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Contact Tracing not only plays a huge part in stopping the spread of Covid-19, it also allows people to speak to someone and receive answers during a very scary time. Those who live alone or those who live in an area where it is hard for people to reach them, with contact tracing you are letting them know their next steps, guidance on what to do if their condition gets worse and instruct them on how to properly isolate so they do not spread the virus. 

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1. The Basics of Covid-19

We have recently celebrated our two year anniversary of the Covid-19 Pandemic, and while we might “never want to hear another word about Covid ever again”, it still exists. We are all familiar with the basics: wash your hands to the tune of Twinkle Twinkle Little Star, 6 feet apart, wear a mask, but, some of us may still be unsure where the virus even came from (we were right about the bats) how easily it spreads, the signs and symptoms and other ways to prevent it. Below I have even more basics which is a lot of what I have learned mixed with a little bit of what I already knew  about SARS-CoV-2. 

         A coronavirus comes from a large family of viruses that you can only see under a microscope. It is given the name coronavirus because of how it looks; corona means crown and if you look at photos of the virus, it has crown like structures around it. Coronavirus affect mammals and birds and there are a wide range of different viruses within the group. Although the coronavirus itself is not new being it lives in bats, the virus that causes Covid-19 is new. Although the virus, SARS-CoV-2 is present in bats all the time, it learned how to transmit between species, affect people and then also be transmitted from person to person...very quickly. This specific virus is the third one since 2002 that has developed this ability to spread, all three coming from bats, and the first emerging in 2002 in Guangdong China. In 2012, MERS, or Middle Eastern Respiratory Syndrome emerged in the middle east. Most recently we have SARS-CoV-2, or Covid, which emerged in Wuhan China in 2019, causing the most recent pandemic.

Symptoms       After being exposed to the SARS-CoV-2 virus, it causes an illness that we have nicknamed Covid-19 after it’s emergence in 2019. Not every person who comes in contact with a virus gets sick, but those who do will feel symptoms such as fatigue, nausea, loss of taste or smell and body aches. The feeling is similar to the flu. Signs to look out for if one is concerned they came in contact to a virus is body temperature, if they have a fever and also the way they are breathing. If someone is breathing faster or more difficult than usual while at rest, as if they just ran up a flight of stairs carrying two full laundry baskets, this is cause for concern. Covid-19 symptoms are trickier than a typical virus because a person can contract the virus and be completely asymptomatic, meaning they have no symptoms. This is scary because although someone does not feel symptoms, they can still spread the virus from person to person. Going to parties, spending time with their grandparents, snuggling babies, all while having and spreading Covid-19 can lead to infecting someone who’s body may not be able to fight it off as well as yours can. Covid-19 also includes a larger range of symptoms, and more serious ones such as a high fever, fatigue, chills, muscle pain, loss of smell and taste, difficulty or shallow breathing, wheezing, and headache. Some people can become sick with Covid and be just fine, some show mild symptoms, and some may become so seriously ill with the virus that it can lead to death. Some of the symptoms are common virus symptoms such as the muscle pain and fever, however, what is specific to Covid-19 is losing one’s ability to smell or taste. This occurred to one third of patients who were infected including myself. Losing your sense of taste while you’re sick and knowing you must eat in order to get better is awful. The same day they announced this was a symptom, was the same day I lost my sense of smell and taste and I did not regain it for 21 days. Although losing your taste is a bit frustrating, it is very important to make sure you are eating well and getting nutrients so your body has the strength to heal. 

Signs          Those who contracted the coronavirus and were fortunate enough to experience no symptoms were lucky compared to those who contracted the virus and became very ill, however, those they came in contact with and spread the virus unknowingly were not so lucky. Knowing whether a person should seek help is important when understanding how sick someone is. If the person infected begins to have pale or blue colored skin, experiences shortness of breath or shallow breathing, chest pain when breathing, can’t seem to catch their breath, or experiences confusion upon waking up, they should seek medical attention. I was asked to count to 8 and if I could not do it without taking a breath in between I was okay. This was a popular test in hospitals. The reason Covid is so dangerous to the body is the way it attacks the lungs. By congesting the lungs, it cuts off oxygen flow to the body not allowing a person to get the amount of oxygen they need to sustain. Lack of oxygen to the brain can cause serious long term effects. One of the most frightening things about Covid aside from the rate of infection is how long the window of infecting others is. The incubation period of Covid-19 is 2-14 days which means after coming in contact with the virus it could take from 2-14 days to experience the symptoms. Even before someone feels symptoms, they are contagious and actively spreading the virus! After 10 days from the onset of illness, meaning when you feel symptoms, someone is no longer in the infectious period.

