Perry Roth-Johnson (00:00):
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Perry Roth-Johnson (00:18):
Hello! This is Ever Wonder? from the California Science Center. I'm Perry Roth-Johnson. So I'm proud to say that I'm now halfway vaccinated! But remember before we had COVID vaccines available? We relied solely on other tools, like physical distancing and wearing face masks, to slow the spread of the disease. Another important tool we've used that you might be less familiar with is contact tracing. This is when public health workers call people who test positive or who have been exposed to COVID-19 and ask them to isolate to stop the spread. Now on paper, this sounds straightforward. But in practice, it's a lot messier. Getting a phone call from a stranger that you might have COVID can be really scary. And being the person who makes that phone call can be stressful, too. Do you ever wonder what it's like to be a contact tracer? Early in the pandemic, many state employees were recruited to be contact tracers. This included our very own curator, Kenneth Phillips, who has spent most of the pandemic as a contact tracing supervisor at the LA County Department of Public Health. He joined us on this episode to tell us what it's been like for him and his team for the past year. Take a listen.
Perry Roth-Johnson (01:54):
Dr. Kenneth Phillips, you are a contact tracing supervisor currently assigned to L.A. County Department of Public Health. And you're also a curator of aerospace science at the California Science Center. Ken, welcome to the show.
Kenneth Phillips (02:05):
Oh, thanks Perry. It's great to be here with you.
Perry Roth-Johnson (02:08):
Yeah, so Ken, I know you know, I've worked with you for years at the Science Center, but this has been an unusual year and it's probably an understatement. As a curator at the Science Center, you were also a State employee. And so you were reassigned from being a curator to join the fight against the pandemic as a contact tracer. Can you just describe how contact tracing works and why it's useful?
Kenneth Phillips (02:31):
Okay. Yeah. Contact tracing is an effort to get ahead of a disease before it spreads to other people. And what you do is you identify people who already have the disease that you're curious about in this case—obviously it's COVID-19—and you call them up because you know, they've been identified as having it. And you asked them if they could tell you other people with whom they've been in contact. And those contacts may or may not have the disease, and you don't know that. And so what you try to do is call all of them as, as you can and ask them to quarantine so that they don't further spread the disease to others.
Perry Roth-Johnson (03:05):
And just briefly, like why should people participate in contact tracing if they get a call from folks like your team?
Kenneth Phillips (03:11):
Well, if I'm calling somebody, what I'm trying to do is help them understand that we're trying to do what we can to protect them and families and ultimately their communities. And so what we're trying to do is build a rapport and a trust and get people sort of get on board with the fact that the spread of a virus is largely, at least in this particular case, in the hands of people who choose either to cooperate or not. And if you take the call seriously, and if there are no reasons, no incentives for you not to participate like fear, and there are reasons for which people don't choose to participate. But if you can convince somebody to participate, then basically you drastically reduce the rate at which the virus spreads from person to person.
Perry Roth-Johnson (03:54):
You're ultimately trying to slow the spread by convincing as many people who are willing to, you know, to cooperate with your ask to isolate or quarantine.
Kenneth Phillips (04:02):
That's right. I like to put it this way. Um, Perry, I like to say that what we're trying to do is outrun the speed of the virus by the phone calls that we make. And so if we can get ahead of the virus by about 48 hours, because that's the length of time it takes before it shows itself. So one could be potentially capable of spreading it, but you wouldn't know it for 48 hours. If we can run that gauntlet and beat that virus down to that 48 hour mark, we have a chance to actually stop it, if we could. If everybody would cooperate in principle, that's how it works.
