo’s lead, imposing a curfew and closing all nonessential businesses. It seemed harsh at the time, but within a matter of days, there were plans for field hospitals, a hospital ship and too many patients for 911 to help.

Tracking the Test Results

Normally, our communicable disease department tracks maladies like salmonellosis, typhoid and strep. When we get positive results from the labs, the next step is to follow up with the patient to see whom they might have exposed and how they can limit further transmission.

Patients who test positive for hepatitis A, for example, might be told they cannot continue to work in a restaurant until they submit negative stool specimens. A recent mumps outbreak in the local jail was contained and all patients got new MMR vaccinations.

Now, of course, the priority is COVID-19.

Every morning, my supervisor drops a packet of investigation forms on my porch and then emails me a list of names, birthdates and identification numbers for reporting back to the state. The following morning, I exchange the previous day’s completed forms for a new stack of blank ones.

Hiring Now

The test results come from various testing sites, including local doctor’s offices, the federal drive-through site at our community college and multiple urgent care centers. I’ve had doctors who’ve tested themselves and their staff, and a pediatrician who took the elevator down from his office to test a coughing father sitting in a car double-parked on the street.

Sleuth and Counselor

Contact tracing is part detective work and part counseling. I always have a calendar in my hand when talking to patients. We try to determine when they first developed symptoms, where they were at that time, where they’ve gone since then and with whom they’ve come into contact. (Early on, we also tracked each patient’s movements on the three days before they became symptomatic, but as the number of positive cases has increased, our questionnaire has become shorter and more narrowly focused.)

Often, patients tell me they haven’t been anywhere and I have to remind them that they might have gone out for groceries or to the pharmacy to look for something to bring their fever down.

“Don’t Tell Anyone”

There are many obstacles to contact tracing. Some people gave their work numbers for follow-up, and now that those businesses are closed, we can’t contact the patients to give them their test results. I sometimes run up against language barriers as well as people who are afraid they will lose their jobs if their boss finds out they are positive.

I’ve had people ask me not to tell anyone, or refuse to give me the last names of their roommates. I spoke with a physician’s assistant without a fever who had tested positive, but was told she had to continue to work because there is no one to take her place.

High Stakes

Public health has always been an underappreciated and underfunded specialty. The work of tracking trends and stopping the spread of illness isn’t glamorous, nor are our tools: vaccines, education and disease reporting. However, there’s nothing like a pandemic to demonstrate how important those things can be.

As for me, I’ll be at home, sitting at my dining room table (the “field station,” as my husband likes to call it) with my phone and my pen. I’m doing the job I’ve been trained to do for 30 years, but the stakes are much higher than I’ve ever experienced before. I can only hope that doing what we’ve done in outbreaks past will bring us success this time.


Christine Contillo, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.


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