Treatment          Those who are more likely to become very sick after contracting Covid-19 are those who are older than 65 years of age, those who are obese and those who have existing medical conditions such as diabetes, high blood pressure, heart liver and kidney disease and any type of lung disease as well as those with a weakened immune system. However, young and healthy people can also become severely ill. Children are the least likely to become severely ill. Those who die from Covid-19 experience a lack of oxygen and the inability to breath on their own. Covid also causes other lung issues that a person can die from such as pneumonia or blood clots. While there is no specific treatment to cure the disease, supportive treatment will support the body while it fights off the infection. The patients with lung disease will most likely require a ventilator to assist them with their breathing so their body can get the oxygen it needs while the virus passes through them. 

Testing               Testing for Covid -19 includes diagnostic tests such as a PCR test which tests to see if the virus is present in your system, this test is done when someone is experiencing symptoms and it detects the genetic material of the virus by swabbing the inside of someone’s nose, throat or mouth. Antibody tests identify the antibodies left behind after your immune system fights off the virus. These antibodies are not going to show you how long ago you were infected, and we do not know how long they stay in someone’s system for, but we can conclude that if the antibodies are present in someone’s blood, then they have had Covid-19 in the past even if they did not show signs or symptoms. We do not know how long the antibodies last in our system for yet. 

Transmission         Transmission of the virus can happen in two ways, the first way is by spreading the virus from one infected person to someone else through droplets that come from their mouth, nose or throat by coughing, sneezing, talking and laughing. The droplets can then go into another person’s mouth, nose or eyes. The second way the virus can spread is by someone touching a surface after they have wiped their nose or mouth and have the virus on their hands and then someone else touches that surface, this is less common than the first way, however, it still happens. The aerosol droplets that transmit between people can be decreased by remaining six feet apart and when two people are wearing masks. 

Prevention           Stopping transmission is the best way to decrease the spread of the virus. Because the disease is spreadable before the symptoms occur, it is easy to spread the virus to other people. In between the time of contraction and showing symptoms, a person will come in contact with many people who will then come in contact with more people during their incubation period and so on. Preventing even just one case of transmission can have a large impact on slowing down the spread of Covid-19. Washing your hands with soap, staying home when you are feeling sick, quarantining when you have been exposed, isolating when you have been tested positive, and staying at least 6 feet away from others when you can are all ways to prevent the spread of Covid-19. Wiping down surfaces is also important. 

Prepare            While some of us may have been washing our groceries and buying way too much toilet paper, keep in mind that being prepared is very important. Keep disinfectant in your home and in places that you can easily access to wipe surfaces and door knobs and other household items the entire family has their hands on. From my experience with Covid-19 we also now keep disposable gloves, hand sanitizer, acetyl alcohol, a thermometer, and a pulse ox reader (available on Amazon or at CVS) which reads your oxygen levels, at home Covid test kits, Clorox wipes, and disposable face masks in our home and well stocked at all times. 