Perry Roth-Johnson (04:31):
Can we just talk about the nuts and bolts of, um, what happens when either people on your team or you yourself, you know, had to make a call? Like what, what steps are you taking to protect people's privacy and try to reassure them, uh, explain, explain how this process works. Like once someone gets a phone call from your team,
Kenneth Phillips (04:54):
Okay. So what happens is we've got a database that tells us all the information that we need to know about the person's contact. First and last name. We've got their date of birth. We've got a number of things that allow us to verify who they are once they answered the call. If in fact they choose to answer. And so the protocol is that we try people three times a day for three consecutive days. And once we get a hit, once somebody answers the phone, we immediately identify ourselves, say that we're from L.A. County Department of Public Health. And before providing any information or suggesting anything at all, we say, "May I kindly speak to Dr. Perry Roth-Johnson", for example. And, you might say, "Yes, who is this calling? And why are you calling me?" And I would identify myself and give my call back number and say, "I'm calling you with a very important health message, but I'd like to make sure that I'm speaking to the right person." I would ask you your day, your um, the spelling of your name to make sure I have that correct. I'd ask you to verify your date of birth, and I'd ask you to verify your address. Um, and I would ask to volunteer that information to me, and then I can certify that, in fact, it's correct. And I might have to meet you halfway. I might say, "Would you give me the address that you have on, I have you at main street? What would be the confirmation? What would be the confirming address?" And that way we're working together to make sure that you are, who, who, who I think you are. And then I would notify you, um, about the status of your COVID-19 tests. You may or may not have already known about that. And then we would have a conversation that lasts about anywhere from 30 minutes to an hour, depending on the number of questions that your answers suggest that I need to ask. So if you were to identify let's say five people with whom you had been in contact, I would ask you for as much information as you can provide me on those five. And so each of those people would be a new contact record that I would generate.
Perry Roth-Johnson (06:54):
Got it. So you start with this database of known positive cases of COVID-19 and it sounds like your team's job is to take those cases, interview them and produce a new list of contacts that they may have interacted with around the time of their positive, um, infection.
Kenneth Phillips (07:17):
That's correct. And then in addition to identifying the contacts, we were trying to give the cases some guidance on how they can protect themselves and their families. And not all people are, have the resources to quarantine themselves for a period of 14 days. It's not a trivial thing to do depending on your financial situation. And so we have a list of resources that we can refer them to and a lot of it has to do with in many cases, comforting people who are quite distressed about what it could mean to their jobs and are their family members going to get sick if they have elderly people in the family that simply need to be cared for, and there's no other alternative, how do we do that? So we refer them to food delivery services, and there are places where they can get medical attention in anything that we can possibly do to incentivize them so that they comply with our requests for quarantine and isolation. This is what we're prepared to do. Yeah.
Perry Roth-Johnson (08:09):
And that's a big ask. I mean, I'm glad you brought that up, that not everyone is in a position to do that. Um, can you speak a little bit to some of the most challenging parts of being a contact tracer?
Kenneth Phillips (08:21):
Let me answer the question two ways. When it comes to making an actual call, the most challenging part, quite frankly, is convincing somebody that you're not a scam artist and that you are really there not in any way to compromise them or to deny them any services whatsoever. You're there to help them. That's all you want to do. And you're there to inform them about what this virus is, what it can do. And you're there to explain to them that they are empowered to really help their communities. That's the hard part, getting your foot in the door, as it were. And then once you're there and you're having a with them, no two conversations are the same and some people are so ill, they can barely manage to speak with you. Others have kind of a flippant and dismissive attitude about the whole thing. Most fortunately do not, but some do. And so the idea is to kind of feel your way through the interview as it goes on, because you don't want them to kind of put you out of the house as it were. You've got your foot in the door and you want to convey this information. And the other part of it is how you ask information that has to do with divulging people with whom they've been in contact as well as workforce information, because a lot of the contacts are normally be in the workforce. You and I, for example, are at the California Science Center. And there are hundreds of people that are on our team and we could principally identify either of us 10 or 20 of them from any given day. So how comfortable are you going to feel doing that?
Perry Roth-Johnson (09:50):
Kenneth Phillips (09:50):
What's that going to do to your, uh, you know, your rapport with, with your employer and things like that. And many people work for, um, very small kind of mom-and-pop operations. So you might have somebody who is a professional gardener, and that person is on a small team. And that team is compensated only as a function of the work that they do. So if you're asking somebody to isolate 14 days, there is a direct impact on the inflow of income to their families. And so that's the hard part. Now, the hard part, if you step back and don't talk about it in terms of, of individual interviews, but if you look at the number of interviews that you have to call in a day and you figure out that each one is to say, roughly, let's say you get lucky. And each of those interviews is about a 30-minute interview with a 15-minute prep, and then a 15-minute summary just to make sure the data is accurate. You've got really one heck of a day ahead of you. You're doing nothing but calling people and trying to convince them to do something they'd rather not do. They don't want to hear from you because it involves the illness and it's just repetitive. It just doesn't let up.
