Vermont Health Update: Contact Tracing And A Statewide Mandate On Masks
A statewide mask mandate is slated to take effect in Vermont on Saturday, Aug. 1. This hour, our weekly health update focuses on this and other efforts by the state to quell the spread of COVID-19. Plus, contact tracing: What is it and how does it work? We get a firsthand account of the process and answer your questions.
Our guests are:
- Shayla Livingston, public health policy advisor for the Vermont Department of Health whose done contract tracing across the state
- Tracy Dolan, deputy commissioner for the Vermont Department of Health
Broadcast live on Tuesday, July 28, 2020 after Gov. Phil Scott's 11 a.m. press conference. Rebroadcast at 7 p.m.
The following has been edited and condensed for clarity.
Q&A With Contact Tracer Shayla Livingston
Jane Lindholm: How did you come into the role of ‘contact tracer’? Is that just something that, if you work for the health department, you are expected to do?
Shayla Livingston: Many of us are doing jobs that are not our usual jobs. We are organized through a health operations center. In March, when they were deploying different people throughout the department, this was the role that they gave me, along with many of my colleagues. I was more than happy to help. In that moment, we were definitely feeling the urgency and everyone was ready to pitch in and willing to pitch in. I was excited by it. I had never done it before. Contact tracing is something that the health department does and has done for decades here in Vermont, and all over the world. But sort of like maybe some of your listeners, I vaguely knew what it was and I knew from epidemiology courses I'd taken, but I had never done it. And so it was exciting, in many ways.
So what is the training like? What do you actually get trained to do?
The big thing is to know is that, with contact tracing, the purpose is to partner with the individual who has the disease that you are trying to contain and work with them to determine the best way and the safest way for them to recover and stop the virus from spreading. In my day-to-day job, I'm working on policy in Montpelier, and the people who train me are often social workers and they do this work every day. And they, I think, are part of the reason that Vermont has had the success we've had with contact tracing, because in their training, they really emphasize empathy, compassion, listening and open-ended questions and the value that brings in terms of getting really good information and helping to support the individual where they are. And we were all trained by them. I think that in Vermont, that makes a big difference, because it really improves our ability to understand where people are and contain the spread.
The big thing around privacy that's so important is knowing HIPAA, and at the health department, we are all trained in HIPAA and patient privacy. But one of the really interesting and important things is that when you're contacted by a tracer because you've been exposed to COVID-19 through an individual, we don't disclose that person's name. So we just give you the date and we give you the information. So that's an important privacy piece that some people are surprised by.
Jane Lindholm: So could we role play for a moment, Shayla, and pretend you have to call me? You have discovered that I may have been exposed. What would you say? How would you call me? How would I know that you're legit?
Shayla Livingston: Sure. So I would first start by validating that you are Jane Lindholm, so I would say...
"Hello. This is Shayla Livingston I'm calling from the Vermont Department of Health. I'm looking for Jane Lindholm." Jane Lindholm: "I am Jane Lindholm." Shayla Livingston: "Hi, Jane. I'm calling because the health department is calling all individuals who have been exposed to somebody who tested positive for COVID-19. And unfortunately, you were exposed last Thursday. I just want to walk through with you what that means for you, give you some information and answer any questions you have. Is now an OK time to talk?" Jane Lindholm: "Yes, but now I’m freaking out." Shayla Livingston: "Yeah, it can be scary, but I think some important things for you to know are that if we work together, you can access any medical assistance that you need. And also that many people who are exposed do not actually end up contracting the illness, and of those who do end up contracting the illness, for many of them, the symptoms can be mild. So let's just start with your exposure. You were exposed last Thursday and today is Tuesday. So what we ask of people who are exposed is that they quarantine, which means you stay home and you don't go out to grocery shop or do other errands or see other people for two weeks from the date of your exposure. Are you able to do that? Do you need assistance either with food or rent or getting groceries or medication?" Jane Lindhom: "Yeah. I mean, I was supposed to go to the pharmacy today. I have medication I need to take every day. Can I even pick up my kids this afternoon?" Shayla Livingston: "Those are great questions. So what we're going to do is just walk through the things that you have to do today and then think about how we can plan for them going forward. Do you have any friends or family who you feel comfortable having pick up your medication?" Jane Lindholm: "Yes, I do. But do I have to tell them that I've been exposed? Are they exposed?" Shayla Livingston: "That's a great question. No. So you are a contact of a case. They would be a contact of a contact, so they are not considered exposed and they are not at risk at this time. If you develop symptoms or if you end up testing positive, then we might have to work with them, as well, as contacts. But for right now, they are not considered contacts and they are not at risk. They can go and pick something up for you at the pharmacy. We just ask that they drop it off outside your house. They can go and get your kids and your kids actually weren't exposed to this person. And so they, even though they live with you, are also contacts of a contact. And they're OK as well."
Jane Lindholm: Thank you. That was so informative. I think for a lot of people who haven't been contacted by a contact tracer, there's curiosity and there's some trepidation. What have people you've actually contacted said to you or how have they responded?
Shayla Livingston: Vermonters have been amazing for the most part. People are definitely willing to quarantine and they understand the importance of it. They are willing to share information about who they've been in contact with. They understand the importance of providing that information when they're a positive case. I think this community has responded in a really positive way.
There are the very sad and devastating connections that you make with people, because it's part of this whole thing. I get a list of names who are the positive cases, and that's how you start your day.
And that's how you get the list of names from those cases?
Yes, and then, it's a matter of working with them and walking through their contagious period and who they could've been exposed to. Those are the conversations that have been harder, in some instances because people are very sick. Again, I'm not a provider. I don't normally work one-on-one with people in that kind of counseling or clinical sense. And I've had the experience of talking to somebody, and then a week later finding out from a provider that they have passed away. And that is incredibly emotional and in many ways very draining and exhausting. It feels like a failure. It's hard.
With the contacts, it's less like that. Luckily, many of them don't actually end up getting sick, and those conversations tend to be easier. There are some that end up being very long conversations to try to get somebody to where you need them. With younger people, I've had experiences with group housing where it's a bunch of roommates who don't really know each other and somebody gets sick. And then they've all got to stay inside in their apartment altogether for two weeks. It can be challenging.
"I've had the experience of talking to somebody, and then a week later finding out from a provider that they have passed away. And that is incredibly emotional... It feels like a failure." - Shayla Livingston, contact tracer
You're a public health policy adviser. Has doing this contact tracing work given you different insight into the lives of your fellow Vermonters that you think might benefit you in your regular job?
Shayla Livingston: That's a great question. I think that it has informed me so much about the way that I understand public health communication. And that's not necessarily something I use every single day. But it's a really important part of public health and how we communicate and what people have understood from what we've said through either the commissioner who's at the press conferences every week or through our social media campaigns or other communications we've done. It's really brought home for me how important the clarity is and how important that messaging is. And when we get it right, when we get it wrong, what that could mean for Vermonters. That's been a really, really important lesson for my job going forward.
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