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3. Contact Tracing: The Basics

      Contact tracing is an important way to prevent the transmission of Covid-19. The first step to contact tracing is proceeding to act when a person has become infected. After someone has contracted Covid and tested positive, making sure they have proper access to medical care and resources that will help them is crucial. An infected person must get the required treatment and be educated on the steps they should take, how to monitor symptoms, when to seek help and also how they can limit their contact with others in order to avoid spreading the virus. We must also ask the infected person to try and recall who they may have come in contact with during the incubation period which is the time in between becoming infected and feeling symptoms. Keep in mind, a person can be contagious up to 5 days before feeling symptoms. The most infectious time during a Covid case is the first day of symptoms. This period lessens as the days go on and usually after 10 days post onset of symptoms is when the infectious period ends. Locating the people that a Covid positive person encountered is important so they can also be notified of their exposure, be offered treatment, and receive education on care and how they can also avoid the continuation of transmission. One of the best ways to prevent the spread of Covid-19 is by limiting the opportunities for the virus to spread by limiting contact between an infected person and others. This technique of contact tracing needs to happen very quickly because the timeline to catch those infected before they infect others is very short. Acting quickly is the only way for contact tracing to be make a difference.

           Within contact tracing there are terms to become familiar with. A case is someone who has contracted Covid-19 after a positive laboratory test, usually a PCR test. A suspect case is someone who has not been tested yet, however, shows symptoms after having been exposed to a case. Being exposed to a positive, infectious case is called contact and there are three different types of contact. The first type of contact and the easiest way for the virus to spread is physical, direct contact. Direct contact when someone hugs, kisses, shakes hands with or engages in any other physical contact with another person. Close contact is when two people are within 6 feet for more than 15 minutes such as on a bus, in an elevator, standing online at the grocery store. The reason you can get sick just by standing near someone infected is because of the droplets that spray when a person talks, laughs, coughs, or sneezes. Being in close range to someone who is infected creates a high chance of becoming infected yourself. Respiratory particles can also travel further than 6 feet if they are small enough so being in the same room as someone for more than an hour, while being six feet away can also cause a new infection, especially when there is poor ventilation in the room. These types of contacts are called proximate contacts are less common but still possible.

           Other terms that we have heard hundreds of times and are very familiar with are isolation and quarantine. The difference between the two can be tricky and one might not know when to do one or the other. Isolation is done when someone has been infected with Covid-19 and it keeps them separate from healthy people to avoid spreading the virus. You must limit contact with this person by having them separate and restricted to their home, or a designated wing in the hospital. One should isolate for the entire duration of infectiousness which is two days before the onset of symptoms and at least 10 years after onset, as long as they are fever free, and symptoms have improved. It is difficult for those to isolate at the right time prior to symptoms onset because typically, one would not get tested for Covid-19 unless they feel symptomatic. As we know, a case is infectious up to 2 days prior to symptom onset so before even knowing to test, they are actively spreading the virus. When someone quarantines, that is when they have come in contact with a case. Quarantining means avoiding areas where other healthy people are until you are sure you did not contract the virus from the case you came in contact with. The quarantine time should be for ten days after initial contact with a positive case. For example, if I tested positive for Covid-19 on April 15th, and I began feeling symptoms 4 days ago, whoever I encountered from April 11th and two days prior (that sneaky infectious period) would then have to quarantine for ten days starting the last day I saw them. Let’s say I saw my best friend on April 13th, they would have to quarantine until April 23rd and monitor for symptoms. If my best friend then becomes sick as well and tested positive for Covid-19, they will then have to reach out to whoever they came into contact with from two days prior to symptom onset to when their positive test was. If someone quarantines properly, and we can contact trace quick enough, this will reduce the amount of people that cases are coming in contact with.

           If a case is living in an environment that makes it hard for them to quarantine, or somewhere that many people live in a small area, such as a homeless shelter, halfway house, or nursing home, they may not have the option to isolate themselves from others. Difficulties also lie in tracing contacts when a case has been somewhere that many people have been as well such as movie theater or business meeting. It is important to know details of the person’s encounters, the times they were in these places, the names of the establishments and get a hold of the supervisors of these places to inform them of a positive case so they can contact people who may have been there as well.

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4. Resources for Contact Tracing

1.     https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/contact-tracing.html

The CDC provides information on contact tracing for CPVID-19 in the “Your Health” tab located at the top of the Covid-19 page. The page offers a short 1-minute animated video that gives a basic idea of what contact tracing is and why it is important to answer a call and work with a contact tracer. It goes on to let you know that the information is kept private, and they do not ask for money or your social security number. The site goes on to guide you on what to do if you come in close contact with someone who has Covid-19, what to do if you are waiting for a result and if you are diagnosed as a positive Covid-19 case.

