COVID Contact Tracers Navigate Cultural and Emotional Nuance

by Sally James

When Ben Meana calls, people have all sorts of reactions. They might hang up. They might worry. Or they might be glad to learn more about protecting their family and community from COVID-19.

Meana is a contact tracer for Public Health — Seattle and King County. Every morning, whether he's working from his home or his office at Harborview Medical Center, he starts calling people who have tested positive for COVID-19. These people have recently taken a virus test, some at the drive-up or walk-up testing stations established across Seattle, Renton, Auburn, and Shoreline. Meana has plenty of experience doing this job — before the pandemic, he performed contact tracing for sexually transmitted diseases.

Meana speaks Spanish fluently because both his parents are from Spain and he grew up in a bilingual household. But when he's calling a local Latinx person, they might notice that his Spanish isn't quite the same as those whose Spanish heritage is from Mexico or Latin America at large. The Emerald asked Meana to talk about the nuances of providing bilingual tracing calls in this time when people from the Latinx community are hit by the disease at higher rates than whites. According to the Washington State Department of Health dashboard, Hispanics comprise 41% of the cases in the state while making up only 13% of the state's population.

Meana cannot share with us any real examples of people from his work — public health authorities maintain the privacy of everyone with whom they talk. So the Emerald invented an imaginary person, Brenda, a single mother of two who works in retail at a big box store, and asked him how he would tell her about her test and the need to reach anyone she may have exposed.

First, Meana tells us, he would say his own name and explain that he's calling for the public health department. He would need to ask her birth date in order to verify that he's speaking to the patient who tested positive and not someone else answering that phone. He always asks: "How are you doing? How do you feel?" Frequently, he says, he senses hesitation from people at this point. They may fear that they are in some sort of trouble, or that he will call their boss, or — if they have immigration concerns — that he will call the authorities. He says he won't do any of those things, but people worry.

Contact tracers have a dual role: on one hand, they are trying to help support the diagnosed person with immediate information. They can supply a doctor by phone if the person is coughing terribly or sounds ill. If money is tight, they can arrange for a food benefit to be delivered to a home and can even link to social-service agencies that might provide rent.

But their other role is to identify anyone in Brenda's life who might have been exposed and needs to know so they can quarantine themselves, seek out testing, and prevent further spread of the epidemic.

"I might say something like, 'Look, the reason we're asking you to do that [name contacts] is we want to make sure that your coworkers are aware and are safe and that they can keep their families safe,'" Meana said.

Meana may advise Brenda that she should stay home and quarantine for 10 days to protect other people, including her coworkers. She may feel the loss of pay is too great — that she won't be able to care for her family.

Meana understands the financial consequences for workers who don't have paid leave and the stigma that some people might feel around the diagnosis. He's been doing contact tracing for sexually-transmitted diseases, including HIV, for many years. He says the tracer has to reassure the patient while gently making suggestions for how they can protect others by naming their contacts and telling the tracer where they have been. Brenda may have been contagious and able to spread COVID-19 even when she didn't feel any symptoms. She has a coworker who is pregnant. If she reveals the name of her coworker, the tracers will call that person and just tell her she was exposed to COVID-19 without ever naming Brenda.

Women who are pregnant have less immunity and could have a more serious infection during COVID-19. Knowing in advance about exposure could help that woman get tested, possibly arrange for medical treatment faster, or even save her life.

After Meana's call, most patients receive a text every other day, in English or Spanish, reminding them of their quarantine. For other languages, there is an interpreter who follows up by voice call.

Talking to people about their disease is tricky in any language. Meana noticed a few months ago, in the earlier part of his tracing on COVID-19, he would tell people how to disinfect to prevent the spread of the virus. He used the Spanish word "lejia" for bleach, but some people acted like they didn't know that word. As it turns out, bleach is often called "cloro" — short for the brand name "Clorox." This is just one example of how the tracers, as a group, are improving day by day at getting messages across in the best way for every household.

The key, Meana said, is "understanding who your audience is, and then you have to code switch. I've been using my Spanish professionally for the past five years. You have to be fully honest and say: Hey, this is the word that I use in my culture and my language. Let me know if I just confused you."

Matt Golden, M.D., who runs the contact tracing program for Seattle-King County, says 85% of potentially exposed people are successfully contacted, leaving only 15% who can't be reached with the tracing effort. But outside of King County, much of the contact tracing is done by the state Dept. of Health, and they recently reported that about 25% of people were not reached. The numbers are in a Sept. 16 story from The Seattle Times.

Tracing is just one of the many ways to fight the war against the epidemic, Golden said. But it's not enough to win by itself.

"Society swings between, 'this is some sort of panacea,' which it is not, and then despair. Right? It is not in and of itself a comprehensive program," he said. Even if the contact tracer doesn't reach the first person very fast, they still might help find a second or third person exposed and lead to an earlier diagnosis for those other people. "That's where we really have the opportunity to make that prevention difference," he said.

He also explains, in a hypothetical way, how maybe Brenda is just one case at her big box employer. But the contact tracers uncover two more employees, and that can lead to an investigation of the workplace that helps squelch a bigger outbreak. Maybe physical changes, such as better air flow in that workplace, can reduce any risk of transmitting the disease.

"You have to see this as part of this web of intervention. It is not just [Brenda]. It's their context and the information they're providing about the places where they've been, which are potential hot spots of infection," Golden said.

When someone hangs up on Meana, they may feel safer for not talking to him. But the community is safer if they answer that call. Some people are enthusiastic, and have a list of their contacts waiting for Meana. He has received texts of thanks. At least one text included a heart emoji.

Sally James is a Seattle-based science reporter.

Featured image by Carolyn Bick.