As businesses and public spaces reopen across the nation, the old-school public health detective work known as contact tracing is becoming a major component of the battle to contain the novel coronavirus that causes the deadly COVID-19 disease.

It’s an investigative strategy long used for finding and informing people exposed to contagious diseases, such as measles and STDs, and now agencies across the country focused on combating the pandemic need support to expand their workforce to conduct contact-tracing interviews and save lives.

To provide training for this expanding workforce, the 91±¬ÁĎ’s created the free, online course to support public health agencies — including smaller, rural public health districts and tribal health departments — to help their existing and growing workforce in the art and science of conducting a contact-tracing interview.

“At the Northwest Center for Public Health Practice, we were keenly aware of the strain public health workers and agencies were under long before the novel coronavirus hit,” said , professor in the 91±¬ÁĎ School of Nursing and director of the center. “As COVID-19 spread, we knew from practice partners that a training was needed for the public health workforce that ​could quickly and efficiently assist a wide variety of public health agencies.”

While Washington state has launched a large-scale effort to train contract tracers, other states and their partners can take similar steps using instead of creating all of their own training from the ground up. This is why Every Contact Counts was developed at the request of and in partnership with the Kansas Health Institute, which has been helping Kansas enhance its contact-tracing efforts at the state level. Now, the Kansas Department of Health and Environment is requiring Every Contact Counts as part of its training plan for all new contact tracers.

“We wanted to create a foundational training that not only met the needs for us in Kansas, but could support other states across the country in assisting their own local health departments where a lot of the COVID-19 containment work is being done,” said Charles Hunt, a senior analyst with the Kansas Health Institute. “While many local health departments manage their own contact-tracing workforce, they need access to training resources, like Every Contact Counts, that set their staff up for success and protect their communities.”

The federal Health Resources and Services Administration promoted the training in an email to public health professionals, along with the and other national organizations.

With Every Contact Counts, professionals will learn to describe contact tracing and why it’s important to public health, articulate why COVID-19 is unique when it comes to contact tracing, identify the key components of a successful contact-tracing interview and complete an interview with confidence, clarity and compassion.

Since each state has slightly different policies for containing the outbreak, the 91±¬ÁĎ training provides a foundation for performing contact tracing and a certificate to verify successful completion of the course.

“Contact tracing is going to be an essential part of our reopening and containment efforts moving forward,” said , professor of epidemiology in the 91±¬ÁĎ School of Public Health whose work with 91±¬ÁĎ graduate students provided the basis for the training. “We need to trace every contact possible, because every contact counts in stopping this disease.”

Cold-calling people who have tested positive for the virus or who may have been exposed to it — and getting them the information and help they need to self-isolate — can be challenging. While some will be thankful for the information and help, others can be annoyed or agitated. Protecting privacy is paramount in these encounters, and some subjects may actively resist engaging with the interviewer. The 91±¬ÁĎ training is designed to help interviewers approach, with skill and compassion, the fears and the sudden, dramatic change in their lives that subjects face.

The training falls into three main categories — what contact tracing is, contact-tracing specifics for COVID-19, and communicating with cases and contacts. Exercises include interview skill-building videos, section quizzes and an exercise where participants practice key decision-making during a contact interview.

Throughout the training site are tips and encouragement from experienced contact tracers, such as this segment from Neil Abernethy at the 91±¬ÁĎ School of Medicine:

At the end of the course, there’s a final assessment. Participants who receive a score of 80% or better will get a non-credit certificate of completion that they can download and use to verify the training they received.

“With Every Contact Counts, we want public health professionals to feel like they have the knowledge and resources to complete a contact-tracing interview with confidence, clarity and compassion,” said , e-learning manager at the Northwest Center. “We know they will be talking to community members who are scared, overwhelmed or possibly even dismissive of contact-tracing efforts. This training helps interviewers prepare and practice so they can provide needed information in a way that encourages people to listen and slow the spread of COVID-19.”

