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As COVID-19 cases ramp up, so does contact tracing

Rick Bates, 37, of New London thinks he contracted COVID-19 on Election Day, when he went to Harbor Elementary School to cast his vote, visited the Home Depot in Waterford and spent time with his 10-year-old son, Derek, who goes to Bennie Dover Jackson Middle School.

A few days later, he felt like he had bad allergy symptoms for just a few hours. His girlfriend urged him to get tested for COVID-19. Within the week, he, his son and girlfriend all tested positive for the virus.

Cases in Connecticut were climbing this week, with 2,088 reported between Friday and Saturday, according to state data, and state officials say contact tracers are reaching nearly 100% of individuals who test positive for the virus, and about two-thirds of those they reach are willing to participate in an interview.

But Bates and his son were never contacted.

Contact tracers reached out to Bates’ girlfriend, Jamie Carreira, within 48 hours of when she tested positive, but never called him to see who he had come in contact with. No one ever reached out to ask any questions about his son’s exposure, either.

Bates and his family are continuing to quarantine after getting tested at Shaw’s Cove in New London and learning they were positive on Nov. 12. Bates is feeling fine, and his son only experienced allergy-like symptoms for a little over 24 hours. But Carreira, he said, is battling a painful headache, a bad cough, and can’t taste or smell.

Contact tracers are, according to the state, supposed to reach out to people who test positive within 48 hours of them getting their results, to ask them questions about where they have been and who they have come into contact with.

The process is meant to slow the spread of the virus by informing individuals who may have come in contact with an infected person and urging them to quarantine for two weeks and get tested themselves.

In a news conference with Gov. Ned Lamont on Thursday, Lamont’s Chief Operating Officer Josh Geballe said tracers in Connecticut are “reaching out to almost 100% of the people who test positive within 48 hours.”

“Our teams continue to do a tremendous job getting quickly after those people,” Geballe said of the nearly 750 people working as tracers, either as staff or volunteers.

The state’s new exposure notification app is complementing those efforts, he said. Connecticut residents can opt in to the program on their smartphone and receive notifications if someone they have come in contact with tests positive for the virus. The notifications are completely anonymous and don’t reveal any information about who may have exposed them to the virus or where they were when they were exposed.

In April, when the state was under lockdown, there were 300 contact tracers working across the state, as volunteers and as paid staff with the state Department of Public Health. Connecticut was at that point, and still is, below the threshold for the number of contact tracers recommended by The National Association of County and City Health Officials, which suggested states have 30 tracers for every 100,000 residents during a pandemic. That suggestion means that Connecticut, which has a population of 3.5 million, according to the U.S. Census Bureau, would need about 1,050 tracers.

Connecticut has not slowed its efforts to build the contact tracing force.

“We’ve continued to grow it in continuation of continued case growth, wanting to constantly stay a couple steps ahead and make sure that we have excess capacity to meet the need,” Geballe said Thursday.

He said the system the state has in place to trace COVID-19 contacts is effective, even as cases surge: “the process we’ve built is very scalable,” he said. “We’ve got great partnership with our local health departments and we've created a surge capacity team at the state level to step in if a local health department gets overwhelmed or fall behind.”

Tracing in southeastern Connecticut

Mary Day and Kris Magnussen, two of the three public health nurses who work on contact tracing for Ledge Light Health District, said they are working closely with the state when they need assistance and for notifications of positive cases in the area. They’re trying to reach everyone, but in line with what the governor’s office said, a significant number of people aren’t interested in talking to them.

Day said it's tough to say how many contact tracers Ledge Light has "because it's sort of always changing," but in addition to the nurses, there are about five people from the Medical Reserve Corps and about five in training. Ledge Light also gets assistance from the state Department of Public Health contact tracing pool.

According to Day and Magnussen, most cases are reported by the schools but Ledge Light also gets calls from long-term care facilities, and some people even call to self-report that they've tested positive.

