Combatting a pandemic one phone call at a time
Carmen DeRaleau starts her workday at 7 a.m. by logging into the Department of Public Health’s Massachusetts Virtual Epidemiologic Network (MAVEN) to see how many new cases of COVID-19 there are on the Cape. Then she begins making phone calls.
DeRaleau is the director of provider relations at the Visiting Nurse Association of Cape Cod (VNA) who works with Meg Payne, VNA director of public health and wellness. Both have worked as contact tracers seven days a week, including holidays, since March of 2020.
“We have to work holidays because COVID doesn’t take a break, so we can’t either,” DeRaleau said.
“We both have other jobs to do as well,” Payne added. “Previously, communicable disease surveillance was a very small part of what we actually did.”
While the VNA has been providing contacting tracing for the bulk of the Cape towns during the pandemic, (except Provincetown, Barnstable and Sandwich), Barnstable County recently took over tracing duties in Yarmouth, Dennis and Harwich.
A recent tally from the VNA’s original tracing towns showed that, since the pandemic began, they have contacted more than 13,000 people who tested positive for COVID-19 and another 13,000 people who came into contact with infected people.
“This is really a conservative estimate of cases because cases don’t all get into the report,” DeRaleau said. “I would say it’s probably double that number.”
When someone gets tested at a pharmacy, doctor’s office, urgent care center or hospital, the specimens are sent to the DPH lab. The state then alerts DeRaleau and Payne of every positive case in the VNA’s jurisdiction through the MAVEN system. There has not been a single day since March 2020 without a new case.
“This morning I had 30 new cases, so those are 30 new calls that need to be made at a minimum,” DeRaleau said. “Those are just the positive cases at seven in the morning, but by nine o’clock, three more cases had dropped in and then throughout the day, more and more cases drop in. Remember the episode of I Love Lucy with Lucy and Ethel in the chocolate factory where the conveyer belt keeps speeding up? Then, of course, one call can mushroom into up to 30 calls, because some people have been everywhere.”
The most time-consuming cases are people who have attended weddings and those who have traveled on airplanes.
When doing contact tracing, DeRaleau and Payne follow a script provided by the Department of Public Health. They clarify a person’s name, date of birth, address and determine whether they go to school, college or work.
“We go over their symptoms, when their symptoms started and then we determine when their isolation period ends,” Payne said. “Then we go through a lot of education and explanation on what isolation is, what quarantine is. When we do contact tracing, we collect all of their contact information for close contacts and we reach out to them and we educate them too.”
Gratitude and Verbal Abuse
When the COVID-19 pandemic first began, people they called were mostly grateful to get the information. But, over time, a combination of divisive politics and COVID fatigue set in. As a result, the calls have become much more challenging.
One of the problems they encounter is that people ignore their phone calls. The phone call shows up as the VNA on your phone, so they urge all Cape residents to answer if they call. If someone who tested positive doesn’t answer, they leave a message, send a text and send a letter asking the person to call them back so they can educate them on the latest information. Payne and DeRaleau both attend weekly conference calls with the state DPH to get updates on the guidance, because it has evolved so much over the course of the past 18 months.
“It is very confusing for people which is exactly why people need to answer the call, because we are relaying all of the information directly from the Department of Health,” Payne said. “It’s the most accurate and up-to-date information. People can’t go based on what they saw on Facebook or what they knew about COVID last year, because it’s changed.”
The phone calls can be a matter of life or death for vulnerable people, especially if they are unvaccinated, immunocompromised or elderly.
“If these people don’t understand our message, they will be out in the community spreading this incredibly infectious disease to other people and, especially when it comes to students and schools, we have to be extremely cautious,” DeRaleau said. “With children, it’s so critical because many of them are being raised by grandparents who are elderly and fragile who could die. We’ve had that happen.”
Vaccines: Success and Drawbacks
Home tests and vaccines have added a new layer of complexity to the COVID landscape. Home tests are accurate, but, because they aren’t official, the state doesn’t record that data, so contact tracing isn’t done. If a person does test positive, it’s important for them to get an official test from a medical professional to confirm the results. The PCR test is still the gold standard.
Vaccines have been wonderful at preventing severe illness, but vaccinated people can still be infectious. The success of the vaccine is also one of its drawbacks because people have milder symptoms, so they don’t recognize that they have COVID, Payne said.
“If I had a dollar for every time someone thought it was allergies, I could retire now,” she said. “We still urge people to be very cautious with social distancing, wearing a mask, and staying home if you have any symptoms whatsoever, even if you think it is just allergies.”
Contact tracing has been highly effective in cutting down the risks of community spread, especially since the highly infectious Delta variant came along. Since DeRaleau and Payne reach out to people on the very same day they receive their positive notification from the state, they are able to contact people immediately.
The VNA contact tracing team has been working collaboratively with the Barnstable County public health nurses after they received a substantial grant from the state health department meant to support ongoing contact tracing efforts. Some towns have opted to utilize the Barnstable County contact tracers due to financial circumstances, however, the VNA still carries the majority of the Barnstable County jurisdiction.
“We are excited to be freeing up some of our resources to focus on other public health initiatives that have taken a back seat to contact tracing.” Payne said.
Some of the other public health services provided by the VNA include immunization clinics, maternal child health, senior home visits, wellness clinics, and exercise and education programs.
“As far as the public health standard goes, I’m honored to be doing this work,” Payne said. “I feel like we’re a part of history here. I know in my heart of hearts that we’re making an impact, but the past several months have been particularly challenging because of the pushback we’re getting from callers.”