May 7, 2020
Photo via Centers for Disease Control
Inside one county’s efforts to use contact tracing to flatten the COVID-19 curve.
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Dan Gorenstein: In January, Tair Kiphibane watched China build a hospital in two weeks as the coronavirus ravaged parts of the country.
As the death toll climbed an ocean away, she got worried.
Tair Kiphibane: At that moment, I think it really hit me hard. You know, this could totally come to our community, that we may be dealing with with this. Yeah. I got scared.
DG: Tair — a nurse who runs the infectious disease bureau in Salt Lake County, Utah — knew it was just a matter of time before coronavirus made its way to her corner of the world.
And she was going to do everything she could to be prepared.
From the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein, and this is Tradeoffs.
Tair is a contact tracer — sometimes called a disease detective.
Super cool name, but Tair admits tons of people just stare when she tells them what she does.
TK: Contact tracing means that we’re trying to find people that have been around a person who is infected with an infectious disease, meaning a disease that can spread to other people if they have been close to the person who it’s infected.
DG: Contact tracers call themselves detectives because tracking down people can mean looking through old receipts, bank statements, calendar appointments, reaching out to family, coworkers, people at a bar, anyone who may have been exposed.
And the clock is always ticking.
TK: That is the heart and soul of the work that we do because without contact tracing, we can’t really stop the spread of the disease. When a person has been exposed, it’s critical that they are being brought to testing or treatment or provided education.
DG: Until last December, Tair and her team aimed to keep diseases like HIV, chlamydia, and tuberculosis from spreading.
That’s when they started preparing for COVID — one of the first public health offices in the country to get operations up and running.
She says the nature of the virus brings a whole new level of urgency.
TK: For instance, with TB there’s time and there’s testing that can be done. There’s a preventive treatment that they can take. Now, in the opposite way, COVID is time sensitive. We got to move very quickly because we don’t want a person who is infected to make any movements, meaning leaving their home. There’s not really any treatment we can tell them but stay home.
DG: So does that up the pressure on you and your staff because for COVID there is no treatment?
TK: Absolutely. Yes, absolutely. Our goal is to be able to reach out within 24 hours. So as quickly as we can, because of that, I think it’s emotional just because we have deaths that are going around in the community. The urgency on our part to want to do a good job to preserve lives.
DG: Public health experts estimate 100,000 to 300,000 contact tracers are needed nationwide.
But NPR reports as of right now, there are less than 10,000 with plans to bring on just another 40,000.
In late April, 14 senators proposed sending public health departments $8 billion to staff up.
A step Salt Lake County has already taken.
TK: We had about 42 employees within the Infectious Disease Bureau. When we got our first case, which was March 4, that’s when I start calling out for help. As of today about 120 to 130 employees.
DG: So your staff has tripled?
TK: Yes, from 40 to 120.
DG: Tair says it’s hard to prove how effective this strategy is.
Eighty to 100 news cases come in the door a day.
They started out with one case on March 4. Today it’s north of 2,900, but it’s been holding pretty steady and the county has had only about three dozen COVID-related deaths.
One reason for the success: great data.
Unlike lots of public health departments, Tair gets clean, actionable information, fast.
TK: We’re pretty connected with all the labs and all the providers. And then we’re really, you know, out there so they know who we are. So even if somebody gets tested, sometimes we even get the report before the lab. It’s even shown up in our system.
DG: Maybe, says Tair, the toughest part of the job is figuring out how to get COVID-positive patients to be honest about where they’ve been.
TK: So one of my employees was having a hard time because this family went on a trip to California and came back and basically everybody that sat in the car was infected. And then a couple people start getting sick a couple of days later and more people start getting sick. There was one particular gal who was really fearful. She didn’t want to give out any information.
DG: Nobody wants to think of themselves as some super spreader.
Tair stepped in to help.
TK: I said, you know what? Let’s just make a call together, let’s just call this young lady. When we were talking to her, I sensed a lot of fear, a lot of “I don’t want people to stigmatize me.”
DG: Tair just listened without passing judgement.
TK: Hey you know, it’s not your fault that you are infected with COVID-19. It’s going around. We saw how it started in China and just moved across the whole world. And now it is in our community.
I said, “I need your help to take the responsibility in stepping up and allow us to be part of our team in stopping this.”
DG: So what happened?
TK: She was compliant. So she gave us all the names that we needed, once she understood what we’re about. And I think that was the first time that I feel like, “Gosh, the work we do really make a difference.”
DG: You will remember this time the rest of your life. What sacrifices have you had to make to perform at the level you’ve performed at?
TK: Every morning, when I leave my house, I just never know what time I’ll go home. And I just really trust that my husband and my children will just do their part.
DG: In the office six days, seven days. Some weeks she’s logged more than 90 hours on the job.
What’s she sacrificed? She’s sacrificed her time as a mom.
TK: They yearn for mommy to go home everyday. When they are just kind of waiting when I walk in the door. They just rush “Mom’s here!” Everybody kind of line up, race each other down the stairs and give me hugs.
DG: Everybody needs to do their part.
That’s the mantra Tair has repeated to her children, to her co-workers and to the people who are COVID-positive.
As strange as it may sound, Tair says it’s a privilege to serve in this scary, sad time, a privilege because she knows she has a role to play and she’s playing it.
I’m Dan Gorenstein, this is Tradeoffs.
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Select Research and Reports on Contact Tracing:
Is Contact Tracing Getting Enough Attention in U.S. Coronavirus Response? (Josh Michaud, Jennifer Kates; Kaiser Family Foundation)
The Effectiveness of Contact Tracing in Emerging Epidemics (Don Klinkenberg, Christophe Fraser, Hans Heesterbeek; PLoS ONE, 2006)
We Asked All 50 States About Their Contact Tracing Capacity. Here’s What We Learned (Selena Simmons-Duffin, NPR, 2020)
Coronavirus in South Korea: How ‘trace, test and treat’ may be saving lives (Laura Bicker, BBC, 2020)
Senators Seek $8 Billion for Efficient, Coordinated Contact Tracing System (Senator Jack Reid, 2020)
Tair Kiphibane, Infectious Disease Bureau Manager for the Salt Lake County Department of Public Health
The Tradeoffs theme song was composed by Ty Citerman, with additional music from Purple Planet and Moby
This episode was reported and produced by Victoria Stern, and it was mixed by Andrew Parrella.
Additional thanks to:
Nicholas Rupp, Ilene Risk and the Tradeoffs Advisory Board…
…and our stellar staff!