Podcast featuring Leischen Stelter, Managing Editor, Edge and
Charlie Hunt, Senior Analyst, Kansas Health Institute
Public health experts predict the country will need 100,000 contact tracers to track down the contacts of positive coronavirus cases. As a result, state public health agencies are scrambling to hire and train these professionals.
In this podcast episode of In Public Safety Matters, hear from Charlie Hunt, a senior analyst at the Kansas Health Institute (KHI) and a former state epidemiologist. Mr. Hunt discusses the critical role of contact tracers, the skills needed to be an effective contact tracer, and the challenges states face recruiting, hiring and training contact tracers during a pandemic.
Also learn about KHI’s collaboration to create a free, online training program, Every Contact Counts, to help prepare contact tracers for their vital public health role.
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Leischen Stelter: Welcome to the podcast In Public Safety Matters, I’m your host Leischen Stelter. Today, we’re going to talk about the growing need for contact tracers, which is one of the most important public health strategies to stop the spread of COVID-19. Contact tracers are public health professionals who track down and reach out to the contacts of new positive coronavirus cases. They advise them of their potential exposure, provide them with education, information, and instructions to help them avoid exposing other people. And, they connect them to needed services and resources. Experts have predicted the country will need at least 100,000 contact tracers, and states have been scrambling to hire these professionals.
Today, my guest is Charlie Hunt, who is a senior analyst at the Kansas Health Institute, also known as KHI, and serves as the deputy director of The Center for Sharing Public Health Services, a national initiative managed by KHI, with support from the Robert Wood Johnson Foundation. Charlie served as a state epidemiologist for Kansas from 2008 to 2017, and he and others at KHI have been supporting the state’s COVID-19 response. Charlie was involved in the creation of a free online training program called Every Contact Counts, that was developed by the Northwest Center for Public Health Practice at the University of Washington.
Charlie, welcome to In Public Safety Matters, and thank you so much for joining me.
Charlie Hunt: Hello, it’s my pleasure to be here. Thank you for having me.
Leischen Stelter: So I wanted to just start our conversation by giving our listeners a little bit of a better understanding of your background as an epidemiologist. Could you just share a bit about how long you’ve been working in this field, and your primary area of expertise?
Charlie Hunt: Sure. Well, it’s been a long time. It’s been, I guess, more than 25 years. My first job as an epidemiologist was back in 1994, I worked as a communicable disease investigator at a large suburban local health department in the Kansas City area.
Over the years, I’ve worked, really, in many areas of epidemiology, including infectious disease, chronic diseases, injury and trauma, so I really consider myself as a generalist, which was very helpful to me in my role as state epidemiologist, and even in the work that I do now.
Leischen Stelter: So I’m curious, when COVID-19 first started spreading around the world, with your background as an epidemiologist, did you immediately recognize this as a virus that needed to be taken really seriously? Did you think it would be as widespread and infectious as it turned out to be?
Charlie Hunt: Well, any time a new disease emerges, particularly one that can cause serious illness in humans, there’s reason to be concerned. This is the third novel coronavirus that’s emerged in the past 20 years, following SARS in 2003, and MERS-CoV in 2012. While SARS and MERS-CoV are certainly serious diseases that have a high case fatality rate, they never spread around the world quite like COVID-19 has.
I’ve often said that we, in public health fields, have spent a lot of time preparing for something like this, but you never can predict what a new disease is going to do.
Leischen Stelter: So I want to talk a little bit about the contact tracing element of this, I understand it’s something you’ve been really involved with in the state of Kansas. And, I also understand that contact tracing itself is nothing new, it’s something that public health professionals have relied on for years to identify the spread of infectious diseases. But, can you talk a little bit about what it’s been like for contact tracers, during this outbreak? And maybe a little bit about how their role has not only changed, but really become a prominent and critical element in our fight against COVID-19?
Charlie Hunt: Well, you’re absolutely right, contact tracing has been used as a core strategy for public health for many, many years, and for lots of other diseases. It’s something that’s done, really, every day in public health.
As you had indicated earlier, contact tracing involves identifying people who have been in contact with a person that’s been diagnosed with an infectious or a communicable disease. It’s important to, then, reach out to those people, and let them know that they’ve been exposed, provide them information on how to protect themselves, and instructions on how to avoid spreading the disease to others. If they’re sick or need to be treated, they’re referred for care, and so forth.
