Part nurse, part detective: A day in the life of a Michigan contact tracer

Christina Zilke sits at her home office, where she spends the day calling and texting COVID-19 patients and their close contacts, who are in isolation or quarantine to prevent them from spreading the virus further. (Courtesy photo)

Christina Zilke’s first interaction with her patients is often unpleasant.

As a contact tracer with the Washtenaw County Health Department, she must ask them to relive the onset of an illness that has made them a statistic in a global pandemic.

Zilke knows how important it is to interview COVID-19 patients as soon as possible after they contract the virus. The earlier she can learn where they were and who they saw before testing positive, the faster she can reach those people and quarantine them to stop the disease from spreading.

But often, her patients don’t want to talk. They may have already been asked to provide this information to several other people. They’re frustrated and scared. Sometimes, they’re so sick that they struggle to talk.  

“It’s retraumatizing to make them think of every little place they were, who they talked to,” she said, adding that she’s learned to recognize not to take it personally if patients are rude or angry.

It’s a whole new skill set for Zilke, a nurse who until recently worked as the health department’s education and outreach coordinator. That was before COVID-19 slammed into Michigan, forcing the state’s public health system into pandemic-response mode. 

Washtenaw and other southeast Michigan counties have experienced some of the highest infection rates in the state. At one point, things were so bad in Detroit that Dr. Anthony Fauci, the nation’s top infectious disease expert, declared it to be one of the nation’s hot spots. As of Saturday morning, 1,160 people have tested positive for the virus in Washtenaw County, and 80 have died. 

In the absence of a coordinated statewide effort to conduct contact tracing, local health departments have independently decided whether to ramp up tracing capabilities locally.   

With many of the Washtenaw County Health Department’s usual activities on hold while Michiganders are under orders to stay home with exceptions only for essential needs, county health officials reassigned Zilke and many of her colleagues to serve as public health detectives.

Related: What to know about Michigan's contact tracing program

She now spends her days keeping tabs on dozens who either have coronavirus, or have come into close contact with a COVID-positive patient. Since the pandemic hit Michigan, she has traced more than 80 cases. 

The routine starts with a daily 9 a.m. conference call.

A supervisor, armed with a list of the latest Washtenaw County residents to test positive for COVID-19, begins assigning each patient to a tracer. Once they have their caseload, Zilke and her colleagues start making phone calls to the names on their list.

“Our goal,” she said, “is to figure out, when did you get sick? When did your symptoms start? What were your symptoms, and how have they progressed?”

Once she pinpoints the date the patient started feeling off, Zilke backtracks 48 hours. Then, more questions: Where did you go? Who did you see? She’s aiming to identify and then contact any person who had close contact with the COVID-19 patient before the patient entered isolation. 

Those close contacts are advised to quarantine at home for two weeks in case they, too, are carrying the virus. They shouldn’t even interact with their own family members, if they can help it. 

If they leave the house, “it’s really important that they stay masked all the time,” Zilke said, “because if they start to become sick, they’re already putting people at risk.” 

For people who have tested positive, the recommended restrictions are even tighter. Unless they live alone, they shouldn’t leave their room. Zilke directs family members to leave food at the door, then retrieve and immediately wash empty dishes. This routine continues until the patient’s symptoms have disappeared for at least three days. 

That’s easy enough for patients who live in homes with ample room to isolate. But what about those who share a single bathroom with family members? What about those who are responsible for taking care of someone in their household? Or those who have no house in which to isolate? For them, isolation may be impossible.

“At that point,” Zilke said, “it’s really important to talk to them about how you clean the bathroom after using it.” 

She’s trained as a nurse, but Zilke has learned that as a contact tracer, she must also often act as a de facto social worker, emotional support coach and advocate for her patients.

With Zilke and her colleagues’ help, some homeless patients and others with no way to isolate at home have checked into a local Red Roof Inn. Once they’re isolated, Zilke checks in on her patients every couple of days to ask them how they’re feeling and whether they need any assistance. 