The Northwest Center for Public Health Practice developed this training, which was made possible thanks to a grant from the and contributions by the Kansas Department of Health and Environment and the Kansas Health Institute.

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For more information, news media can contact Baseman jbaseman@uw.edu and Bekemeier at bettybek@uw.edu.

Learn more about the ±«°Â’s Population Health Initiative: a 25-year, interdisciplinary effort to bring understanding and solutions to the biggest challenges facing communities.

A little after 10 p.m. on March 19, 91±¬ÁĎ graduate students Anne Massey and David Coomes happened to be online when they received an email that would give them an unexpected role in Washington’s rapidly evolving response to the outbreak of a novel coronavirus.

As context, the World Health Organization had just the spread of the virus a pandemic, the state of Washington had gone from having the country’s for the virus to having the nation’s from COVID-19. The number of infections had jumped to statewide and in the nation.

The two graduate students in the Department of Epidemiology are members of the , or SEAL Team, established in 2015 in the 91±¬ÁĎ School of Public Health. Roughly 20 team members had been working since early February with Public Health  — Seattle & King County, the state’s Department of Health and other agencies to track health information. Massey, Coomes and others had already helped in various ways.

And as the official response to the outbreak changed day to day, some assignments ended while others were still developing. Here was a chance for Massey, teaching assistant and student leader of the SEAL Team, and Coomes to put their nascent expertise back to work in the state’s response.

“We had the initial training we all went through in the SEAL program. The expectation was that because response to the pandemic was changing so fast, we wouldn’t know what we would be doing until we got a call. So we had to be ready,” Massey said.

Backstage access

The late-night email came from 91±¬ÁĎ School of Public Health associate dean, professor of epidemiology and SEAL Team director Janet Baseman: Could they make it to the Washington State in Shoreline  the next morning to help launch a new system registering people for a pop-up ?

“My first thought was about getting child care,” said Coomes. “I have a 2-year-old and had to lean on my partner to cover child care for the day. But I wanted to see them get it off the ground. The response was changing all the time, because they’re constantly getting new information and dealing with resource challenges. They were throwing this together at a moment’s notice.”

The two were able to commit. The next morning, a Friday, at the lab in Shoreline, they climbed into a state vehicle with a state official and headed for the Tacoma Dome. On the way, they learned how the program worked for this particular use: People remotely filled out an online survey, and based on symptoms, risk factors or involvement in a frontline occupation, they got a unique number and appointment to get tested.
At the Tacoma Dome, the students had to wander around the essentially deserted building for a bit looking for the way in. Once they found the right door, they were sent to backstage rooms meant for concert performers and got to work training local public health workers on the registration program.

“It was all very exciting,” said Massey. “We had worked with that software application before, but this was an expedited use of the program. And, because we had the relationships with state officials and this tool was already created, we were able to quickly respond to the pandemic, to deploy skills and be creative.”

First wave

Every quarter for the past five years, roughly 20 students from across the School of Public Health get trained and can then volunteer for assignments to help state and local health agencies in outbreak investigations — such as the 2019 or food safety issues.

But the field assignments for this spring quarter would be on a whole other level: Helping agencies respond to the greatest infectious disease threat in at least a generation.

“SEAL students are trained to provide surge support to our public health practice partners,” said Baseman. “The fact that their skills can be applied now to a global pandemic as it’s unfolding is pretty amazing.”

Epidemiology graduate students Haylea Hannah and Erin Morgan thought so, too.

The two SEAL students had jumped into the first wave of Public Health — Seattle & King County’s efforts in early February to get a handle on who might be bringing the virus to Washington from out of the country. They made phone calls to help monitor travelers who had symptoms of the disease and talked to family members and other close contacts.

“When I did the symptom-monitoring calls,” Hannah said, “people would be really nice. I think they thought it was kind that they were hearing from the county health department. Most of them said they had heard a little bit from the CDC when they got off their flight, but they were glad to have the information and to know who they should reach out to.”