2.     https://covid19.nj.gov/pages/testandtrace

The state of New Jersey also offers information on contact tracing and how important it is to keep your friends and family healthy by doing your part to stop the spread. The site has subcategories such as “How Contact Tracing Saves Lives” and “Work As a Contact Tracer”. The information provided on how contact tracing saves lives is good information, however, it is not provided in a way that is easy for everyone to read. Although it may be easy for myself and fellow classmates to read, the paragraphs are made of very small text with very little spacing, this might be difficult for others to read. The CDC has the right idea by providing a video and a narrator, so it is more easily understood.

3.     https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-contact-tracing

The World Health Organization has a very easy to navigate page giving information on contact tracing. The page has tabs you can click that say “What is contact tracing? Does contact tracing help in controlling the spread of the virus? As well as other frequently asked questions. The site also provides options to translate the page in other languages on the left hand side which I think is very useful if they do not provide a video.

4.     https://coronavirus.health.ny.gov/system/files/documents/2020/05/13114_covid19_contacttracing_051420_0.pdf

The New York state official site gives you a contact tracing tool that you can print out in order to track your contacts on your own in order to be ready for a representative to call you. The steps on the form include identifying your date of first symptoms and to then subtract 2 days so you know your contact tracing date. Step 2 is to name anyone who has been in your house with you since your contact tracing date. Step 3 is a list of what you did each day since your contact tracing date as much detail as you can remember. This form will then help the contact tracer reach out to these people and places to let them know they have been exposed.

5.     https://www.youtube.com/watch?v=_yCQzLNDyeM

Partners in Health, a health focused page on YouTube explains in this video how contact tracing works and what the contact tracer will do after someone has been tested positive. I like the videos provided because it can be a good way for those who may struggle with reading English understand how contact tracing works, as well as gives teachers or parents a chance to teach their children as well.

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5. Investigate and Trace 

In order to begin the investigation of a case and trace their contacts you must get in contact with the case by phone, introduce yourself and get their basic information. You will want to inquire about their infectious period and when they began feeling symptoms and whether or not they had a fever or felt like they had a fever. While speaking to a case you will also want to pay attention for the need for medical assistance such as if they are having trouble breathing, gasping for air while they talk or show an obvious wheeze. Pay attention to specific words such as chest pan, look for confusion and possible signs of low oxygen levels. Ask about what medications they are taking for symptoms and if they have improved the symptoms or if symptoms seem to be getting worse. If the case reports that they felt no symptoms, then you will go off the date they received their positive test.

Explaining what isolation is to those who may not know is crucial. In the simplest way, you can tell them that isolation is when you do your best to avoid coming in contact with other people, unless of course it is to receive medical help. “If you can, use a different bedroom than your spouse, use a separate bathroom from others, wear a mask if you are around others.” If the case seems like they are not understanding, or they are confused or frightened, keep calm and ask them a few more questions such as whether or not they have help getting food and if not when they might need their next meal, what medications they take and if they have enough to last through the isolation period and if they have proper safety gear such as a mask or thermometer. Ask if they have any concerns with their isolation such as if they are the only parent caring for children, or the only one caring for their elderly grandparents. Provide resources for them on who they can call for help, ways they can get food and any other support groups.

Other questions you want to ask the case to adequately track their contacts is if within the last week have they traveled, if so where to, and if they have been in contact with anyone else outside of their home. Some people might need help remembering who they were with and where they were so it is important to be as helpful as you can by asking the right questions and being as patient as possible while they try to remember. A few important questions to ask would be whether or not they have an in-home caretaker, a cleaning service that comes into their home, if they have been in close contact with a doctor or someone who provides care to many people. It may be helpful for them to take a look at their phone or their calendar to recall where they were during the time they were infectious. It is also important that you provide clear isolation instructions to the case, have them let you know of any challenges they might be experiencing in their household that keeps them from staying away from certain family members or roommates and provide understanding, support, and tips on how they can keep others safe while they are in their infectious period. By the end of the conversation, you will want to have answered all of their questions and plan a follow up call.