So really, the basics of contact tracing have not changed with the emergence of COVID-19. What has changed is the scale, and how the work was actually getting done, and needs to get done. Frankly, the workforce of people doing contact tracing has had to increase dramatically, and we have a long way to go. The existing public health workforce simply does not have the capacity, so new workers are going to be recruited and trained. The other thing, of course, because of the massive scale of this, the public health system doesn’t have the physical space to house people, and frankly, we don’t want to have a whole bunch of people coming together to work in person anyways, so a lot more of this work is going to be done remotely, which is a big change as well.
Leischen Stelter: So can you talk a little bit about contact tracers, how they were organized or hired in the past? Were these people who were dedicated as contact tracers for public health agencies? Or, were these professionals who jumped in when they needed to be contact tracing, tracers were needed?
Charlie Hunt: It’s an important point, because again, contact tracing is a core public health strategy. So this work was typically done by people who are working in public health as part of their day-to-day job. Typically, those contact tracers were also the case investigator, so it was just all integrated into one strategy.
Now again, because of the scale of this, we’re seeing the need to actually separate those roles to some degree, so that the case investigators, those who are reaching out and talking to someone whose been diagnosed, needs to concentrate on that work. Once the list of contacts has been identified, then it’s handed over, and the contact tracers need to then do that legwork to follow up with all those contacts. Again, because of the massive scale of this, it’s important that we try to develop the most efficient process that we can.
Leischen Stelter: So when it became apparent that the state was going to need a lot more contact tracers, people to fill this role, can you just walk us through that process on your end? Did the state come to KHI and ask for your support? What was the lead-in to eventually developing this training program?
Charlie Hunt: Sure. Well, I think it’s important to understand that we have a really good relationship with our state and local public health departments here in Kansas. So, it was through those relationships that we were able to offer support. We have several staff at KHI that have a variety of backgrounds and expertise that we thought would be helpful, so we simply reached out and offered support, so we’ve been engaged in a variety of different activities.
The training program itself really emerged out of the network that we have, particularly our affiliation with the National Network of Public Health Institutes. I think there was a recognition that health departments all across the country were going to be grappling with this very substantial challenge of needing to bring on a lot of people to do the work of contact tracing very quickly, and it would make sense to develop a training program that would be useful to health departments all across the U.S., rather than each health department trying to go about this on their own, so that was really the genesis of the development of this training program.
Charlie Hunt: Through NNPHI, we were connected with our colleagues at the Northwest Center for Public Health Practice at the University of Washington, and they were interested in developing this program. So with our relationship with the Kansas Health Foundation, we were able to get funding, and Kansas Health Foundation generously provided funding for the development of the program.
Really, the objectives of this training program are to be a foundational training that accompany, not replace, training that needs to be conducted in each state. So it’s important that additional training is done that provides the specific processes, and protocols, and information systems that the contact tracers are going to have to use in that particular state or jurisdiction. Again, this is a foundational program that can be applicable, no matter where the contact tracer’s going to be working.
Leischen Stelter: So I think that’s an interesting point, that this online training program was really developed to benefit anyone in the country, any state, because it’s so important. Like you said, why should each state reinvent the wheel, so to speak.
Could you talk about those initial conversations on what should be included in this online training program? Were you involved in creating the steps required in each module?
Charlie Hunt: Sure. I have to give credit to our colleagues at the University of Washington, were the ones that really developed the content. Our role was to review, and provide some feedback. We also had someone from Kansas Department of Health and Environment participating in this, to provide feedback as well. But, to really review and provide feedback on the training, obviously we wanted to make sure that it was something that could be used in Kansas, so that was really our role.
In terms of the overall objectives, again, when you think about the role of a contact tracer, they need to understand the basics of the disease. What is COVID-19, how is it spread, what are the symptoms, those kinds of things, whose at risk, and so forth, so that’s one of the first things about that.
They need to understand what contact tracing is, and I think as importantly, or perhaps even more importantly, how their role as a contact tracer is really going to help us with our response to COVID-19, and help protect public health. Understanding that importance, I think, will help them be more successful in the work that they’re doing.
Leischen Stelter: Let’s talk a little bit about the most important personality traits, or characteristics of contact tracers. Can you talk a little bit about what skillsets they need to be good at their job, or to be successful and identify a lot of these cases, and providing support to people who have tested positive?
Charlie Hunt: If you think about the nature of the work, I think probably one of the first things is that you can’t be shy, you have to be comfortable contacting people that don’t know who you are, and reaching out to them, and telling them that they might have been exposed to COVID-19. So that’s one thing, they have to be comfortable talking with people, having good communication skills. Being able to listen, I think, is also really important.
