“Before the pandemic we had 50 people on staff. Now we’re up to 500”: What it’s like to work as a Covid contact tracer

“Before the pandemic we had 50 people on staff. Now we’re up to 500”: What it’s like to work as a Covid contact tracer

Mahad Nur became interested in the spread of disease when he contracted malaria as a child in Tanzania. Now he’s an investigator and team leader with Toronto Public Health, spending his days on the phone with people who have Covid and collecting information to curb the spread. We talked to him about how he got into this work, how his job has changed during the pandemic, and the challenges of building trust with Covid cases. 

As told to Isabel B. Slone

“I moved from Somalia to north Etobicoke with my parents in 1990, when I was four years old. Eight years later my father, who was a physician, decided to move the family to Tanzania so he could volunteer in a hospital there. He thought it would be a good opportunity for me to have a change of scenery and check out that part of the world. One day, I was running a high temperature and feeling drained. My father took me to a hospital, where I was diagnosed with malaria. It was a harrowing experience. While I was at the hospital, I got into a conversation with the technician who was taking my blood, and I asked him how I caught malaria. He explained that the disease is transmitted through mosquitoes: a mosquito will bite an infected person then carry the disease and transmit it to the next person it bites. I was totally fascinated.

“I soon recovered, but my brush with malaria kickstarted my curiosity into how we get sick, how diseases can spread and what can be done to keep people safe. After two years in Tanzania, we returned to Toronto, where I attended high school at Kipling Collegiate. After graduation, I studied public health at Ryerson and got my certificate in public health inspection. I chose that field because it touched so many different spheres: food safety, water treatment, vector-born diseases.

“I’ve been working in public health for 13 years now. I started out as a public health inspector, and now I’m a supervisor at the Communicable Disease Liaison Unit at Toronto Public Health, overseeing a team of 30 people. Before the pandemic, I spent my days liaising with hospitals across the city of Toronto, investigating influenza outbreaks, clostridium difficile outbreaks and diseases like streptococcus and Creutzfeldt-Jakob disease. If someone came down with one of these diseases in a hospital, it would get reported to TPH. We’d call the patient to collect information on their symptoms, exposures and occupations, and follow up accordingly. If someone tests positive for hepatitis A, for example, we’d educate them on how to prevent transmission, attempt to identify the source of infection and follow up to determine if any of their friends or family were exposed.

“Working in public health, I never knew what to expect day to day. It could be light, or it could be a day where I had five outbreaks. Now it’s Covid all day and all night. I joked around with some of our senior management and asked them if the City of Toronto covers divorce fees—by the time this is all said and done, I don’t know if I’m going to be married anymore. At the beginning of the pandemic, I was working a minimum of 12-to-13-hour days. I was running on adrenalin. There were times when I wouldn’t even make it to bed before I had to get up for work again; I would fall asleep on the couch.

“Now that infections have dropped, I’ve been able to go back to working my regular eight-hour day. This is the first time I’ve been able to take weekends off in several months. The job continues when you go home as well, because my family and friends all had questions about public health. Sometimes I find myself talking about Covid all day, all afternoon and pretty much all evening as well. It’s been tough, but I’m up for the challenge.

“We try to contact 90 per cent of cases—people who either have Covid or have come into contact with someone who does—within 24 hours. Right now, we’re reaching 95 per cent of cases in that time. Before the pandemic we had 50 dedicated contact tracers on staff, and now we’re up to 500. Everyone doing contact tracing has some experience in communicable disease management; we aren’t hiring people off the street. It’s mostly public health inspectors and public health nurses who are already employed by Toronto Public Health, as well as some medical students who have volunteered to help out.

“We train the new contact tracers for about a week. There’s an introductory training where we get them comfortable with the idea of calling up people who have come into contact with the disease. Then we do one-on-one, in-person training where they go through mock case scenarios and shadow people who are currently doing the job. Most of the new contact tracers already have an understanding of how to do case management, so it’s just a matter of giving them training on the coronavirus itself—how it presents itself, and the various modes of transmission.

“Whenever somebody is tested at an assessment centre or the hospital, the specimen will be sent to a lab. If the specimen comes back positive for Covid-19, the lab will report the result to the jurisdiction where the person resides; so if a person lives in Toronto, the specimen will be reported to Toronto Public Health. Once we get that first phone call from the lab, we go through the report and collect as much information as we can—the person’s identity, demographic information and where they got tested—and then we give the person a call. We do not assume that the person knows the results of their Covid test, so that’s the first thing we ask.

“The first couple of minutes of the call are the most important because that’s when we have to build trust with the person on the other end. I’ll introduce myself, explain the reason for my call, confirm the identity of the person and start collecting information. I will ask them about where they’ve been, whether or not they’ve travelled, and who they’ve been in contact with. Some people are not comfortable giving out their contacts, and I explain that we keep their identity confidential. There might be a language barrier, so it’s important to take the time to explain to them what the conversation is for, to pause during the interview, ask them if they have any questions, ask if they want to take a break. These initial phone calls usually last anywhere from one to three hours.

“Then we reach out to the list of contacts the person provided. We let them know we have identified them as a close contact of a Covid case and explain that they need to self-isolate for 14 days. We follow up with each of the cases and contacts every day for 14 days. We ask them about their health status, how they’re doing, and ensure that they’re complying with self-isolation. Some calls might last two minutes, if the person is feeling healthy and hasn’t gone anywhere, while others might last 15 minutes. For example, I might call someone who lives in a household with six or seven people, where I have to follow up with every single person. It’s like a big spiderweb. It can grow fast.

“Contact tracing is very detail-oriented. We pay particularly close attention to the date of symptom onset, because that information is used to determine the period of communicability. We always double-check a person’s symptom onset date and ask if they recall having any other symptoms prior to that. It doesn’t have to be the typical symptoms of coughing or shortness of breath—maybe they’d lost their sense of taste and smell prior to that. We really have to nail down that onset date.

“A few times, I’ve been on the phone and the person becomes very suspicious, asking, ‘How do I really know you’re calling from public health?’ I explain to them that I understand they went to a specific hospital to get tested, or let them know we’ve received this positive report. Once we start providing them with information, usually they begin to understand that it’s really us calling. Other times, when there’s a language barrier, I can transfer them to someone on staff who speaks the language or use our interpreter service line. Some individuals even give us permission to speak with a family member to assist in the conversation. We try to make every person comfortable enough to ensure we obtain the information needed.

“Sometimes I think I’m done with a case, but then a person will call me back later in the day or the next day to let me know about something they forgot to mention. They will remember another activity they did, another place they went, another person they were in contact with. You might think you’re finished with a case, but you’re holding on to that file for 14 days, so it’s important to keep those lines of communication open.

“It’s a stressful job, but I find there’s a lot of joy in it. When you’re around other people who are also working hard and everyone is doing their part, you feel capable of anything. At the beginning of this pandemic there were so many unknowns about this virus. That amplified the need for us to work smart, dispel misinformation and ensure that we provide the right services and information to help contain the spread. Sure, you get tired, but you just keep going.

“Although the number of cases has gone down, we’re doing our best to ensure we have enough resources in place in case of a possible second wave. Right now, I’m just grateful for the fact that I’m able to provide my assistance to help control this pandemic.”