Next you will call the case’s contacts and inform them of their exposure and what to do next. You want to give proper quarantine instructions as well as ask about symptoms they might be already experiencing. You may come across people who are upset or scared, these situations must be dealt with the utmost compassion and clear instruction on what they should do next. You will check in with your case and their contacts to see how they are doing, how they are handling their isolation and quarantine and if they might have come in contact with someone during this time that you will also have to reach out to. Following up with cases and contacts is important to determine the end of the isolation period by paying attention to their symptoms and how they are improving.

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 6. Apps for Contact Tracing

The top contact tracing app that I found for NJ is Covid Alert NJ. I downloaded the app on my phone and used it for 3 days. The app itself is easy to navigate and it teaches you what exactly it is doing while in use. When you are in direct contact with someone, within 6 feet for more than 15 minutes, the app will alert you. The app will sense a close contact and will exchange a random code with the other person’s phone. Your phone stores the contact codes in a list. The app description says that the codes are random and do not reveal any information about the other person or collect names, phone numbers or locations. This only works if others also have this app downloaded. If you test positive for Covid-19, a contact tracer will call you and ask you to share the list of contacts. The app keeps your information private and does not reveal who you are to other contacts. Every person who has the app downloaded compares its own list of close contact codes to the list of the person who tested positive for Covid-19 and if there are any matches, they will get an alert.

            The app’s home page shows you current positive cases, the total death rate and Covid-19 hospitalizations. The apps also shows you the number of people in NJ who are vaccinated, whether they are fully vaccinated or with a single dose, and which vaccine they received. The app also breaks the number of vaccinated people down by county. You are also offered a Covid Check In option where you can check symptoms and get advice and your information is still kept private. You can also get information on Covid-19, proper tips on avoiding coming in contact with others, what to do if you test positive and plenty of information on the vaccines available and where you can get them.

           All in all, I would say this is a very clever app with only a few flaws. I give it a 4/5 rating. The cons of the app begin with the fact that it only works if everyone has the app downloaded. For those utilizing the app and all its features, it works well. With that being said, having your Covid-19 Alert settings on your phone activated means you have your Bluetooth on all of the time, this depleted my battery life much quicker than if I did not have it turned on. Obviously in order to send codes from one phone to another means Bluetooth must be on, this is not a design flaw per say but rather a reason I would personally not use an app that requires my Bluetooth to always be on. Lastly, although I read the privacy information upon downloading the app, I personally question the integrity of how private the app truly is and who exactly is monitoring my location status. Without proper protection, hackers can access whatever information they wish to, keeping your Bluetooth on only makes it easier for them. Aside from those factors, the app is easy to use, very clear, organized and also filled with information without making it too difficult to navigate. It is a great app for those who prefer to be extra cautious when it comes to Covid-19.

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7. Contact Tracing is a very important strategy used to help stop the transmission of diseases. Not only used for Covid-19, contact tracing helps in cases of tuberculosis, HIV, syphilis, and Ebola. There are important key factors to remember when it comes to being a contact tracer. A person who decides to contact trace must have the desire to help people, patience, some sort of experience talking to and working with the public, and most importantly, ethics. The importance of ethics while working as a contact tracer includes keeping people’s personal information private and secure. You must agree to maintain contact’s confidential information to yourself while you are asking them personal questions and only use this information to contact trace. Everyone has the right to privacy and many people may feel as though their information will not be kept private and effuse to speak to a contact tracer, that is their right, however, it is up to contact tracers to continue to earn the trust of the contacts in order to gain reciprocation and cooperation. Some of the information you need to ask your positive case are confidential, such as possible medical conditions they might have such as asthma or diabetes. You may also want to ask your case their habits, if they are heavy smokers, or if they already have a condition that limits their oxygen intake such as COPD or sleep apnea. It is not necessary to ask anything that is not relevant to Covid-19 and contact tracing purposes. This information is confidential and expected to be kept private the same way someone would keep patient information private using HIPPA guidelines in a medical setting.