The other thing is the ability to establish trust and rapport with a person that you’re talking to, because people who’ve been exposed to COVID-19, when they learn about it, they might be scared and not sure what to do. They aren’t sure what’s going to happen to them, they might have concerns about having to stay home and not being able to work, how to care for their family members, and so on. There are a lot of challenges that people who are exposed to COVID-19 are going to be faced with, and the contact tracer really is that person that can help them understand what needs to be done, and try to help set them at ease.
Charlie Hunt: They also have to be someone that is very detail oriented. There are a lot of instructions, and information that the contact tracer has to give to the person that’s been a contact, and that information has to be conveyed clearly and effectively so that there’s not a lot of confusion about that on the other end.
I think the other thing is being comfortable with using the technology, the information systems. We have to be able to track this information, whose been exposed, who might be experiencing symptoms, and so forth, and this information has to be tracked in some way. So the contact tracers need to be comfortable working with whatever system is being used in that state, or that local health department.
Leischen Stelter: Did the online training program, which, by the way, I really like the name, Every Contact Counts, I think that was a great name for that training program. Does it touch on a lot of those skillsets that you just mentioned, about being detail oriented, having a lot of empathy, but also making sure you get information needed? Does the program elaborate on that?
Charlie Hunt: It certainly does. And in fact, one of the unique features about this program is that it actually has a mock interview. So it has the person that’s going through the training sit through a scenario, and then they respond in a certain way to that scenario, and the program provides them feedback on the response, and the best way to handle things.
It certainly does go through those aspect of things, and emphasizes the need to build that rapport and trust.
Leischen Stelter: You mentioned one of the important elements for contact tracers to have is basically understanding some of the science behind COVID-19 and how it’s transmitted. A lot of that information is still being discovered by scientists. Has that been a challenge to convey that information to contact tracers? Or, even as an epidemiologist, to better understand the elements of this virus?
Charlie Hunt: I think, to some degree, it’s been difficult for all us to understand. As you mentioned, the information continues to evolve, that’s the nature of a novel disease. Particularly in the beginning, we don’t know a lot about it, and we’re learning more every day. That emphasizes the need that contact tracers, it’s not that they go through one training and then they’re finished, and then they’re set, there’s a need for continual refresher trainings, and additional information, and changes in protocols, for example, that might need to be made, that they need to understand. There’s a continual need for reviewing new information that’s coming out, new research that’s emerging, and translating that into the specific practices, and processes, and protocols that the contact tracers will need to use.
Leischen Stelter: Another element adding to the challenges of this entire situation, something you did mention earlier, was just that all this training is having to be delivered in a remote work environment. So when you may have had onboarding in-person at one point, now all of this is being done remotely.
Can you just talk a little bit about some of the challenges that that may bring up? Is it, basically, needing to have more regular contact with contact tracers? Are you hearing those kind of challenges from your partners in the state?
Charlie Hunt: Well, certainly there’s a need for continuous communication to make sure that the people that are doing this kind of work, if they have questions they know who to turn to, and get clarification on something, so yes that’s important.
I think that we’re all adjusting to doing more remote meetings, more remote training sessions and so forth, so this is the way things are right now, and probably will be for some time. I think that we’ll all continue to get more comfortable with doing this kind of work.
Leischen Stelter: I want to ask, also, there’s a lot of folks who are out of work, as we all know, right now. It seems like becoming a contact tracer might be something people are interested in. You did talk quite a bit about the skillsets and personality traits, but are there any other, either educational, or areas of expertise, that would really help someone whose interested in pursuing a career in content tracing?
Charlie Hunt: Well again, I think that folks that have had experience working with the public, interacting with people, and are comfortable doing that, I think that’s important. If someone has a background in a healthcare field, or in social services in some way, those are all good ways to prepare for doing this kind of work.
But in terms of if someone’s interested in doing this, I think the best thing to do would be to get in touch with their local or state health department, and talk to them about the potential opportunities that might be available to get into this. As I mentioned, this is something that I think is going to be needed for quite some time to come.
Leischen Stelter: I want to go back to a big picture and pick your brain a little bit, as someone who’s been working in this field for a really long time. We’re over six months into the response to this pandemic, and I was curious just to hear from you about what you think are some of the most important lessons we’ve learned so far, from a public health perspective?
Charlie Hunt: Well, I think some of the most important things we’ve learned is that this disease, like many other things, do not affect everybody in the same way. Some people are at higher risk for contracting COVID-19 because of the nature of their work, or the environments that they’re working or living in. Some people are more susceptible to it because of their age or underlying conditions, for example, and they’re going to be more susceptible to complications from it. But, I think the other thing is that the response has also affected people differently. Those people who are working in critical infrastructure jobs, or essential function jobs have to be at work, and are going to be at higher risk for it. I think that’s an important lesson for us.
