Joining us today is Nerdy Guest, Sivanthy Vasanthan, a Case Investigator for New York City’s COVID-19 Test and Trace Corps, the public health initiative that oversees the city’s contact tracing program. She has been in this position since the program’s inception in May 2020. Sivanthy is a recent graduate from Columbia Public Health, where she received her Master of Public Health (MPH) in Sociomedical Sciences with a specialization in Health and Human Rights.
Q. Walk us through a typical trace.
A. As a Case Investigator, I am responsible for calling individuals with a confirmed, positive diagnosis for COVID-19. When someone tests positive for COVID-19, that data is reported to the NYC Department of Health and then to the Test and Trace Corps. When I receive this information, I call the individual who has tested positive (the “case”). After verifying their identity, I ask about the case’s experiences with COVID-19 symptoms and then I provide them with educational information about COVID-19. I also provide cases with information on hotel rooms, groceries, treatment access, and other health-promoting resources in order for them to safely stay at home as much as possible. As part of this call, I also ask cases about the people they have been in close contact with in the days before testing, and up until our phone call. I ask for the names and phone numbers of these contacts, if available, so that these individuals can be informed about their potential exposure to COVID-19, but without identifying the case.
Q. What is your biggest challenge in tracing a case and in tracking down a contact?
A. One of the biggest challenges I face is when a case doesn’t experience any symptoms of COVID-19 and wonders why we recommend they stay at home for a specified time period. When that happens, I explain to them that cases who are asymptomatic can still transmit COVID-19 to others and that staying at home can also help with treatment if cases develop any symptoms of COVID-19 at a later date.
It also can be hard to track down a contact if a case remembers that they have been near a certain person but they don’t have the information for a contact, or are hesitant to share it. When this happens, I provide cases with a phone number they can call at any time if they manage to get a contact’s information later on, or if they become more comfortable sharing this information at some point after our call.
From my experience, most cases are willing to share information about SOME of their contacts but not ALL of their contacts. For example, although most cases are willing to identify family members, fewer are willing to share information about their friends, roommates, or co-workers. I get the sense that the questions sometimes feel intrusive to the case, or they may feel fear, guilt, or embarrassment which can be influenced by the nature of the activity in which they were engaged. For example, for people who continued to work outside the home in non-essential jobs for financial reasons, despite orders to remain at home, they may be more hesitant to volunteer any information about this activity and associated contacts. Additionally, home health aides and other healthcare workers have understandably been reluctant to share the information on their patients with whom they have been in contact due to HIPAA laws.
Q. What are concerns that cases or contacts have raised with you?
A. A key concern relates to worries about privacy and surveillance. These worries are not with me as an individual, but rather with contact tracing in general, and what is done with the information gathered by Case Investigators. I’m not surprised, but I am concerned about how to better ease these concerns to make cases feel more comfortable, and to have the contact tracing program work as effectively as possible. Many cases are reassured when I tell them that any information they provide is completely confidential, and is not sent to immigration or law enforcement officials. Case Investigators also do not ask any questions related to citizenship status. Any information the Test & Trace Corps obtains is stored securely and used only by authorized Test & Trace Corps staff for the limited purpose of protecting public health.
Q. What are the kinds of activities you are seeing which appear to be contributing to more infections at least in NYC?
A. Just based on my own experience, I haven’t seen infections cluster around any particular activity or location, though other tracers in NYC might have a different perspective. What I have seen more of is clustering within households. For example, after talking to a case and reaching out to their contacts, I’m seeing a pattern whereby other household members eventually test positive too. And in households with more people, this can lead to even more infections. But I otherwise haven’t seen high clusters of infection developing in other settings so far. Though some of this could be because places like bars and indoor dining remain closed in NYC unlike in other part of the US where infections seem to cluster in these locations.
Q. What made you decide to become a contract tracer in NYC?
A. I’m passionate about using my privilege to help other people, and it’s why I went into public health. After recently graduating with my MPH in May 2020, I wanted to apply the knowledge, skills, and training I received at Columbia to help the city successfully respond to the pandemic.
Q. Anything else you’d like to tell our audience?
A. Contact tracing is one of the few tools available to public health professionals to stop the spread of COVID-19. I truly appreciate all of the patience and participation of cases and contacts who work with me to complete calls and provide me with as much information as possible to help limit the spread of COVID-19.