In Search of 20,000 COVID-19 Contact Tracers, California Taps Local Librarians, Tax Assessors, City Legal Staff

After more than two months at home, librarian Lisa Fagundes misses managing her sci-fi book collection so much, she feels like she’s in withdrawal, longing to see new books, touch them, smell them.

“It’s like a disease,” she says, with a laugh.

Instead, while libraries are closed, Fagundes is one of dozens of librarians putting her skills to use as a contact tracer, calling people who have been exposed to the coronavirus and asking them to self-quarantine at home so they don’t spread it further.

Librarians are an obvious choice for the job, says Fagundes, who normally works at the information desk of the San Francisco Main Library. They’re curious, they’re tech savvy and they’re really good at getting people they barely know to open up.

“Because a lot of times, patrons come up to you and they're like, ‘Uhh, I'm looking for a book —’ and they don't really know what they're looking for or they don't know how to describe it,” she says.

Or they’re teens afraid to admit out loud that they’re looking for books about sex or queer identity. Fagundes is used to coaxing it out of them in a calm, nonjudgmental way. It’s the same with contact tracing: asking people about their health status and history.

“Talking about sensitive subjects is a natural thing for librarians,” she says. “It’s a lot of open-ended questions, trying to get people to feel that you're listening to them and not trying to take advantage or put your own viewpoint on their story.”

Fagundes is part of the first team of contact tracers trained through a new 20-hour virtual academy led by UCSF. California awarded the university an $8.7 million contract this month to expand the academy and train 20,000 new contact tracers throughout the state by July, one of the largest such efforts in the country. Gov.Gavin Newsom has said counties need 15 contact tracers for every 100,000 residents to adequately contain the virus after shelter-in-place orders are lifted. Nationally, experts have estimated the U.S. needs between 100,000 and 300,000 contact tracers.

With many people staying home in recent months, counties that haven’t yet built their contact-tracing teams to pandemic levels have generally been able to manage caseloads. Each new person who tests positive for COVID-19 has been in contact with an average of four or five people while infectious — usually family members and neighbors — according to local health officials. But as counties begin allowing businesses to reopen, a person’s average contacts will go up to 40, necessitating a larger team to identify and call them.

“You have a four- or five-day window to find people and get them isolated, which is what we do instead of treat them because we don't have treatment for COVID,” says George Rutherford, a professor of epidemiology at UCSF who’s been leading the training effort.

Librarians, Tax Assessors, Paralegals

The new training program takes place over the course of five days and involves lessons on epidemiology and motivational interviewing, and demonstrations of contact tracing phone calls. In addition to librarians, San Francisco has been asking government employees from county tax assessor and city attorneys’ offices to help out, including financial analysts, paralegals and investigators. Some rural counties have also been recruiting sheriff’s deputies for the job.

“The major qualification is being able to talk to people,” Rutherford said. “In other states they love to pick up people who worked as airline reservation agents, because they're used to talking to people all day long and trying to work things out for them.”

Megan Elliott is used to having conversations where she has to tell people things they don’t want to hear. She is a manager in the San Francisco Assessor’s Office, where she oversees the valuation of real estate to figure out how much tax to charge.

“For residential properties, a lot of times it has to do with a property owner who believes that we unfairly valued their new construction project,” she says. “So my job is to communicate to the taxpayers in a way that they can better understand why we do what we do and to help them see the reason and rationale behind that.”

It’s the same idea with contact-tracing phone calls — telling people they can’t go to work for the next two weeks because they were in contact with someone who tested positive for COVID-19. Similar to parsing tax code over the phone, and empathizing over how the tax laws sometimes seem unfair, she explains the importance of protecting the community from the virus, or the difference between quarantine (staying home if you've been exposed but aren't symptomatic) and isolation (avoiding family members within your home if you are symptomatic).

Investigators from city attorneys’ offices have been really helpful applying their people-finding skills, says Rutherford from UCSF. Some people who become ill may be reluctant to share information about their close contacts or just don’t know the full names or contact information of people they’ve been with in close quarters.

“Let’s say you’re on a job site, working construction and you had lunch with a guy, ‘Oh, it’s Bob, he’s a steam fitter,’ ” says Rutherford. “That's the kind of thing that we’re facing, that we get partial locating information.”

City investigators are familiar with databases and electronic gumshoe strategies for finding Bob’s last name and phone number, he explains, so he can be notified and get tested.

County-by-County Effort

The program’s goal is to train contact tracers to serve all 58 counties in California, but the state is leaving it up to each county to decide how to roll out their own programs and what kinds of support services they will offer to people asked to self-quarantine.

In San Francisco, for example, when people who may be infectious are asked to stay home, contact tracers give them referrals to get tested and offer free cleaning supplies and help with having groceries and medications delivered. If they can’t isolate themselves safely from other family members in their home – a common occurrence in San Francisco where the high cost of housing often forces multiple family members to live together in cramped apartments – they have the option of staying in a city-funded hotel room.

San Francisco is also launching a program to help replace two weeks of lost income, up to $1,200, for people who test positive and don't have paid sick leave or cannot access unemployment insurance benefits.

“At a societal level, it's a bargain to not have X-more coronavirus cases for the cost of a week or two of wages,” says Rutherford. “It’s a pretty good deal.”

What other counties offer will depend on what they have the funding, and the will, to provide. Most counties have barely begun ramping up their corps of contact tracers.

South of San Francisco, in Santa Clara County, where the first COVID-19 cases in the U.S. were identified, health officials have struggled to recruit enough librarians and other county employees to become contact tracers and are now asking for 800 volunteers from the community to meet their goal of building a 1,000-person team.

Other counties may also need to turn to volunteers, especially since it’s unclear what will happen when government offices eventually resume full operations. In San Francisco, some city attorney office staff have been told they will go back to their regular jobs part time and continue contact tracing work, but they don’t know when that might be. Communication from the city has been “muddled,” says Fagundes, the San Francisco librarian, who’s been doing four four-hour contact tracing shifts per week.

“It’s something that I feel like I could do for the rest of the year, if needed, then when the library starts ramping up, I could do both,” she says. “I think that the library will not be ramping up to full service anytime soon, because it's not an essential service – as much as we may disagree.”