Perry Roth-Johnson (10:57):
Kenneth Phillips (10:57):
Yeah, it can be. And I really do everything that I can as a manager to be supportive of my team, not only to support them in, in terms of the research I can do to help them, but also in terms of continually reassuring them, that the work they're doing is just tremendously worthwhile. And the fact that they can't measure a success rate, that is to say, there is no head count that we can divide people into. This one behaved and this one didn't. This one saved two or three lives because they quarantined when we asked them to. Because we don't have the ability to quantify that, does not mean we're not effective.
Perry Roth-Johnson (11:35):
Do you have some data right on, you know, of the people you call, how many typically will pick up the phone and cooperate. Can you give us a sense of that data?
Kenneth Phillips (11:46):
Sure. Right now, well unless there's a surge, and we can talk about that later if you're interested. Unless there's a surge, about 60% of the people that we'll call are cooperative. And I'm assuming that of those 60%, I'm going to give them benefit of the doubt and say 90%, maybe 95, I don't know, will actually follow through with the things that you've asked them to comply with. They will indeed quarantine or isolate. There are 40% that will not cooperate with you. A third of them really want to, but they feel that they can't because it's a financial burden if they do. A third of them, don't want to, because they are fearful of it. And then about a third of them don't think it's a thing at all so they've dismissed the entire notion of there being a pandemic that we need to worry about. And that's how that 40% breaks down into those three categories that I mentioned. Roughly.
Perry Roth-Johnson (12:36):
Did you and your team's work change throughout the course of the pandemic? Like, was it different during this especially awful surge we had during the winter of 2020?
Kenneth Phillips (12:45):
Yeah, it really was because what had happened was people were hoping... Remember people had been at this since July and they hadn't taken vacation and they hadn't been with their families to any appreciable degree. And it was something that we were bracing for, but when it hit, it hit like a tidal wave because the number of cases were so large that people were unable to take the family time that they would normally take. And instead of having an average of, let's say six or seven cases per day, which would be ideal, I was assigning to some interviews as many as 20 cases per day.
Perry Roth-Johnson (13:20):
Kenneth Phillips (13:21):
And so what that meant was the quality of the interview drops dramatically because instead of the protocol whereby you call somebody three times a day for three days, we ultimately wound up scaling that back so that we were making one call to one person every day. And either we got a hit or we didn't. And of course the success rate in terms of the calls completely went down, dramatically so.
Perry Roth-Johnson (13:46):
So it was 60%, you know, before this winter surge, roughly what was it during the surge?
Kenneth Phillips (13:51):
It had gone down as low as 30% and came up to about 40%. Yeah.
Perry Roth-Johnson (13:57):
And this was lasting for what? Like a month.
Kenneth Phillips (14:00):
About a month. Yeah. Yes. And it peaked, it was kind of like a normal distribution. It's kind of Gaussian, you know, it started off slow. We knew it was. And then it just ramped up and ramped up and, I think in one evening I assigned something like a thousand cases.
Perry Roth-Johnson (14:13):
You assigned a thousand cases?
Kenneth Phillips (14:15):
I assigned a thousand cases to five managers, myself included.
Perry Roth-Johnson (14:18):
That's an unbelievably large number.
Kenneth Phillips (14:20):
Yeah, that's right. And an interesting thing happened. Um, we, we noticed a change from there being few contacts that people were willing to divulge to everybody in the entire family being infected, the children, the grandmothers, the moms and dads, the entire households were infected by this thing. And there was very little to report outside of the household. And so what that meant was that people were finally getting the idea that quarantining was a good thing, but by the time they did that, everybody in their household had it. So it's almost like everyone had transmitted the disease across the boundary of their own dwelling and it was all inside and everybody was affected.