With a current caseload of 40 people, she has to write names on a homemade calendar to make sure nobody falls through the cracks.

In addition to monitoring their symptoms, Zilke and her colleagues connect their patients with help fulfilling daily needs, from restocking their groceries to filling prescriptions.

And they coach them through the grueling mental and emotional experience of prolonged solitude. One of Zilke’s current patients was in the hospital for four days, then forced to isolate at home for more than a month as his symptoms lingered.

“It’s very hard for him, but also his family members,” she said, who must resist their instincts to help and comfort their suffering loved one. 

The job is also hard on the tracers. Sometimes, patients die, leaving behind sick family members who must wrestle with grief while wondering whether they’re next.

She and her colleagues cope by checking in via text or Facebook, sharing photos of their pets to lighten the mood.

“And I eat a lot of ice cream,” Zilke said. 

Still, there are days when she cries after learning that a patient has died in one of Michigan's hard-hit long term care facilities. “I think about my own grandmother, and how they’re dying all at once and how the staff in that facility must be heartbroken.”

But as much as the job can be tragic, it’s also gratifying. Most of Zilke’s sick patients recover from COVID-19. Often, by the time they’re released from her care, they’ve come to appreciate all of her relentless questions.

“I’ve had people tell me,” Zilke said, “‘when the pandemic is over, I’d love to meet you.’”

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Comments

Revere
Sat, 05/09/2020 - 3:09pm

Useless job that will do nothing to stop the spread of coronavirus which has been spreading across the country since January, and likely since December, and has already infected at leaast 1/3rd of the population.
What a waste. And she thinks she's doing the "right thing".

Susan
Sun, 05/10/2020 - 7:54am

Regarding the previous comment: Upon what data do you base your obviously strong opinion? It sounds more like a rant than an alternative approach.

Revere
Sun, 05/10/2020 - 10:53am

Susan,
As a scientist who took his education very seriously, I value real science.
Sounds like you value what people tell you.
Where's your watering hole? I'm guessing it's full to the brim with kool-aid. Good luck with that.

Myla
Sun, 05/10/2020 - 4:26pm

Please provide a reference for “at least one third” of the population. Nowhere near that many have even been tested. As a serious scientist, surely you don’t want to spread misinformation (?).

Revere
Mon, 05/11/2020 - 12:31pm

Myla,
Please go back to basic statistics - Did you pay attention in highschool?
Tell me, do you need to sample 1/3rd of the population in order to estimate infection rate of the whole population?
Do you know what a confidence interval is?
Etc?
Go back to your corner, you dolt.

CherylMcD
Sun, 05/10/2020 - 6:05am

Kudos to you Ms. Zilke! Your important work is saving Michigan lives and could have saved thousands more if trace contact programs had been launched sooner and in more locations.

Mary Scott
Sun, 05/10/2020 - 8:56am

Interesting article- thanks! It really brings home the fact that Covid 19 is different, as far as the length of recuperation is concerned, from the flu.

David Barnosky
Sun, 05/10/2020 - 1:23pm

Wondering if the training includes uses of Google maps location histories? They send me a summary of mine every month and most people leave it turned on but may not know Google is collecting it.

Michael
Sun, 05/10/2020 - 2:17pm

We do not answer the phone when there is no identification of the caller and I suspect many do the same because of the large number of robocalls, some from local area codes. When the contact tracer calls from home, how is the call identified on the recipient's phone? If it's just a local phone number with no other ID, I suspect there will be a lot of folks who don't pick up

Revere
Mon, 05/11/2020 - 10:04pm

Michael,
I have great news for you! You have been pre approved for a credit card interest rate deduction, effective immediately!
Also, your car warranty has expired or is about to expire and I would like to help you get your extended warranty that you have also been pre-approved for!
Oh! And I almost forgot! You have been chosen to receive a 5 day, 4 night vacation for only 99 dollars, act now before it's gone!!!
:D ;)