Diversity Among Disease Detectives Key to Containing the Coronavirus

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When contact tracer Eric Chan calls people who have been exposed to the coronavirus, he often speaks to them in Cantonese to build trust.  (Stan Gabriszeski)

At the same time Eric Chan started training to become a contact tracer, he also started tuning in to Chinese-language news on TV.

He wanted to brush up on his Cantonese, especially the medical terms for the pandemic, so it would be easier to talk to people who weren’t comfortable with English, especially those who might assume his call is a scam.

“Quite often, just speaking that language directly, instead of having the interpreter on the line, it helps a lot with the communication and the trust,” he says.

Normally, Chan works as a financial analyst in the San Francisco Assessor’s Office. Now, he is one of 73 city employees, including librarians and paralegals, who have been trained as contact tracers to notify people when they’ve been exposed to the coronavirus and ask them to stay home for two weeks to prevent further spread. The city has focused on recruiting people who speak multiple languages in an effort to reach communities of color that have been hardest hit by the virus.

Nearly half the people who have died from COVID-19 in San Francisco are Asian American. Statewide, Latinos account for 54% of coronavirus infections even though they make up 39% of the population.

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“COVID is a disease that has disproportionately affected certain racial and economic constituencies within our society, and we wanted contact tracers that represent those groups,” said Mike Reid, an infectious disease physician at UCSF who is leading a program to train 20,000 new contact tracers across the state.

Early on, Chan noticed the potential for some things to get lost in translation. The main work of contact tracers is to inform people when they need to quarantine or isolate themselves to stop the chain of transmission of the virus.

But in Cantonese, the words for quarantine and isolation, are the same word: “Gaak-lei,” which roughly means “separating from others,” Chan says.

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Quarantine is for people who’ve been in close contact with someone who’s sick and are asked to stay home in case they develop symptoms.

Isolation is for those who know they’re sick and have to isolate themselves in a separate room within their home to protect their family.

Chan describes himself as very detail oriented – he normally spends his days in the tax assessor’s office carefully reviewing spreadsheets – and he wanted to get this right. So he called his colleague, Vivian Po, who also speaks Cantonese.

They decided every time they translated each word, they would give the definition, too.

“We're very used to explaining tax code to taxpayers, so our tendency is to go specific,” she said, “to make sure not just to say the terms, but also explain what they are.”

It’s important to find contact tracers who have not only language skills, but who understand cultural customs, says Jon Jacobo with the Latino Task Force for COVID-19.

Take the common polite response among Latinos when you ask, “How are you, do you need anything?”

“The first answer is always, ‘Oh, no, no, I'm good. I don't need anything,’ ” Jacobo says. “But if you pry a little more, you get the real answer, which is, ‘You know, actually, maybe.’ ”

This is important, he adds, because people may need help getting groceries or medications in order to stay home, or they may need to stay in one of the city-funded hotel rooms if they live in close quarters and can’t adequately isolate themselves from family.

“The more we can have people that know these sensitivities and can connect with people, the more we're going to get accurate information and accurate data, which helps all of us, because then we can truly begin to track down and mitigate the spread of COVID,” Jacobo says.

California is running public service announcements in English and Spanish that emphasize help is available for people who test positive and anyone they’ve been in close contact with. This is a first step toward getting people to answer the phone when contact tracers call.

Most of the calls Jazmin Flores makes are to people who only speak Spanish. Flores is usually an administrative assistant at the San Francisco City Attorney’s Office, but she began training and working as a contact tracer after shelter-in-place orders took effect and she was furloughed. She has a lot of experience working at the front desk, with people barging into City Hall who are upset, desperate for help or just lost.

“You just never know who’s going to walk in the door, and it’s your job to get information and pacify them, whether they're supposed to be there or not,” Flores says in her slow, soothing voice. “I'm really happy to have those tools to help me in this.”

Some people she’s called have been worried about revealing their immigration status and get nervous when she asks things like, “Who's living with you? Where do you live?”

“Some people might not want to share all of that information,” she says.

While she never forces anyone to share what they don’t want to share, she reassures them nothing they tell her will go beyond the local public health department.

“You just let them know that this is all confidential and it's just to help you and to help others and to help try to resolve this situation and stop it from getting worse,” she says.

Overall, most people she’s called have been very receptive. So far, San Francisco contact tracers have reached 91% of people they try to call, and program leader Reid says the overwhelming sentiment is positive. In Long Beach, disease control officials estimate fewer than 1% of those contacted refused to participate.

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“I'm actually quite surprised at how open they can be and how they actually kind of feel like chatting,” Flores says. “I feel like we're just chatting about them and how they're doing and their family.”