Q&A: Two contact tracers at Linn County Public Health discuss their job and what they’re seeing during the county’s current surge

Nicole Pruchno (left) and Alicia Steines are two of Linn County Public Health’s contact tracers. They both call individuals who have tested positive for COVID-19 to find out more information and inform others about possible exposure. — photos courtesy of Nicole Pruchno and Alicia Steines

Confirmed cases of COVID-19 in Linn County — and across Iowa — continue to increase daily. As of Thursday morning, Linn County Public Health was reporting 2,204 confirmed cases in the county and 87 deaths. There are 299 active cases, according to LCPH.

Community spread makes up nearly 70 percent of the county’s total confirmed cases. Linn County’s seven-day moving average is trending upward and has surpassed the peak the county saw during its April surge.

With every individual who tests positive for the virus comes figuring out where this person was and if they had possibly exposed anyone — a task known as contact tracing.

Nicole Pruchno and Alicia Steines are two contact tracers at LCPH. Little Village interviewed them both about what their job entails, what a phone call with someone who tests positive looks like and what they have been seeing during the current surge. (Due to their busy schedules, the interviews were conducted via email.)

Their responses have been edited for clarity.

Can you tell me more about you and your background?

Nicole Pruchno: I am a nurse practitioner, and I started at Linn County Public Health on Jan. 13. Prior to starting at Linn County, I had six years of experience working as an oncology nurse practitioner. My job description included STI testing and treatment, HIV PrEP prescribing, travel visits for vaccines, refugee physicals and school and sports physicals. Just as I was beginning to become comfortable in my duties, we closed down and focused solely on our COVID-19 response.

I am from Waterloo, Iowa but have been in Cedar Rapids since 2001.

Alicia Steines: I graduated from Mount Mercy College in 2007 with my Bachelor of Nursing and started my nursing career work in child and adolescent psychiatry for three years. I then switched my nursing career to work as a surgical nurse at a local hospital and an outpatient surgical center. In April of 2017, I started my public health nursing career as the HIV/HCV/STI Outreach Coordinator at LCPH. The focus of my job is to provide testing services for individuals disproportionately impacted by HIV and Hepatitis C.

When did you start working as a contact tracer?

NP: Initially, when we closed the clinic and we started to see cases of COVID in Linn County, I was on phones to help answer questions that varied from general COVID questions from the community to questions from business owners/executives and everything in between.

I was eventually moved into unified command and managed the long-term care facility and group home outbreaks with Alicia. We did hire contact tracers in early May to help with contact tracing and one of them who just graduated with her MPH was trained on the facility outbreaks and that has now been transferred to her completely. Since that time in May, I have been helping with the contact tracing.

AS: At the start of the COVID-19 pandemic, I started contact tracing for individuals who tested positive for COVID-19. Prior to the pandemic, I completed contact tracing for individuals who were diagnosed with HIV.

Can you share what a typical phone call looks like? What questions do you ask?

NP: When we are notified of a positive case from IDPH, we contact the patient and go over the case interview form that can be found on the IDPH website. We explain who we are and that COVID is a reportable disease in the state of Iowa. We tell them we would like to go over some questions with them and would like to provide guidance relating to isolation recommendations. We ask if they are willing to participate and if so we start the interview.

Questions consist of: What brought you in for testing? Were you having symptoms or are you a close contact? If they have symptoms we ask when they started and what the symptoms consist of. The reason behind this is to get symptom onset date so we can determine release from isolation date. We ask about employment and if they have notified their employer. We can provide a letter to them to give to their employer that indicates the individual is being monitored by LCPH and is under isolation due to their COVID-19 diagnosis.

We will reach out to businesses as well to provide guidance as needed. We ask about past medical history and any travel history outside of Iowa for the 14 days prior to their symptom onset. We ask about household contacts and close contacts. Close contacts are traced back 48 hours prior to symptom onset (or test date if the person is asymptomatic). Close contact is closer than six feet for more than 15 minutes. We ask for the names and contact information of their close contacts so we can reach out to them and inform them they have been listed as a close contact and provide them guidance on quarantining. We can also provide close contacts a letter for their employers. At the end of the interview, we go over isolation guidelines for them and any household members and go over any questions they may have.

Are people typically surprised to hear from you? How does the conversation go in the first few minutes?

NP: At Linn County, we reach out to the ordering provider (except for Test Iowa) to verify that the individual has been notified of their COVID results before we call them so the majority of individuals are expecting our call. The majority of the individuals that we contact are willing to provide us the information we ask and are grateful for the guidance we provide and for answering their questions.

AS: Individuals appreciate LCPH following up because they have additional questions or needed a note to remain off work.

How long does one case typically take?

NP: In the early days of COVID-19, the contact tracing interview took roughly 20 to 30 minutes because people were staying home and large group gatherings were restricted. Since things have opened up, our calls can now take up to an hour or longer. With people traveling, attending large gatherings and sporting events, there are more contacts, which requires more time to contact. We are now back to covering weekends for contact tracing for a few hours each day so that when we come in on Monday we are not so overwhelmed with cases.

AS: Each call varies. If an individual had a lot of travel history, close contacts, questions and/or concerns, the conversation can take quite some time. I would say on average one phone call may take about 20 to 30 minutes.

As you’re having these conversations, are you seeing any trends over the last few weeks?

NP: There had been a surge in cases in individuals in their 20s that we were able to see was associated with the Fourth of July, bars and restaurants opening to higher capacity and general summer activities (bonfires, boating, etc.). We are now starting to see more individuals in their 40s and up (but still many cases of people in their 20s).

AS: There was a spike among people in their 20s when the restaurants/bars opened, but currently, we are seeing more people who are in their 40s as well. It is a good mix of these two age groups.

Anything else you’d like to share?

NP: We also do daily calls on our active cases. We try to get to them daily, but with the increased number of cases, we may triage some of those calls to every other or every third day. The purpose of this is to confirm to an individual that they are OK to be released from isolation. If an individual’s symptoms are worsening, we will encourage them to reach out to their primary care provider and seek care. Once we release them from isolation, we are also able to provide a letter to their employer indicating this individual is able to return to work.

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