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When a person tests positive for coronavirus in Long Beach, Crystal Nicholson may be the first person to tell them they’re infected, and then she’ll ask an important question: Who else might have been exposed?

Nicholson is one of more than 85 city workers from various departments now reassigned to help track COVID-19 cases through contact tracing, a process through which she investigates where people have been and who they’ve been with to piece together an intricate web of who might also be infected. Local health officials say the process is one of the most effective methods for slowing the spread of the pandemic since there’s still no vaccine.

In order to have enough contact tracers to address a virus of pandemic proportions, Nicholson was among those reassigned from her role as a customer service lead in Energy Resources, where fewer people were needed due to coronavirus shutdowns. She went through a few days of online trainings, took an oath and is now registered as a disaster service worker, specifically assigned to case investigations.

Handling a caseload of up to 10 patients a day, Nicholson said she was initially nervous about her reassignment because she’s not a medical professional, but the training and her experience handling an average of 100 calls a day from utility customers prepared her better than she realized.

“Within the first 10 to 20 seconds of talking to someone, you know where the call is going, and that comes from my call center experience,” she said.

Her new assignment also allows her the flexibility to work from home, which she’s been grateful for since she has a grade school-aged daughter at home. She also feels good about her work, believing she’s making a difference.

“You need empathy, that’s the most important thing—these individuals are scared,” she said, noting that most of the time people have the most questions about how long they need to say at home and how to protect their families.

The hardest part is building trust to ask people who they’ve been in contact with—from where they work to who they’ve slept with. She said, “If they aren’t comfortable, that’s fine, they don’t have to answer,” about the questions asked in what’s typically a 30 to 45-minute phone interview.

Long Beach Communicable Disease Controller Emily Holman said the city typically has fewer than five epidemiologists who do contact tracing for measles, salmonella, and other illnesses. To handle the pandemic’s caseload, the overwhelmed department quickly realized it needed help.

“This is something that comes along once in a century,” Holman said about the pandemic creating an immediate need for more contact tracers.

As of Friday, Long Beach officials have reported 2,934 positive cases of COVID-19, and 118 deaths attributed to the virus.

Initially, as the rate of infections increased, Holman said the department could only focus on tracing those it deemed “most vulnerable,” such as the homeless, first responders and heath care workers, especially those employed in skilled nursing facilities where most of Long Beach’s infections have been reported.

Now that the rate of infection is decreasing and the city has trained more contact tracers—exceeding the state’s standard of 15 tracers per 100,000 residents—Holman said the scope is widening beyond those deemed most vulnerable.

“Long Beach is really unique, and we have an advantage,” Holman said, noting that other cities must rely on county health departments, which can be larger and less nimble. “We are ahead of the game. We have more flexibility and can make decisions more quickly.”

City Manager Tom Modica said Long Beach has tailored its approach and, especially early on, maintained higher contact tracing for its population than Los Angeles County or other surrounding communities that also are now reassigning workers to be contact tracers.

“We work very closely with them (the county)—it’s not a competition—it’s something that allows us to have a little bit better response, and then when we need to, we partner with the county,” Modica said.

Contact tracers in Long Beach use phone calls and log data into a digital and confidential platform called California Connected, signing on as one of the first jurisdictions to use the new technology. The city does not use mobile phone technology to track an infected person or their contacts’ whereabouts.

“This type of work saves lives, no doubt about it,” Modica said, explaining that whenever the city declares an emergency, workers may be reassigned to critical functions, especially from departments where—during coronavirus shut downs—fewer people were needed, for instance at the Long Beach Public Library or Long Beach Airport.

“This (contact tracing) isn’t the only area where we are reassigning staff,” he said. “We have staff that are now manning our homeless shelters. We have staff doing the testing sites. For awhile, we had all of our lifeguards doing testing, and now the lifeguards are back on the beaches…

“It’s the whole city pulling together trying to get the critical operations done.”

In this file photo from April 26, 2020, workers are conducting patient interviews and case followup at the Long Beach health department’s operations center. Photo by epidemiologist Nora Barin.

It’s unclear how long employees will remain reassigned, but lead contact tracer Teresa Ayala-Castillo said the Health Department is bracing itself for any impact that lifted stay-at-home orders may have on their ability to trace the virus.

Thus far, she said tracing has been somewhat simple because people have mostly sheltered in place; they know who they’ve been in contact with and can easily provide phone numbers. But with people returning to work, the process is quickly becoming more complicated as each infected person interacts with more people who must be contacted and may be asked to isolate or get tested. If those contacts also test positive, a separate new case is opened.

“Now that everybody is out and about, the job is going to get more difficult,” Ayala-Castillo said. “We are definitely revamping because we were focusing more on calling just cases because people were just staying home … it wasn’t contact tracing like this.”

She noted that, to protect patient privacy, contacts are only informed that they may have been exposed. They are not told who they came into contact with or where the exposure may have occurred. Most are notified by phone, but if their number isn’t listed in available databases they may be sent a notification by mail; if a contact lives outside of Long Beach, the city will communicate that to the correct jurisdiction.

“You are calling them completely out of the blue for the most part,” Ayala-Castillo said about reaching out to people who were in contact with someone who tested positive. “Sometimes they know they’ve been in contact with someone (infected) but sometimes they don’t.”

Ayala-Castillo was reassigned from her role as a vital records and billing supervisor in the Health Department, where she’s worked for two decades. She’s managing a team of contact tracers and calls the work a unique art form, describing the delicate balance between needing information to help prevent the virus’ spread and the needs and fears of the people learning they’ve been exposed. She said it’s not always easy to ask someone to share personal health information over the phone with a stranger.

“You have to remember to be human the entire time, and that really has been the key,” Ayala-Castillo said. “Calling folks during this scary time and making them feel comfortable is my priority one. Then once I’m able to get them comfortable and they trust me, they give me all the information I need to help them and keep their family members safe.”

In every instance there are challenges, she said, whether that’s helping a homeless person find a safe place to quarantine, providing documentation for a person to stay home from work, or connecting someone in quarantine to grocery delivery and other support services.

The work is exhausting but rewarding, Ayala-Castillo said, and she feels lucky to provide a service that she knows is helping save lives.