She Was a Librarian. Now She’s a COVID-19 Contact Tracer

Elizabeth Perez feels “a moral obligation” to help fellow Latinos navigate the pandemic. Before the outbreak, the bilingual 36-year-old librarian worked in San Francisco’s main library branch downtown, spending her days fielding research questions, doing story time readings for kids and assisting locals with computer access.

Now she’s a contact tracer, working from home as a COVID-19 detective. She uses her sleuthing talents to talk to people who may have been exposed to the novel coronavirus — and track down people they may have had contact with. She also helps them understand their situation, connects them to resources and helps them protect themselves from the potentially lethal virus. While she hopes the library can reopen safely soon, especially since so many people rely on it for the internet, she is fulfilled by putting her Spanish-speaking skills to work for her community.

In California, coronavirus cases and hospitalizations have spiked sharply in the past few weeks. Latinos have been especially hard hit. They comprise about 39% of the state’s population but make up about 55% of COVID-19 cases. Many Latinos are considered essential workers and are concentrated in industries that are seeing major outbreaks, like warehouses, manufacturing and meatpacking plants, restaurants and retail. Many also live in highly dense neighborhoods — especially true in San Francisco where rents are so high that extended families are often forced to cram together into tiny apartments, conditions ripe for viral transmission.

[Read: Unraveling COVID-19 Has Been Like Starring in a Michael Crichton Novel.]

In her new role, time pressure is a constant, as she races to unravel the web of potential transmission to help contain the spread. “In contact tracing, your goal is to reach the contact as soon as possible because you want them to stay at home,” Perez says. “We’re often calling what we call a cluster, and the person who is infected lives in a home with lots of people. I’ve seen up to 16 people living in a home, mostly because housing is so expensive in the Bay Area. When you’re sharing a bathroom and kitchen, your risk of coming in contact with an infected person increases, so the whole household becomes contacts. A lot of it is work-related, but people are also exposed visiting families or going to parties.”

Perez is part of a large-scale initiative by University of California-San Francisco, in partnership with the California Department of Public Health, to train thousands of people throughout the state to do case investigations and contact tracing. Called the UCSF Pandemic Workforce Training Academy, Perez was among the initial wave of trainees in May. The program recruited city employees, including furloughed librarians and assessors who were assigned to be disaster service workers, as well as retired public health professionals and medical students at UCSF. Since then, the program has been expanded to California’s 58 counties and three city health departments, and has trained 7,000 individuals.

Similar programs have sprung up nationwide in response to the pandemic and are conducted under the auspices of public health agencies to provide support and information to people who may have been exposed to the novel coronavirus. (For more information about initiatives across the country that are spearheaded by the U.S. Centers for Disease Control and Prevention, check out this agency resource.)

[Read: Dr. Sanjay Gupta — Holding America’s Hand Through the Pandemic.]

In the absence of effective treatments or a vaccine, contact tracing is the epidemiological tool that’s been used for decades to contain epidemics; it’s a strategy that helped nations like Germany and South Korea suppress the new coronavirus. The basic premise is straightforward: If someone tests positive for COVID-19 (or is suspected to have it), everyone he or she has come in contact with may be infected, too. Those contacts need to be warned and quarantined for 14 days to stop the spread.

Unfortunately, the U.S., which experts say needs at least 100,000 contact tracers across the country to effectively control the pandemic, has no national strategy for contact tracing (although Congress is considering allocating $25 billion for tracing and testing in the latest pandemic relief bill). Instead, experts say the U.S. is relying on a patchwork of state programs, some of which are underfunded or understaffed.

Florida, which is in the midst of a serious outbreak, has seven contact tracers per 100,000 residents, while Arkansas has about 900 tracers even though it needs at least 3,000 to do an adequate job, experts say. Massachusetts, New York and Washington state, early virus hot spots, have mobilized large programs. Massachusetts, for instance, earmarked $55 million and trained 1,900 contact tracers who were able to reach 90% of contacts (of people who’d been infected) within 24 hours. The UCSF-California Department of Public Health partnership also gets high marks, especially because of its efforts to target the state’s diverse population.

Over the course of five days in May, Perez, who still draws her librarian salary as a city worker, went through 20 hours of web-based classes, and shadowed instructors online who were talking to people who’ve come in contact with an infected person. She learned the best ways to approach newly infected people and how to connect them with services so they can be safely isolated and treated. She learned the art of determining through conversation who their close contacts are, and to provide support for these people so they can quarantine until they know they’re not infected.

Every day, Perez fires up her laptop while sitting on the couch or bed at her home in north Oakland. She logs in to a virtual meeting with her team, which consists of about 10 people: other contact tracers and a nurse or physician’s assistant who provide background details on the people they’re calling. Afterwards, she consults a database containing a list of people to call who’ve been in contact with an infected person. She usually talks to about five to seven people during her four-hour shift.

[Read: Doctor Treats COVID-19 Overnight, From His Living Room.]

San Francisco offers a wide range of COVID-19-related services to city residents, including a website that lists free testing sites, food and medication-delivery programs and where to find cleaning supplies, and even provides referrals to hotels for those who need help isolating. “These are all things to help people stay at home,” Perez says. “We help them determine if they’re experiencing symptoms and try to get them tested as quickly as possible. If they live with someone, they need to get tested, too. We also refer them to other services so they can finish their 14 days of quarantine in isolation and minimize the risk of infecting others.”

There can be some initial wariness, but most people are receptive. “I’m a stranger to them, and people are afraid of being scammed because we’re asking for their date of birth to verify who they are and an address to track what areas are being affected,” says Perez, who often feels emotionally overwhelmed when she finishes her shift. “It’s scary to navigate this on your own, and I’ve had people on the verge of tears or angry because they waited a long time to get tested and to get results. But the majority are very grateful to get the help they need.”

There are a lot of layers to contact tracing, Perez says. “When we reach that one person, we’re actually helping a whole community.”

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