We also know that the response, the way that we’ve had to shut down businesses, limit gatherings of people and so forth, that has also had an impact. It’s not an impact that’s happened to everybody equally or equitably. Some people have been more severely affected by those things. Some types of jobs, some occupations, don’t have the luxury of being able to work from home. That’s been a challenge for us in public health.
Charlie Hunt: The other thing is that I think we have to recognize that the tolerance for the public health measures, closing down businesses, we’ve seen a shift in attitudes towards that as well. I think early on, in a lot of places, people were pretty supportive of it, but as this has dragged on, week after week, month after month, the economic implications are severe, and it’s very difficult for people to maintain that. I think that’s also something that we’re going to have to continue to grapple with.
Right now, of course, we’re all trying to figure out what is going to happen with schools, that’s going to be a challenge as this new school year is starting, or about to begin in many places. So folks are really struggling with trying to figure out the best way to do that, while also keeping people safe.
Leischen Stelter: So I was wondering if it’s possible for you to even give your perspective on where you think we are in fighting this virus? I’d imagine you’ve been keeping a close eye on infection rates throughout the country. And maybe this is impossible to know, too, but do you think that we’re halfway through this? Or, do you think it’s just not possible to even know?
Charlie Hunt: I really don’t know. I think that the recent increase in cases, again, is cause for concern. We thought that maybe things would slow down a bit over the summer, and we would see a resurgence in the fall. But as things have opened back up, the businesses are reopening, and a lot of the restrictions that were put in place early on over the last few months have started to lift, we’re seeing those cases go back up and it’s certainly a cause for concern.
But in terms of what the future holds, I don’t know that. I think it’s like that, again, we’re going to be having to deal with this for quite some time, and we’re going to have to be in this for the long haul.
Leischen Stelter: If you could convey a message to the public about what it takes to just continue fighting this virus by not spreading it, is there something that you wish everyone would keep in mind as we’re all going through this together?
Charlie Hunt: Well, there’s some basic things that have not changed, basic advice and ways to prevent illness from even before COVID-19. That is the importance of washing your hands, covering your coughs and sneezes, and certainly staying home while you’re ill.
But, with COVID-19, we’re also seeing that the use of masks when you are out and about, and in public, is emerging as a way to help prevent the disease being transmitted to others. I think that’s important for people to understand, is that is an important way to help do that. We need to avoid having lots of people in close proximity to one another, particularly indoors.
It’s all those basic messages that we’re hearing from public health, to not put yourself in close proximity to others, stay away from others as much as you can. That’s how we’re going to beat this, at least for now.
Leischen Stelter: So one other thing I was curious about is what kind of source of information do you regularly look at, to see where we are with this virus? Are you keeping close eye on Kansas state’s health department? But, are there other sources of information that you regularly assess?
Charlie Hunt: Well there are a lot of wonderful places to get really reliable information across the US. There are a lot of resources that are tracking the cases and other metrics across the country, and across the world. Harvard, Johns Hopkins, CDC, lots of other places are doing this, so those are the kinds of things that I look at.
Certainly, watching the numbers here in Kansas closely, to see how things are going. Like I said, there are almost too many to name.
Leischen Stelter: Great. Well, is there anything else about our fight against COVID-19 that you really want the public to know about, or keep in mind? Or even, those public health professionals who are in the front lines, for them to keep in mind to stay strong through this?
Charlie Hunt: Yeah, I’m glad you actually mentioned that because we also recognize that this has been very challenge for public health professionals. It’s several months now, of long hours and working under challenging circumstances, and trying to navigate the public perceptions about things, and trying to provide guidance and advice to political leaders who are, ultimately, the ones who have the decisions about that. I just say to hang in there to them, we know it’s been a challenge.
But other than that, in terms of the public, again, it’s listen to your public health department, and do your part to help prevent spreading this to others. Even though you may not become terribly ill from it, you might transmit to somebody who might have severe complications. Your grandmother, or somebody’s grandmother or grandfather, or loved one that has some underlying conditions, and won’t be able to fight it off, and that it’s a serious situation.
Leischen Stelter: Well Charlie, I just want to thank you so much for taking the time to share your expertise and perspective. Thank you so much for joining me today, for this episode of In Public Safety Matters.
Charlie Hunt: Great. Thank you very much for having me.
Leischen Stelter: Thank you to our listeners for joining us. You can learn more about these topics and others by visiting inpublicsafety.com. Be well, and stay safe.
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