What Are the Options for Training
Contact Tracers?

Alicia Ault

June 02, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.

Hundreds of thousands of people, both clinicians and laypeople, have leapt at the chance to join the small army of contact tracers being recruited and trained throughout the United States to help contain the spread of COVID-19.

States began ramping up their contact tracing recruiting initiatives in May. At least 44 states and the District of Columbia have recently been expanding their contact tracing workforce, according to NPR data.

That's because it's possible to reduce the infectivity rate by 30% with contact tracing, in addition to the 30% reduction with a strong testing program, a study in the United Kingdom suggests, said Marcus Plescia, MD, MPH. He's the chief medical officer of the Association of State and Territorial Health Officials (ASTHO).

"A lot of states started out trying to use volunteers," like medical and nursing students, Plescia told Medscape Medical News. But it's hard to build a big network quickly with volunteers, and to keep a voluntary system organized, he said.

Massachusetts was one of the first to start hiring. To date, the state's tracing team consists of 300 nurses and others from local boards of health, 300 from community health centers, and 1500 who have been hired directly by Partners in Health, said KJ Seung, chief of strategy and policy for MA COVID Response, Partners in Health/Commonwealth of Massachusetts. But that's still not enough. ASTHO estimates that Massachusetts needs at least 6000 contact tracers in order to work effectively.

As of yesterday, more than 300,000 people nationwide had enrolled in one of the many training courses being offered, a free online course from the Johns Hopkins Bloomberg School of Public Health.

Who Can Be a Contact Tracer?

The skills and experience required of potential tracers vary by location. In New York City, basic contact tracers must have good communication skills and the "ability to understand the concepts of institutional and structural racism and bias and their impact on underserved and underrepresented communities," along with "a demonstrated commitment to supporting communities who have experienced systemic oppression and bias," according to a local job listing that is no longer active.

Contact tracing is tough enough in nonpandemic times, noted the National Association of County and City Health Officials (NACCHO) in a mid-April statement. It's only going to be harder now, NACCHO said.

In addition to being able to gain the trust of the contacts, the group notes, contact tracers may also need to employ case management skills when an individual is asked to quarantine, linking them to additional services and resources such as grocery stores, safe housing, behavioral health services, or child care.

As difficult as these tasks may be, they're necessary, said Seung at a contact tracing webinar sponsored by the Alliance for Health Policy and the Commonwealth Fund. "If you can't do all of those things in an effective, efficient, and rapid manner, you really have no chance against COVID," he said.

"Good contact tracers are going to be people who are good with connecting with other people and helping other people," Emily Gurley, PhD, MPH, an associate scientist at Johns Hopkins Bloomberg and lead instructor for the online course.

"I don't think you need to have a public health degree to be a good contact tracer," Seung added. "There is a great opportunity for lay people who are highly motivated to learn how to do this."  

But he noted that contact tracing for the pandemic would require a long-term commitment. "These contact tracing programs are going to be needed not just for 3 months, not just for 6 months, but for a year or more, maybe 2 or 3 years until a vaccine is developed," he said.

Training Opportunities Abound

Many organizations, public health departments, colleges, and universities are offering contact training courses. Some are modeled on the CDC's recommendations and others are internally produced.

The Hopkins Bloomberg School of Public Health course, launched in mid-May, was designed to train the 6400 to 17,000 tracers that New York state aims to hire, but is open to anyone. It's a free course and takes 6 hours to complete.

The university has divided its course into five modules:

  • Basic information on the virus

  • Fundamentals of contact tracing, such as how to define a case and calculate how long a contact should isolate

  • Steps involved in investigating cases, including simulated scenes of potential interactions the tracer might have

  • Ethics, which covers privacy

  • Skills for effective communications

ASTHO has developed an introductory course teaching health agencies how to train contact tracers. More than 10,000 people from 600 organizations in all 50 states, Washington, DC, and 7 US territories have completed the training, said ASTHO spokesperson Jane Esworthy. 

Community colleges, too, have developed training courses. Oakton Community College outside Chicago has a four-module course — following CDC and local health department guidance — that launched last week. The course can be completed in less than 3 weeks, according to the school.

All of the courses emphasize communication — including the ability to handle potentially fraught situations. "Contact tracers will be talking to people and giving bad news," said Hopkins' Gurley. "We try to give them skills and ways to talk to people and support people through what will be scary and difficult situations," she said. 

And, she noted, contact tracers will always have back-up in the form of supervisors who have more extensive training and expertise.

"A lot has to do with how well people are able to initially communicate and explain the situation without needlessly stressing people out," said Joshua Sharfstein, MD, vice dean for public health practice and community engagement at Johns Hopkins Bloomberg. "It's very important that people approach it with some humanity, and that's really clear in the way in which the course is developed," he said.

After all of this, however, some skills simply can't be taught. Some locations in particular will need to hire people who are already known and trusted. In Massachusetts, Seung said, he's found that to penetrate the hardest-hit areas, like some neighborhoods in Boston, his tracers have had to work with local boards of health, community health centers, and community leaders.

"So much of the success of contact tracing has to do with gaining the trust of the person you're making contact with," said ASTHO's chief medical officer Plescia.

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