Perry Roth-Johnson (15:04):
Right, right. I mean, you're reminding me of other conversations that we'd had, um, with other public health experts. That in L.A., in particular, but this is general across California and in many regions of the US, A lot of folks live in what's considered overcrowded homes, or they live in multi-generational homes.
Kenneth Phillips (15:27):
Perry Roth-Johnson (15:27):
And if you get a positive case and you ask someone, can you please isolate? They say, "Where? Like, I do you know what my living situation is like?" And so that was another driver of inequity that we just had so many overcrowded homes in L.A. A lot of people were getting sick because they just couldn't have a room to themselves necessarily to isolate away from their family members.
Kenneth Phillips (15:53):
There is a difference between isolation and quarantine. Quarantine is a situation that is lesser in intensity. Quarantine is where you're asked to stay away from people, and you're not supposed to go out of your home. You're supposed to maintain strict social distancing. Isolation is more strict than that. That's when you're pretty much in principle, you would be, you'd be put in a bubble and someone would, would make sure you were fed, you know, inside that bubble, they would slip food under your door. And then you would slip the trays back when you were done. And of course you'd use restroom facilities that would be completely, um, sterilized and washed down after each person used it. So it's a much stricter way of preventing the spread of the disease. And it's more, it's much more difficult to your point to comply with. That's hard to do. And that's why, that's why I think it became just such a rampant, uh, rampant thing among families. I mean, everybody was infected within a household. It was a really stunning thing to see.
Perry Roth-Johnson (16:47):
Uh, I'm just curious, like, looking back over the past many months, when did you see major changes in how fast the virus was spreading?
Kenneth Phillips (16:56):
I saw major changes, um, I saw a blip in July of 2020, because that was very early on. We onboarded formerly on July 1st. Then of course, July 4th came right there. They usually have a two-week time period anywhere between two to three weeks where you you'll actually see, um, the time delay that's associated with a surge because it takes that much time before it manifests and people begin to social symptoms. And then we saw a minor increase, a bump that was kind of a warning on the radar as it were around Halloween, and then not so much on Veteran's day, but a little bit. Um, and then we really braced for impact on Thanksgiving, and it was much more than any of us anticipated. And the Thanksgiving, Christmas and New Year's holidays were what really brought everything to pretty much a screeching halt in terms of our ability to actually get our arms around it. And then starting February, I'd say about mid-February, we were waiting for a possible bounce again, but we didn't get it, fortunately. And there's been a precipitous decline since then. Actually there has been a slight increase in cases, but I don't know that it's statistically significant anyway. So, you know, we're running, I'm assigning maybe to my own team, maybe a dozen cases in a day. These are new infections.
Perry Roth-Johnson (18:14):
That's significantly lower than like, what was the most you assigned in one day during the winter search?
Kenneth Phillips (18:20):
Oh to my own team?
Perry Roth-Johnson (18:20):
Kenneth Phillips (18:20):
I would say probably, uh, about 300 cases to my own team.
Perry Roth-Johnson (18:27):
Wow. Okay. So more than, it's like an order of magnitude drop, basically.
Kenneth Phillips (18:32):
Oh absolutely, yeah.
Perry Roth-Johnson (18:32):
That sounds so difficult. Um, it brings us though to, you know, the timeframe around December and January when the first vaccines were getting authorized for use in the US. But it did take a little while to distribute them and start getting them into arms as we're recording this this week though, uh, everyone ages 16 and up became eligible to make an appointment to get vaccinated, um, in California. So has that changed your job yet again, uh, once these vaccines are becoming more widely available to Angelenos?
Kenneth Phillips (19:08):
Changed it dramatically, because what happened was as the case numbers decreased substantially, um, our attention was turned to support the vaccine. And what we do is we call people and, um, that call list begins with closed cases and closed contacts that we already have in our database. And so what we're doing is we're going back through the same database that we created with the cases and the contacts and recalling those people. And we're saying, yes, even though you've already had it, we're not going to suggest that you rely on the antibodies to get you through. We'd like you to get this vaccine and we'll do whatever we can to match you with the kind of vaccine that you want. Our recommendation is that the one that you're offered is the best one to go with. But if you insist that we will do what we can to support it.
