After listening to Vermont Health Commissioner Dr. Mark Levine talk about efficacy of Vermont’s COVID-19 contact tracing team, The Valley Reporter reached out to the department of health curious about how it works and curious about how contact tracing seemed to be the intersection of science and sleuthing.
What we learned from Daniel Daltry, program chief for the Vermont Department of Health’s HIV, STD and Hepatitis Program and an administrator of the state’s COVID-19 contact tracing team and a member of the team, is that contact tracing is about science and sleuthing but also about psychology.
Valley Reporter: Given the fact that contact tracing was underway locally after two COVID cases were reported at a local middle school, could you walk us through how you might contact trace one of the students or others involved?
Daltry: One of the biggest concerns about COVID is that we’re constantly looking at the issue of stigma here. Emotions range from feeling guilty to angry. “How could someone have done this?” Or people who thought they were making the right choices and couldn’t believe it was happening to them or didn’t feel at risk. It’s a very sensitive topic. Look at the number of people impacted, 1,600 and it hasn’t been a year. It’s common. It’s moving up our charts. Chlamydia held the crown for many years in a row and COVID is coming at an incredible rate. I get nervous about talking about any case. I’ve seen lives really impacted by this.
And basically, we’re trying to partner with a person at that moment to answer questions and provide that facts that we know. Science and public health are interfacing. As Dr. Levine says, we’re in uncharted territory. We’re writing the playbook as we go based on the best emerging data and science.
VR: Can we make up a proxy or typical case and you can walk us through it?
Daltry: Here’s a hypothetical case. James Doe gets tested on September 12 and got a positive result on September 14. He’s married with two kids, 5 and 7 years old. He was asymptomatic. Part of what we’ve learned is that once people are exposed, they could test positive in two to 14 days. We’d want to look at his infectious period which starts on September 10. I’d call him as one of our 33 tracers and look at all his contacts from September 10 through when he went into isolation, which he did after his test. His close contacts would be people who were unmasked and closer than 6 feet for more than 15 minutes.
VR: What about his family?
Daltry: Let’s assume his family knew he was getting tested and also quarantined. His health care said it might be a good idea to hunker down and stay close to home. He could be infectious up until September 22. His family could get tested on September 29 and if they’re negative on October 1, end quarantine. Or if they’re not getting a test we’d want the family to be in quarantine until October 5.
VR: How about people he encountered prior to his test?
Daltry: We’d look at any people anywhere he went prior to his test, including the hardware store or post office and then determine if anyone was unmasked or exposed longer than 15 minutes or whether anyone recalls a sneezing or coughing event. That might end up crossing people off the list.
VR: Any clue where James got exposed? Did he go out without a mask?
Daltry: Yes, he was running on a bike path with his running buddy Al and sometimes they were less than 6-feet apart and there were other people on the path as well. They were running together on September 5 and it was one of their longer runs. He was contacted by one of our tracers and told he may have been exposed. We would not disclose Al’s name.
VR: What about people with whom James interacted before getting the call from a contact tracer telling him he may have been exposed?
Daltry: It turns out that James has an elderly neighbor named Wanda who is hard of hearing and he often helps her get her garbage out. Usually he stays 6-feet away, but she asked him a question and couldn’t hear his answer so he stepped closer and shouted it. That’s a risk. We don’t want people shouting or singing even with masks on. Wanda would get a call from us.
VR: What would you say to Wanda?
Daltry: I’d identify myself and make sure I had the right person. Then I’d ask her if she could talk and was comfortable speaking at that time. I’d tell her that she’d been identified as a contact of concern and talk to her about next steps and what supports I could offer her. I’d answer her questions. But I’d also ask how she was doing. It’s counseling right out of the gates. We want to know how people are feeling. These are real people. All of us have to approach this as a blank slate. No one is sitting by the phone waiting for the department of health to call. They could be asymptomatic or planning a trip and we’re calling to recommend quarantine or testing.
VR: What is Wanda going to do?
Daltry: Quarantine or isolation can be a barrier for folks. Contact tracers will ask about what barriers there are for isolation, whether it is groceries or work. Tracers try to solve problems with individuals. Some can’t be solved in the moment and we have three case managers (social workers) deployed to the COVID response team who are care coordinators as needed. They’ll help Wanda find help with grocery shopping and her other needs.
VR: What kind of reactions do you get from people when you call?
Daltry: Across the board I hear a lot of strength. People might be angry, but there’s a place of strength in that strong response. After Tropical Storm Irene, we talked about Vermont Strong and I’m seeing another reminder of Vermont Strong whether people are newly diagnosed or a contact of concern. Then sometimes there’s fear and worry and in two people I’ve heard guilt. They don’t understand how they could be infected since they’ve been following the guidelines.
VR: Other reactions?
Daltry – I’ve heard gratitude and thanks for reaching out and thanks for walking me through this as well as thanks for walking me down the worm holes of thoughts and thanks for normalizing and humanizing this. There’s been a tremendous response from Vermonters when it comes to reactions to contact tracing.
VR: Tell us about your background.
Daltry: I have a masters in social work. My background is in HIV and AIDS. I came to Vermont in 2006 where I was manager of the STD and Hepatitis C program. I’ve been trained by the CDC on how to do STD interviews. When COVID came, the epidemiology staff had been doing exercises in preparing for this while the virus kept edging closer to us. When it came to Vermont in March, it was no longer an exercise, it was something we needed to address, yet another disease investigation. Contact tracing disease investigation services were established in 1940 around syphilis by the way. With this new virus, we’ve had to learn as we went along. Science has grown since we’ve seen more cases.