"When we interview a positive case, we try to understand their onset of symptoms, when they were tested, and we determine their infectious period and determine their isolation period," Day said. "Then we identify the close contacts from the start of their infectious period up until they began isolation."

That's if they cooperate. Magnussen said she frequently hears, "I don't need big government telling me what I can and can't do."

Day said infected individuals are usually contacted within 48 hours of when their positive test result enters the contact tracing software — but there's sometimes delays with getting results into the system.

She explained that the labs send results to DPH, where they're entered into the Connecticut Electronic Disease Surveillance System and then into ContaCT, the statewide software platform used for contact tracing.

"Some labs are not very good about sending the laboratory reports timely, so that’s the big issue, and especially with more and more testing being done, it’s taking longer for results," Magnussen said. She added that sometimes by the time results enter the system, the person could be finished with their isolation period.

Magnussen said that in the spring, "people pretty much stayed home or went to work ... but now, oh my gosh, people are going everywhere," making contact tracing much more involved. Day added, "Since everything has opened, contact tracing has become so much more complex."

Michelle Seagull, commissioner of the Department of Consumer Protection, joined the governor’s news conference Thursday and urged residents to cooperate with contact tracers. She said her office has heard that many residents are wary of sharing personal information over the phone with tracers, but reassured the public that legitimate contact tracers will never ask them questions that could put them in danger.

“If they are a real contact tracer, they are not going to ask you for money, they aren’t going to ask for a bank account, credit card or Social Security number, and they aren’t going to ask about immigration status,” she said. She hopes people will feel comfortable working with contact tracers knowing that they won’t be asked about those things. 

“It’s really important to take those calls and work with these legitimate contact tracers, it’s how we’re all staying safe and helping to reduce the spread,” she said.

Uncas Health District Director of Health Patrick McCormack and nurse Jennifer Ceccarelli, who is spearheading their organization's contact tracing efforts, said they’ve been reaching about 90% of people who have tested positive in the district.

McCormack said that earlier on in the pandemic, the district was deferring more to the state for help due to staff shortages, but now is doing most of its contact tracing “in house” and only deferring to the state when necessary, when there’s an issue such as a language barrier.

Not only are health district officials making contact with most infected people, they’re getting them to engage.

McCormack said he thinks that “having the connection to people in the community, calling from a local number, being able to speak to them with the knowledge of the community” is helpful because it allows the tracers “to reference things that they’re familiar with, so yeah, we know your business, we’re familiar with that school nurse,” and ask questions like “would you like us to call your doctor for you? Do you need any assistance?”

The local knowledge, he said, “builds a rapport with that individual” and makes them feel more comfortable.

Early on in the pandemic, one full-time nurse was doing all of the tracing with McCormack’s help. Now, Ceccarelli has been hired to contact trace full time.

Each morning, nurses print a list of all the positive cases in the district and identify the new names. Then, Ceccarelli said, they log onto the state database and contact tracing program and start conducting interviews.

Ceccarelli said she thinks it's helpful that she is contact tracing full time, because she thinks people battling the virus are more comfortable when they are hearing from the same person in follow-up calls. “They actually appreciate the same person following up, monitoring their status daily,” she said, adding that less than 1% of people she has called have been uncooperative.

She credits the district's success rate to its dedication to assuring contacts that the information they share is confidential and strictly meant to protect the community, and because she offers alternatives like opting out electronically or responding via text message instead of over the phone.

McCormack said he thinks building a strong relationship between health district staff and residents as they navigate the COVID-19 pandemic is helpful for everyone.

“Obviously one of the big concerns around COVID is isolation. These people appreciate we are personally connecting, I hear the conversations that the nurses are having with the public when they’re on the phone, and the conversations aren’t always medical in nature,” he said. Nurses ask contacts things like how their children are doing in school and when they’re going back to work.

That relationship "will hopefully give us a credibility in the community as we move into vaccinations, people in the community will have a trust," he said. “They’ve already talked to us on the phone. They’ve hopefully found that interaction to be a positive one."

Day Staff Writer Erica Moser contributed to this report.


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