Kenneth Phillips (19:58):
And the only prerequisites are that you'd be a resident of L.A. County right now, we are still working on the 65 and over, at least on my teams, um, criteria. And that you have not had a first vaccination, uh, prior to this one, you do need your own transportation. And so that's what we try and do. So, so our workload has shifted again, it's increased dramatically, but it's increased, um, in a different way because we're asking people to not do something that is too difficult for them to do. All they have to do is be willing to show up and get the vaccination. And it might be a little scary because you get a needle and, you know, some people have had adverse reactions, some people not. But the nature of the fear that people are experiencing is very different than it was when we're asking them to please isolate so that they don't spread something that they've already got to other people. It's a very different psychology.
Perry Roth-Johnson (20:49):
Right. You're basically offering them something hopeful instead of something scary.
Kenneth Phillips (20:55):
That's exactly right. Yeah. And we're doing everything we can, again, to provide the resources so that they can do that. The idea is sort of minimizing the number of roadblocks so that people are incentivized to do what you're asking them to do.
Perry Roth-Johnson (21:05):
And just to be clear, like you're not just calling them to encourage them to make an appointment. You're actually helping them make an appointment?
Kenneth Phillips (21:13):
We're actually making the appointment. Yeah. We've got access to several digital databases that show us where Rite Aids are all over the state. And so we will go through those and work with them for as long as we need to by telephone. And then if there is no vaccine available immediately, then we put them on a waiting list. And then they are called by a separate agency. They would be called by the people at Rite Aid once the day rolls around where there was an appointment available. And then the negotiations would take place between, um, the individual who we've asked to get vaccinated and the, uh, the place that's actually going to do it.
Perry Roth-Johnson (21:46):
What's your take on good ways to encourage people, you know, to let you make an appointment for them to get vaccinated. Like how are you trying to reassure people and build their trust in vaccines?
Kenneth Phillips (21:58):
Well, that's a really great question. Um, there is a separate—everything we do is by scripts, so that we can be consistent from person to person. Of course, that varies a little bit because it has to, depending on the nature of the interview. But the script basically encourages people to understand—or encourages us to help people understand—how good it is, um, for them to be consistently vaccinated across the population. It will lead eventually to what we hope is a herd immunity, um, and help them be assured as long as they continue with social practicing distances, social distancing practices, rather, which is what we encourage. It will help them to assure that we are opening ourselves again as a state. And our economy is going to come back, probably will not become roaring back. We don't, we don't sort of advertise that, but we are getting on our feet slowly, but absolutely surely, if people will comply with this. And most people seem to, many do not.
Kenneth Phillips (22:53):
We started the questionnaire about how people felt about vaccinations back when we were in the days of interviewing people who were case positive. And it's interesting because about 60% of the people said that they were definitely going to get a vaccination when they became available. Um, but the other 40% were quite reluctant to do that. Um, and in that particular case, it was because of the efficacy. Some people just didn't think it would have any effectiveness. And so why do it other people said, well, I've already had it. So now that antibodies and I'm protected from it. And then the other people said, well, I don't believe it's a thing anyway. And so I'm not going to worry about it. And so there was, I'm sorry, there was a fourth, there was a fourth, there were people who were fearful that there would be some kind of adverse effects, like the blood clotting that's been associated with the Johnson & Johnson vaccination. Some somebody will hear like that, but it's very difficult to place those numbers in a correct statistical context. So they would assume that the complexities and that the risk is a great deal more than it actually is.
Perry Roth-Johnson (23:58):
Right. I mean, I know from personal experience talking to folks, who've expressed those fears, which yeah when you look at the numbers, when it's one in a million, it's tough to put that into context. If you have, you know, a real, honest human reaction of, of anxiety. Um, but it's important to, to try to remind folks that it's a very rare occurrence. I think with the blood clotting, you know, for example, it's literally less than one in a million, cause there were like six cases out of seven million, uh, shots administered.