           While people have the right to their privacy, they also have the right to make their own decisions. This right is called autonomy. It is important not to sound demanding or frustrated when people refuse to quarantine. We have all been in a position where Covid-19 has gotten in the way of something you really wanted to be a part of, for me, that was last Christmas, it can be frustrating to be told that you have to miss something you have been looking forward to, however, when it comes to the potential harm to others, you must try to convince these cases that quarantining is put in place to keep others safe. While some people may only experience cold like symptoms, others may fall fatal to the disease. It is important to remember that although people have the right to make their own decisions, in some cases, their quarantine or isolation can be mandated if the case seems to be simply negligent and inconsiderate to the wellbeing of others. While you may encounter cases that may not want to cooperate, it is still important to treat each person fairly and equal to the next despite any differences including race, religion, social status, or sexual orientation. Anyone who holds such discriminations should rethink becoming a contact tracer due to the diversity of those they will be calling. Not giving the same level of care to a certain group or individual is discrimination and illegal, it is also imperative with contact tracing that every person understands what it means to help stop the spread of Covid-19 and how many lives they are saving. Contact tracing is a benefit to society as it decreases the risk of others becoming infected. It not only helps others, but it helps you as contact tracer as well. Contact tracing is a public good, it is free and provides for the well-being of the population. There are three legal tests that a public health intervention such as contact tracing must pass to limit the rights of individuals to privacy or autonomy. The first test is making sure the intervention is respectful of people’s rights. Second, it must benefit society in a way that is balanced with the limits on individuals. Lastly, the intervention must benefit all members of society.

           Now, where to the ethics behind obtaining this personal information come in? There are a few scenarios that a contact tracer might come across that requires them to know how to handle the situation without giving away a person’s personal information causing issues for them in their life. For example, if someone tells you that they have been in contact with someone they have intimate with… and that person causes an ethical issue such as an affair, you do not have the right to tell their spouse of the affair, even if it is a contact. You must keep contacts anonymous. You will come across instances where people will ask “who?” when you tell them they came in contact with someone who tested positive. Odds are, if they are close with that person, they will already tell them on their own. Also, if a contact tells you that they are undocumented, it is not up to you to report them in any way. You must remember to use justice when dealing with every contact, it is important to treat everyone equally.

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8. e t h i c s ... online resources.

There are many places online that you can find more information on the ethics of contact tracing. Upon searching, I picked two that I felt gave good information and explained it in a very clear and concise way. The first is a link to a page from counseling.org, where questions were posed to a small group of ethics and legal scholars in the counseling field. These responses give you an idea of how someone who is experienced in ethical studies would handle such a situation. Four counselors spoke about what they would do. For example, one counselor said they would let their client know that if they themselves tested positive they would tell them. They would also be told that only the names of their contacts need to be shared with the tracer. Another counselor said they would emphasize on how easily the virus spreads and the losses associated with it. Most of the counselors mention informed consent which is a principle in medical ethics and law that a patient should have sufficient information before making their own free decisions about their care. Giving patients all of the information, you can, what kind of questions you are going to ask them, what you will do with the information you provide and how contact tracers work will help in aiding their trust and cooperation.

Link 1: https://ct.counseling.org/2020/09/ethics-in-the-time-of-  covid-contact-tracing/

The second source I found was through Johns Hopkins University and Medicine. The page has topics and points made within each topic that a person should follow when contact tracing in order to remain within ethical guidelines. This is a very good source for those who need to know everything when it comes to the ethics on contact tracing whether you are a tracer yourself, or a case questioning the ethics of a contact tracer you have spoken to already. This site is easy to navigate, however, it explains things in a very legal way, which may make it difficult for some to read and understand entirely.

