Who, what, when, where: tracers reveal all

Hundreds of contact tracers are having very difficult conversations with infected Victorians as outbreak escalates.

Epidemiologist Rebecca Hundy says when it comes to contact tracing, ‘older people tend to be more concerned than younger ones, and they are often more unwell’.

They are the disease detectives on the frontline between COVID-19 suppression and a second wave.

Contact tracers are currently working on hundreds of active coronavirus cases as the new outbreak­ in Victoria continues to run. For older Australians and those with chronic conditions, they really do stand between life and death.

Victoria currently has 1400 tracers dealing with the outbreak, Premier Dan Andrews says, a number expected to rise shortly to 1600 before offers of interstate resources­ are called upon.

But how exactly do they do what they do? Are they more like CSI scientists or auditors? And given that they are the first people to tell someone they have the virus and often the first to tell contacts­ that they may be at risk, are they psychologists as well?

Perhaps a little of each, says Rebecca Hundy, an epidemiol­ogist with a science background and a Masters in Applied Epidem­iology who has specialised in contract tracing in the ACT for more than a decade.

Ms Hundy describes a typical COVID-19 contact trace after receiving­ a positive notification from the laboratory. “The first thing we do is get in contact with the person who has tested positive, for two reasons. We’re wanting to establish how and where they acquired the infection­, and we also need to compile a list of their close contacts­ from when they became infectious,” she says.

The conversation can be quite emotional: “Some people are quite upset, some are surprised. Older people tend to be more concerned than younger ones, and they are often more unwell.’’

After the initial news, the hard work starts, as tracers try to recreate the infected person’s last 14 days in as granular detail as possible. As a simple test of how hard this is, try to recall what you were doing at lunchtime 10 days ago.

“It can be quite a challenging task to gather who people saw, who they were with and where they have been over the course of a fortnight,” she says.

“We’ll ask them to pull out a calendar or a diary. We’ll get them to look at their phone and text messages, their emails, sometimes their social media posts — anything that might help them remember exactly what they’ve done in the last 14 days.

“One of the more useful tricks of the trade to help jog people’s memory are bank accounts. Often people will see something on a credit card statement or bank statement and say, ‘Oh, I’d forgotten I’d gone there to buy that’.”

Ms Hundy says the vast major­ity of people are well-intentioned and treated the COVID outbreak seriously.

Once they have looked for the source of the virus, which helps build the overall picture of the outbreak and its links and clusters, it’s time for the contact tracer to turn their attention to people the COVID-positive person may have infected.

“We look at anyone who has had close contact with the case while infectious, which is the period­ 48 hours prior to their symptoms first presenting through to the time they are isol­ated,” she says.

“By close contact we mean anyone who has had greater than 15 minutes face-to-face contact: across the desk in an office is an example. The other criteria is if they have been together for two hours or more in an enclosed space, such as a big meeting room. We also do a risk assessment based on the duration and type of the contact.’’

Close contacts are often warned by the infected person that they are about to get a call from the tracers. But sometimes that doesn’t happen, and those who get a call out of the blue are often more shocked than the person­ who has the virus.

“They will usually ask ­questions about when and where they were exposed, but we don’t disclose­ who the person is on the basis of confidentiality. There’s often a bit of panic and worry about the potential to catch the disease. And asking someone to quarantine for the next 14 days, which is the protocol, is often confronting for the person. They may start asking ‘what am I going to do for money?’.”

Ms Hundy’s team includes mental health workers and social workers who can provide emotional support to confirmed cases, their contact and the tracers.

The ACT process has been adopted by several health departments across the world and made available as a resource by the World Health Organisation.

But each case is time-consuming. Ms Hundy reckons an uncomplicated case, where a person is an office worker and sees only family and some friends, can take up to 24 hours of work to get the full picture.

“But there are other cases that are more complex, say for instance­ where someone has caught a long-distance train and you have to get the passenger manifest, work out where the person­ sat and how much they moved, things like that.”

So is it worth having the COVID­Safe App? “I definitely have it and think it can be a very useful supplement to the interview process to open up lines of inquiry as we conduct the trace,” she says.

She adds that she expects there will be plenty of work for her colleagues in the coming months.

“I don’t see an end just yet, unfortunately. It looks to me like there’s a bit of a way to go.”