TUMWATER, Thurston County — In a cubicle farm on the fourth floor of a state office building lie the seeds of Washington’s next effort to slow and eventually halt the spread of the novel coronavirus.
This is Task Force Kokanee, named for the landlocked salmon, part of the state’s effort to expand tracking and tracing of the virus, and hopefully hem it in, like the salmon.
Washington has trained more than 2,100 people to work as contact tracers, who call every person who tests positive for COVID-19, the disease caused by the coronavirus, to find out who they have had close contact with. They then call the contacts to urge them to get tested and quarantine for 14 days, seeking to stop the spread of the virus.
The process, one of the fundamental tools of public health, dates back decades, if not centuries, and is relatively low-tech, so far.
About 630 employees of local and state health departments are working on the task. The state has also trained 723 members of the National Guard and 769 employees of the state Department of Licensing to help out.
“Case investigations and contact tracing are key pieces of the effort to keep Washington residents safe,” state Health Secretary John Wiesman said. “Both have been critical tools to suppress the virus in other parts of the world.”
Contact tracing to track and stop the spread of infectious diseases is typically the responsibility of local health departments. But many departments stopped doing the investigations in March, when they became overwhelmed with the number of cases.
So, the state has stepped in to help counties ramp back up. So far, state personnel are helping five counties, including King, Lewis and Yakima, with contact tracing, the state Department of Health said. The Health Department declined to name the other two counties it is assisting, saying the counties had asked not to be identified.
Of the more than 2,100 trained contact tracers, about 700 are currently active, the Health Department said. Local officials are spread around the state, while about 50 National Guard personnel are making calls at well-spaced work stations from that Health Department office building.
The goal, which the state has not yet reached, is to contact each person who tests positive within 24 hours, and call each of their close contacts within 48 hours.
“If done correctly, it is a thorough process that helps identify and quarantine exposed individuals so they cannot then transmit the virus to others,” said Diana Cervantes, a professor of public health at the University of North Texas. “It breaks the chains of transmission.”
It also can help officials learn how the still-mysterious disease spreads, by looking at how many people who might have been exposed under different circumstances ultimately get sick.
In Washington, the process starts with health care providers, who, when a person tests positive, report that test to the local health department. The health department, either on its own or with the state’s assistance, then calls the person who has been infected.
Contact tracers go through a three-phase training, said Maria Courogen, the state’s branch director for disease contamination. The training is focused on confidentiality and privacy issues, a crash course in infectious diseases and how to use the electronic data-entry system.
Callers will ask the person how they’re feeling, what their symptoms are like and for the names and phone numbers of anyone they’ve had close contact with in the last 14 days. They’ll ask the person who is infected, and anyone in their household, to quarantine for 14 days.
Then they’ll call the close contacts, and ask them how they’re feeling and ask them to quarantine as well. Tracers will not tell the contacts who the infected person is or who gave the tracer their phone number.
Officials stress the entire process is voluntary. Don’t want to talk to a contact tracer? You’re free to hang up the phone.
“We do try to influence people in positive ways to participate in public health interventions, but if they don’t want to talk to us, that’s their prerogative,” Courogen said.
Sgt. 1st Class Aaron Paul has been supervising a team of contact tracers for the last three weeks or so. He said at least three-quarters of the people they call are happy to participate. Of the ones who aren’t, Paul said, they’re almost entirely because of language difficulties, even though they have translators available.
“I introduce myself, I ask to speak with the contact and we go over some general questions in regard to their health,” said Senior Airman Alicia Day, who has been doing contact tracing for about two weeks. So far, no one has refused to cooperate. “We just try to be polite and friendly.”
People in quarantine are contacted daily, officials said, either through phone calls or automated text messages, to see how they’re doing and what they might need.
Washington is still generally seeing between 100 and 300 new confirmed cases each day. As the state begins to reopen, and many people start going out more, tracking each case will become more difficult.
It’s easy to keep track of who you’ve seen if you haven’t seen anyone recently. But, the first confirmed case of the virus in Washington, discovered in January, had 70 close contacts who had to be traced, Wiesman said.
“If everybody had that, the amount of work that has to happen is enormous,” he said. “So it’s important that everybody continue to keep their six feet of distance.”
The Trump administration has set National Guard deployments to end on June 24, which would leave many troops with 89 days of active service, one day short of what’s needed to qualify for a host of benefits. Gov. Jay Inslee said Wednesday the Guard’s work was crucial and he was hopeful the deployments would be extended.
The state is also in early discussions with Google and Apple about potentially using their location services to alert people when they’ve been in close contact with someone who tested positive. Inslee said they’ve made no agreements with the tech giants and that if they did, it would be entirely voluntary, with people needing to actively opt-in to participate.
“We’ve made no decisions at this point as to whether we’d use the product,” he said. “The main benefit of this technology is it would allow somebody to be notified much more quickly.”
Still, the announcement of the fleet of contact tracers, and especially the National Guard’s inclusion, has fueled conspiracy theories about mandatory participation and enforced isolation.
“This strategy has been used for decades,” the state’s top health officials said last week, in an attempt to tamp down rumors. “The public’s participation is voluntary,” the Health Department reiterated Wednesday.
At its most basic, contact tracing is a form of mapping disease to try to slow outbreaks, a technique that goes back centuries.
The concept of quarantines dates at least to the mid-14th century, when they were used to try to slow the spread of the plague, which killed an estimated one-third of Europe’s population.
The birth of modern epidemiology is generally dated to a mid-19th century cholera outbreak in London. At the time, the general theory was that the disease was spread by a “miasma” of polluted air. John Snow, a London doctor, disagreed and meticulously charted the outbreak, dotting a map of the Soho neighborhood with each positive case. He found the cases were all centered on one public water pump. He convinced city officials to remove the handle from the pump, and essentially ended the outbreak.
Later in the 19th century, after the development of the small pox vaccine, contact tracing further developed, because there was a medical intervention.
“They’d find out who had been in contact with a person who had small pox and try to get them vaccinated,” said Graham Mooney, a professor of the history of medicine at the Johns Hopkins University School of Medicine. “That became one of the ways in which small pox was managed and really it was a way of ensuring better coverage of vaccination.”
In the 20th century, the practice further evolved and has been used extensively for diseases such as tuberculosis, measles, Ebola and HIV/AIDS.
“Each of our epidemic and pandemic diseases that we struggle to control have usually prompted societies to try to figure out who had the disease and how it’s spreading,” said Elena Conis, a medical historian at the University of California, Berkeley. “It’s not just about who is sick, but who has been exposed and in what settings.”