Link 2: https://coronavirus.jhu.edu/contact-tracing/principles

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9. Effective Communication

Effective communication comes from having the skills of a good listener and problem-solving skills that will help people get through a difficult time and guide them on ways they will help prevent the spread of Covid-19. Now, when a stranger calls you and begins asking you a bunch of questions after you have just been told that you are positive for a very serious virus, your immediate thought may be “who is this person and what do they want?” This is where any customer service skill might come in. By gaining the trust of your contact you will find they will be much more cooperative, and it is also nice to feel as though you are truly helping someone. To gain your contact’s trust you will want to build a rapport with them. This means that there is a feeling of mutual understanding and trust between you two. Building a rapport comes from being kind, talking in a way that is not condescending but just informative and caring. You want to sympathize with them especially if you have experienced testing positive and quarantine yourself. You want to be a bit persuasive to get them to quarantine and isolate and to do that you will need to educate them on the virus as well as build this rapport.

Some people who may not be great at public speaking or talking to strangers, might want to brush up on their confidence in order to be more assertive. Being assertive and confident will give your contact assurance that you do indeed have extensive knowledge on what you are educating them on. You are going to encounter many contacts that will have also done their own research and will try to convince you they might know more than you do. You don’t want to respond passively and allow them to convince you they know what to do and they will quarantine how they want to. The key is to convince them that they must quarantine or isolate the way the CDC recommends in order to affectively stop the spread. When you come across a combative contact it is important not to be combative or aggressive, this is counterproductive and will most likely cause them to hang up on you. As mentioned previously, you do not want to be condescending when talking to a contact but you also want to avoid using technical words they might not be familiar with. Using “someone who is sick” instead of “case” or instead of using the word “contact” you want to use the term “someone who has been around a sick or contagious person”. Using words that are easy to understand and also not asking too many questions at once will allow you to get information and give information successfully. Always check in to make sure your contact is understanding you and you are not talking too fast.

           There are five different types of questions you can ask while contact tracing. A closed question, an open question, a probing question, a checking question and a leading question. Here are examples of each.

1. Closed question: Do you have a fever?

2. Open question: Tell me what symptoms you have been experiencing since the symptoms started?

3. Probing question: You said you have felt improvement. Can you tell me more about that?

4. Checking question: You said you had a fever last night, is that correct?

5. Leading question: You must be feeling the peak of symptoms at this point, right?

You can ask these types of questions when it comes to symptoms but also when you are asking about their contacts and who they have been around within the last few days. While your contact is telling you about their concerns, you should also reflect on what they are saying, or paraphrase what they tell you. Verbalize that you hear them and you can see that they are going through a very hard time. You want to sound as empathetic as you can but also while staying on the topic of Covid-19 and what they should be doing to quarantine. Active listening involves observing, acknowledging what emotions are being expressed, mentioning the requirements or needs that lead to a good, healthy life and listening to or giving requests that are necessary for each person involved. Empathetic listening goes hand in hand with honest expression. The people you talk to are going to make statements, express fear, express requests and reflect emotions. As a contact tracer, you want to listen intently and be sure you are hearing what they are saying while keeping the purpose of the call in mind.

           You will come into issues when contact tracing such as people not wanting to speak to you or may not want to speak to someone on the phone for so long, they may not want to cooperate and give you information about their contacts, or they might not have known their test was positive and now they are frightened and frustrated. Don’t panic. There are solutions to these issues. If someone does not want to cooperate, there are “back pocket” phrases you can use such as “Yes, this is a difficult time.” And “I hear you.” You want to avoid using the phrases “I understand” and “I know.” Because you are not in their exact position, you may not understand, and this might be frustrating for the contact when they need most of all a good listener. You can repeat their last sentence in your own words to let them know that you have heard them. Some people may want to ramble on and on, it is important to explain you must stick to why you are calling, and you cannot continue talking with them.

Aside from rambling contacts and those who may not want to cooperate, there are going to be complex situations that you will come across and will need to troubleshoot. After you define the issue, you will generate potential solutions that will help, pick the one that works best for the contact and then implement this solution. You will want to check in with this contact to make sure the solution is working and helping their issue. Other issues you might come across could be if it takes a long time to contact someone, if their information is not correct in the system, and if you must make a follow up call but it is the end of your shift. Some technical issues could occur such as a power outage, your computer or Wi-Fi not working, all of these are issues you may come across. Stay organized and follow local protocol on how to resolve these issues. If something needs to e escalated to a supervisor, do not hesitate to do so.

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