Slowing coronavirus requires more than robust testing. It takes a team of contact tracers to connect with people who test positive—one where IU School of Medicine's expertise in global health is crucial.
ADRIAN GARDNER is no stranger to contact tracing.
Over seven years, he worked with Kenyan colleagues to use this process to combat tuberculosis and HIV in western Kenya. Shuttling people, food and winning trust in remote outposts imparts unique experience. Today, Indiana University is drawing on Gardner’s expertise and that of the School of Medicine to halt COVID-19 on its campuses.
Gardner, MD, MPH, has been charged with overseeing contact tracing as part of IU’s Medical Response Team. This Herculean task requires hiring and training 40 to 60 tracers, managing a trove of patient data, and working with Salesforce to create dashboards that give it utility.
Fortunately, Gardner could look in-house to the faculty and staff who power AMPATH, an IU-led consortium of a dozen American universities partnering with Moi University and Moi Teaching and Referral Hospital in Kenya.
“We had a little bit of extra capacity because a lot of faculty normally based in Kenya were back here in Indiana,” said Gardner, associate dean of global health and director of the IU Center for Global Health.
The tracing mission is part of IU’s mitigation effort. In August, students moving into on-campus housing needed to be COVID-free. As the school year has unfolded, each of the university’s campuses has carried out testing among its students, faculty and staff.
Once a person tests positive, they’re funneled to IU’s tracers. Over a phone call, contact tracers try to ascertain close contacts, defined as people within six feet of a positive case for more than 15 minutes. They direct the person who tests positive to isolate and the close contacts who are exposed to quarantine.
During an outbreak, time is an essential commodity. In the case of coronavirus, its value has grown. “The duration and rapidity with which you have to find contacts are much, much quicker with this disease,” Gardner said.
Tracking them down on IU campuses means the university has ample information—phone numbers, home addresses, email addresses, and class schedules—at its disposal. If a student lives in a dorm, a residential advisor can knock on the door if they don’t answer the phone.
But it doesn’t mean there weren’t early snags. As the program was on-boarding tracers in late August, active cases surged on the Bloomington campus, creating a backlog. “We got a little bit underwater,” Gardner recalled. “For close to a week, we were behind in reaching out.”
The spike underscored the challenge of controlling spread in a college environment. Many students live together, making transmission of the virus easier. Their views about testing positive poses another complication.
“Some of them see getting the infection as getting it over with,” Gardner said. “Healthy young people who get this infection rarely get that sick, and then they have 90 days in which they are no longer susceptible, so they don’t have to quarantine. They don’t have to face any more testing. This interpretation is understandable. But it poses a challenge when we are trying to keep everyone on campus safe.”
Convincing a person to isolate, whether in Kenya or Indiana, also requires a similar approach.
Isolating a person means giving them ample support. In Bloomington, students who reside on campus but test positive spend 10 days isolating in Ashton Residence Center. They live in a single room. Meals are brought to them. They have reliable internet access to attend class virtually. And there’s ready access to health and mental services.
Tracers play an essential role, too, in helping a student with a positive test accept the temporary move. “Let me help you think through whether it’s safe for you to go home,” Gardner said. “We have to guide them through that process.”
There’s also a tension between protecting the public and upholding a patient’s privacy. In Kenya, Gardner and his staff have remote access to an electronic medical record. Yet they have to be creative to share and consult on data, sometimes using an encrypted chat application to discuss treatment.
Salesforce, which supplies IU’s customer relationship management system, helped work around those issues. Data, provided in part by contact tracers, populates dashboards that provide useful metrics to Gardner and his colleagues. With several clicks, they can access the data they need.
The platform also automates some helpful processes. For example, environmental services have a dashboard to track where a positive individual has been on a campus. “If they’ve been there within the last 72 hours, they send a special cleaning team,” Gardner said.
Underlying any system, though, are skilled tracers. Backgrounds can run the gamut. At IU, a tracer might be an undergraduate student, a doctoral student in anthropology, or a furloughed IU employee.
Each receives more than six hours of training, but the essential skill—the ability to build a quick rapport just comes naturally to some people. If they do their job well, they’ll obtain names, contact information, and move down the list. Modest as it seems, it’s also the last line of defense.
“The case has already happened, right?” Gardner said. “The fire’s there. We want to prevent the forest fire.”