The tricky work of the contact tracer

Harry Risale is sitting in his car in full PPE gear.

He is outside the home of a university student, with an urgent message.

Contact tracers have already tried and failed to reach her and Risale, a community finder, has been sent to her home as the final resort.

He toots the horn to alert someone in the house that he is there.

Risale has already prepared for the task at his workplace at The Fono, where he works as a whanau ora navigator at the Pasifika health and social services provider. 

He doesn’t want to cause panic.

“I think to myself, what is the best approach, are these young people, old people? Even the way you walk, people will judge you.

“I’m making sure I am giving out the right signals.”

He tells the young woman he has been sent on behalf of public health. 

The young woman is tense, giving yes, no answers. Then Risale starts talking to her about her studies.

“She said she was studying criminology, I said that was my major. I shared some of my experiences, that it was tough going. I told her, you just have to push through.

“That changed the tone of the conversation, it changed the mood. She tried to open up with what she’s going through.”

The student was Risale’s third case as a community finder. He has successfully found four people and connected them with the public health team.

Navigating the pitfalls

His job is not to give the news that they have tested positive or that they are a contact. He is there to make sure that they will take the call immediately from the public health team.

Risale says contact tracers have been unable to reach them because they may not have a phone or the number is wrong, they may be unwilling to respond to a phone call, or they don’t understand the severity of the situation.

His first community finder case did not believe she was positive because she  didn’t have any symptoms.  He says people are anxious and scared that positive might be a bad thing.

People in the Pasifika community have seen the backlash and think if they stay silent it will eventually go away, he says.

He speaks English to them first but he’s prepared if there’s a language barrier.

“I’m fluent in Samoan and I understand a bit of Tongan. There are always resources to make sure these people understand and are comfortable.

Crucially, he has arrived in a company car and he is from the Pasifika community.

He needs to assure them he is not there to cause trouble or bring bad news, and that the information they give to public health is confidential.

“I’m there for as long as it takes to be contacted by public health. Some of them want me to stay around to have assurance that everything will be ok.”

At first, Risale thought the police should be doing the job.

“But from the Pacific Island point of view when you see police walk into the house, there’s definitely trouble.

The task is fulfilling but exhausting, he says. 

“When I leave them they can go back to their new normal life and trust the system.”

The busiest people in Auckland?

Further back in the contact tracing chain are the hundreds working in call centres 24/7 to track down the thousands of people touched by the Delta outbreak and get them isolated before they infect others.

The Detail approached numerous public health agencies to speak to a contact tracer and was repeatedly told they were too busy.

Just five days into the outbreak health authorities had to rush to recruit and train hundreds more contact tracers, taking the total number to 1400.

More than 35,000 contacts (as of 9am Tuesday there were 34,413) have been identified. 

Behind the staggering numbers is a “humanness” to the process, says contact tracer expert, Dr Andrew Chen from Auckland University’s Koi Tū Centre for Informed Futures. 

From the call centres they are breaking news to people that can be shocking or upsetting.

“No one likes to find out they are a contact,” says Chen.

But that’s not the end of it and the clock is ticking. They need to get crucial information out of the contact as quickly as possible, people they have seen, places they have been and work out their risk.

Changing the rules

“Of course, Delta has changed the rules on who to contact,” says Dr Collin Tukuitonga, associate dean Pacific at the University of Auckland, and a public health leader.

He works a day a week at the Auckland Regional Public Health Service with the team that is handling the Assembly of God church cluster, which has 320 cases.

“Delta is problematic. I have read that a case could infect between six to nine people and they could infect another six to nine.” 

But this is no police interrogation and if the contact refuses to talk, or they lie, it gets tricky.

“One problem is you ring Joe Bloggs and there’s no reply. You ring again and someone requires convincing to get to the QR code.

“It’s a bit of detective work and a lot of human relations,” says Tukuitonga. And because it is more complicated, explanations need to be repeated and repeated.

Chen explains that typically the contact tracer does four sets of interviews with the contact. The first call is a combination of questions about where the contact has been as well as checking on their wellbeing and that they have isolated.

The scripts for the contact tracer vary depending on whether the person is a close or casual contact. 

“From all of these interviews they build locations of interest which go on the Ministry of Health website.”

Households or other locations of interest may not go on the website because all the contacts have already been identified.

Then there’s the detective work. Special investigators are employed to try to piece together a journey, to identify and track down any high risk people in the community.

Privacy and speed

Chen says in the past tracers have used credit card transaction data and CCTV footage. But they are slower and time intensive.

The gold standard, says Chen, was to find 80 percent of contacts within three days.

The contact tracer has the phone number, name, date of birth, address, NHI record, possibly their ethnicity and possibly they can see if they have significant health issues which may need to be followed up.

Questions are carefully scripted, says Chen, and there are strict rules about what they are allowed to tell the contact and what they are allowed to get from the contact.

The Privacy Commissioner, John Edwards points to section 92ZZG of the Health Act that says a contact tracer must not disclose the identity of the positive case to the contact.

Contacts who refuse to give information face a fine of $2000.

Edwards says people’s fears about the government sucking up their personal information from tests or from their QR apps are misguided.

His office contributed to the design of a special Ministry of Health data base which keeps the information. He says the rules, informed by the Health and Privacy Acts, say the data is there for one purpose, the pandemic.

Using robots

Chen says the human-led process of contact tracing come with costs. People make mistakes.

“There’s an argument that if an outbreak was out of control and put pressure on contact tracer capabilities it should be more automated.

“The World Health Organisation says that at a certain point you stop contact tracing and help people who are sick.”

That happened in the UK in April and May last year when contact tracing was stopped and people were deployed into caring for sick people.

“We are well away from that situation in New Zealand,” says Chen.