Kenneth Phillips (24:30):
That's an interesting phenomenon that you're mentioning because, now that I think of it, if you were to say to somebody, "Why don't you play the lottery?" And you say, "Oh, they won't do it because they have a one in a million chance of winning, right. One in the million chance of winning it. And so they'll decline it because they'll think it's a waste of their time. And most people don't play it except for fun. On the other hand, if you tell, somebody there's a one in a million, even if it's a one in a million chance of somebody getting a disease, um, they will somehow convince themselves that they are going to be that one-in-a-millionth person that gets it and they won't do it. It's very interesting. It's a very interesting dynamic.
Perry Roth-Johnson (25:04):
As we wrap up here. I'm just curious, like, did you learn anything surprising or come to appreciate something about public health after going through this experience?
Kenneth Phillips (25:14):
I did indeed. In fact, um, I think the thing I learned most was how vulnerable we really are to things that we don't understand and how difficult it is to get people to cooperate and communicate, openly and candidly, so that accurate information moves from point to point. And for me, it seems like it's all a matter of a network of information and how one manages it and how one puts that network to work so it outruns the speed of the virus, or whatever it is you're trying to prevent. And in the case of a pandemic, which has such a global consequence. That's the problem with it. It's not localized. You know, it just knows no boundaries, except the ones that we can artificially create in terms of people's behaviors. And that's what I realized. I realized that this is all, this is a problem to a large degree of our own making. And I dare say that had we done what we had been asked to do, had we really rigorously policed ourselves, then we could have gotten a lot farther than we are right now with a lot fewer people having died. It doesn't mean that vaccines would have come along any more quickly. That would still be related to whatever timeline it related to. But we would have been in a much better position, I think, to deal with these things as a society, had we all been more cooperative and done what we were, we were trying to encourage people to do early on. That's what I truly believe. So the short answer to the questions, I think it's a fascinating study in what society needs to do in order to get their arms around a problem. That's, that's kind of elusive like this.
Perry Roth-Johnson (26:49):
Yeah. Yeah. Public health really seems like the intersection of not only science, but effective communication, uh, you know, social science to get people to change their behavior. Like you mentioned, it's just like all of these things coming together in a messy environment, and you're trying to produce clear, actionable things that people can do. Looking back on the past year, are you and your team doing anything to reflect or, you know, kind of memorialized this experience? Because it's something really hard that you guys went through.
Kenneth Phillips (27:22):
Yeah, I've actually, that's a great question. I've created something that's called a legacy project for my team. And it's a project that allows them to create whatever memories they think would help them not forget this experience. And for example, I've asked them to think about the top 10, 5 or whatever, most memorable conversations that they had. And I've asked them to think about what they would do to serve our descendants when they come along and maybe 200 years from now, or a hundred years from now, they're facing a similar situation. What would you advise them to do? What would you suggest to them that works? What should they avoid doing? Questions like that.
Perry Roth-Johnson (28:00):
It's funny. Cause, um, you know, if you look back at the public health measures we had in place during the 1918 flu pandemic, there's a lot of similarities. It's like, "Keep wearing your masks." A hundred years later, we're still saying, "Keep wearing your masks."
Kenneth Phillips (28:17):
Wear your mask. That's right.
Perry Roth-Johnson (28:18):
Well, Ken, it's been a pleasure and thank you to you and your team for all your hard work to slow the spread of COVID and keep Angelenos safe. Thanks for joining us on the show.
Kenneth Phillips (28:27):
Oh, always a pleasure. Take care.
Perry Roth-Johnson (28:30):
That's our show, and thanks for listening! Until next time, keep wondering, Ever Wonder? from the California Science Center is produced by me, Perry Roth-Johnson, along with Devin Waller. Liz Roth-Johnson is our editor. Theme music provided by Michael Nickolas and Pond5. We'll drop new episodes every other Wednesday. If you're a fan of the show, be sure to subscribe and leave us a rating or review on Apple Podcasts—it really helps other people discover our show. Have a question you've been wondering about? Send an email or voice recording to [email protected], to tell us what you'd like to hear in future episodes.