Morgan explained that they started out contacting all returning travelers, but quickly realized there were too many. Even with SEAL Team backup, the health agency didn’t have the resources to contact everyone. So she helped the agency brainstorm other strategies. They figured out a way to direct recent travelers to information they needed, without causing an investigator to contact every single traveler.

“This is such an unprecedented time,” Morgan said. “Being in public health and being a student training for a career in epidemiology, it just felt great to have an opportunity to help. It felt impactful for me to do anything that took like one additional thing off a to-do list.”

Nitty-gritty of public health

“The SEAL students came in super excited, and if they had to do something different, they were totally ready to go and do whatever needed to be done,” said Melinda Huntington-Frazier, a public health nurse in the Communicable Disease Epidemiology & Immunization Section of Public Health — Seattle & King County.

“At the time, we were just learning about asymptomatic infections,” Huntington-Frazier added. “There were so many questions. It was great seeing students growing and learning to tackle the bigger questions as new details, like the possibility of an asymptomatic contagion, were coming in.”

The SEAL Team also got experience with the nitty-gritty data work of case and contact investigation in public health while helping out at the Washington State Department of Health.

“The SEALs assisted the data management team at an imperative time during COVID-19 investigations,” said Kelsey Nichols, of the department’s Office of Communicable Disease Epidemiology. “The investigations team was doing phone interviews and transcribing the data on paper when we first began interviewing people, and that data needed to be integrated into our data surveillance system as quickly as possible.”

Real-world impact

The SEAL Team includes newly trained members and experienced members like Coomes, who has transitioned to helping ±«°Â’s Environmental Health & Safety department stay in contact with COVID-19 cases associated with the university. The student group continues to support various agencies combating the pandemic.

Each student can recall that moment they recognized their efforts, no matter how technical or abstract, was really about the people affected and suffering during the crisis.

“When we called the son of one of the women who had passed,” remembered Morgan, “he was just very grateful for someone reaching out and checking in on him and providing more information and making sure he was doing OK. That was probably one of the more impactful moments for me.”

Hannah’s passion for working in public health had brought her to the ±«°Â’s epidemiology graduate program, but along the way she’s discovered a strong interest in how public health agencies communicate.

“I’m familiar with data and its interpretation,” she said. “But once you have that, you have to think about how it will be interpreted by the public. How should we present it so that it’s clear? What numbers do you communicate and how do you do that? That’s the piece this experience has highlighted for me.”

Once the worst is over, Morgan hopes to be a part of research into how injuries and violence played out during the pandemic.

“There will inevitably be side effects of people being told to stay at home, and some of them are positive, such as decreases in motor-vehicle collisions. But with the uncertainty and economic fallout, there’s the potential increased risk for injury, self-inflicted or toward other people. So even when things start to calm down with the pandemic, there will be a lot of questions and a lot of research into what happened,” she said.

Massey, a teaching assistant, continues helping Baseman lead the SEAL Team, a program that was instrumental in her decision to leave a career to go back to school in public health at 91±¬ÁĎ. She grew up in the Seattle area, and for much of her life has had an interest in pandemics and reading about them.

“And to be able to not only help public health efforts but to be in a pandemic in the region I grew up in, reading those books about spillover diseases from animals, all of those things coming together has been really stunning,” Massey said.

The SEAL Team story continues. Some 30 graduate student members are currently supporting the state’s health agencies.

VIDEO: Baseman and other SEAL Team members join School of Public Health Dean Hilary Godwin in her weekly webinar sharing the latest updates on the school’s response to the COVID-19 outbreak.

For more information on the SEAL Team, contact Baseman at jbaseman@uw.edu or Massey at aemassey@uw.edu.

Learn more about the ±«°Â’s Population Health Initiative: a 25-year, interdisciplinary effort to bring understanding and solutions to the biggest challenges facing communities.