If contact tracing workers and volunteers in the Ypsilanti area could get one message across to the public, it would be, "When we call, please pick up."

"And if you don't answer your phone, we'll leave a very specific voicemail," says Betty Beard, an Eastern Michigan University (EMU) nursing professor emeritus.

At age 71, Beard is officially retired but still teaches a few classes virtually for EMU. In her spare time, she is a volunteer contact tracer with the Michigan Department of Health and Human Services (MDHHS).

She says she's just one of an "army of volunteers" calling on COVID-19 cases for MDHHS. Additionally, the Washtenaw County Health Department does its own contact tracing for COVID-19 cases.

"Contact tracing is something health departments do for infectious disease all the time," says Susan Ringler-Cerniglia, communications and health promotion administrator for the health department. "What's going on with COVID is that a lot of people are hearing about it for the first time because of the volume and the fact that it's a pandemic."

While MDHHS staff and volunteers are currently doing COVID-19 contact tracing for most of the state of Michigan, Washtenaw is one of five counties doing their own COVID-19 contact tracing. Ringler-Cerniglia says this is because the health department had been expanding its capacity for contact tracing early on, before the state system and volunteer network was up and running. The county currently has more than 30 staffers working on either case investigation or contact tracing, and just added six to the team in November.

"It wasn't so much that we decided not to use that system as it wasn't ready soon enough, and we had to do that work," Ringler-Cerniglia says. "We reassigned and trained up new staff and created that capacity in-house to handle the volume."

She says Washtenaw County considered using the statewide volunteer network but found that keeping the task in-house made it easier to identify clusters.

"When multiple people are doing this, you start to see patterns and connections," she says. "That's sometimes how we identify clusters or related outbreaks, through documentation and teams talking to each other."

Beard says that while most people she calls are cooperative, some hang up the phone or are openly hostile. She thinks it helps to demystify the process so that people understand what's happening, what information is confidential, and why contact tracing is so important in controlling the pandemic.

"At 71, I can no longer provide direct patient care," Beard says. "But I can honor the frontline nurses by helping to try to keep the numbers of COVID patients lower through my volunteer work as a contact tracer. It is out of respect for all frontline health care workers that I keep signing up for shifts."

It's important to note that contact tracing has two parts, Ringler-Cerniglia says, starting with the case investigation team. That team, mostly comprised of nurses, calls someone who has been identified as a positive case to check on the person's health and to make sure the person is getting treatment and has the ability to isolate themselves. The team member then asks the person which people they were exposed to without a mask for 15 minutes or more, starting two days before they started showing symptoms, or two days prior to testing positive if they don't have symptoms.

That list of contacts goes to a team that does the second phase of contact tracing.

"The contact tracing team then reaches out to each of those individuals and helps them understand that they've been identified as potentially exposed and provides instructions about what they should do," Ringler-Cerniglia says.

The most important step is a 14-day, non-negotiable quarantine period.

"One thing we're working hard to emphasize is that folks cannot test their way out of quarantine," Ringler-Cerniglia says. "A lot of time their first reaction is to run out and get tested, and if they're negative, then believe they're done with quarantine. It doesn't work that way, because the virus can take up to 14 days to make you sick."

As a volunteer contact tracer, Beard makes sure that everyone she contacts has the resources and information they need, including a work exemption letter if necessary.

Beard says calls with parents of young children are some of the hardest and most complicated. She often spends more time talking to those families.

"If you have a 4-year-old who is in quarantine because they were exposed at daycare, you don't not hug and kiss them. That goes against every nurturing concept you've got," she says.

Beard will work with the parents to decide which one might quarantine with the child so the other spouse can continue to go to work.

Beard says most of her calls are "really great," with the exception of eight or nine uncooperative people out of the approximately 1,500 calls she's made.

"But even with the handful that started out negative, by the time we finished, we had a pretty good conversation," Beard says.

Ringler-Cerniglia says the majority of people contacted through the health department's contact tracing team are happy to talk to a nurse.

"They are appreciative that someone is checking on their health," she says.

More information about local contact tracing procedures is available on the Washtenaw County Health Department website.

For more Concentrate coverage of our community's response to the COVID-19 crisis, click here.

Sarah Rigg is a freelance writer and editor in Ypsilanti Township and the project manager of On the Ground Ypsilanti. She joined Concentrate as a news writer in early 2017 and is an occasional contributor to other Issue Media Group publications. You may reach her at sarahrigg1@gmail.com.

Image courtesy of Washtenaw County Health Department.