About two weeks after she tested positive for COVID-19, Jessica Young of Huber Heights got a call from Public Health Dayton and Montgomery County with a specific request. The stranger on the other end of the phone asked her to write down every person she had interacted with for the last two months.
“Anybody I had shaken hands with, sneezed around, sat next to more than 10 to 15 minutes,” she said. “Anybody I had deep conversations with that would keep me close to them for a long period of time.”
This marked the start of the contact tracing process, a tool used to reduce the spread of disease by identifying and monitoring people who have come in contact with an infected person. She got out her work calendar from her marketing job and started retracing her steps.
“It was extremely hard to think back. Trying to think, ‘Did I go anywhere? Did I still get my nails done?’ which, those people, they're touching your hands, your hair.”
There were her coworkers at her open office space, the surgeon and nurses she had seen for an operation, a friend who visited from out of town. When she wrote it all down, her list had 42 people on it. Then came the hard part: reaching out and telling them they may have been exposed.
“I know it sounds weird but it was terrifying to do,” she said. “It's almost similar as trying to tell somebody you have an STD. That's what I felt like. I have this dirty, gross thing and I gave it to you, I could have gave it to you or you potentially have it.”
Public Health also made its own round of calls to some of her contacts. Julie Goode is a public health nurse for Public Health Dayton and Montgomery County who works on communicable disease reporting. She said, while the goal is to collect information, building a rapport is also important for these sensitive conversations.
“Obviously, a lot of times we're not just right out of the gate, ‘Hey, this is Julie at Public Health. What's your race and your ethnicity?’” she said. “Often cases this might be the first time that the case is even learning that they've tested positive.”
Before the pandemic, Goode did contact tracing routinely. She used to work on a variety of communicable diseases, especially for outbreaks of gastrointestinal illnesses like salmonella. But she has never had to do contact tracing at this magnitude, and now focuses entirely on COVID-19 cases.
“It's just the volume, the number of calls that are being made and the number of people,” she said. “We have about 15 or more people right now that are working just exclusively on contact tracing for COVID-19. We were a two person team before for all diseases combined.”
At first Public Health pulled in all kinds of workers to help out, like medical students, retired employees, and volunteer nurses. Now the department is entering a new phase. The department is coming up with a long-term plan with surrounding counties. But predicting the contact tracing needs in Southwest Ohio is a tricky process that involves taking into account a range of different data points.
One number is the case rate. The county currently has a rate of about 100 COVID-19 cases per 100,000 people. That is much lower than in other urban areas in Ohio, which is a good thing in one sense. But a low number of cases so far also means more people could be susceptible to getting infected in the future.
“As things begin to open up, we're going to have a susceptible population that may be relatively larger than the other metropolitan areas, and that may also begin to show up as more transmission and more cases,” said Dr. Michael Dohn, Medical Director for Public Health Dayton and Montgomery County.
Plus, there is the possibility that the case rate is artificially low because of less testing in Dayton compared to areas like Columbus and Cincinnati.
Antibody testing also rolled out this month at the University of Dayton Arena. These tests can show whether someone has already had COVID-19, and that can help Public Health get a sense of how many cases they may have missed in their initial counts.
“We're looking at those numbers and saying, ‘What information are we getting about the number of people out there who may have this infection or have had this infection that we didn't know about?’” Dohn said.
Add to that the calculation of where there could be big clusters of cases in the region, like the largest nursing homes. The department is gauging the maximum staff they would need to do contact tracing on a large outbreak.
Then there is another curveball: businesses are opening up. More people are moving around, coughing and sneezing and touching things, and potentially spreading the virus.
“We've kind of gotten by without having to do a lot of expansion, because it hasn't been that many cases for our population,” Dohn said. “But we can't expect that to last and so we have to plan for more cases and a higher caseload, especially as the testing opens up in this region.”
All of that information comes together into one big, messy equation. In many ways contact tracing for COVID-19 is just beginning and Public Health does not have a timeline for when it will be over.