This piece originally appeared in The Brink.

One of the many new terms that has entered the average American’s vocabulary since the onset of the COVID-19 pandemic is “contact tracing.” While quick to the lips of many public health experts, what contact tracing actually is, and why it plays a critical role in stemming the tide of disease transmission, warrants an explanation for the rest of us.

“Contact tracing is not new,” says Hannah Emily Landsberg (Sargent’12, SPH’13), director of case management and contact tracing for Boston University Healthway, “but a lot of people are hearing about it for the first time.”

Contact tracing involves tracking down anyone who might have been exposed to an infectious disease through close contact with someone infected. The goal is to identify exposed people as soon as possible and to get them into quarantine before they potentially become infectious themselves, thereby stemming the spread of the disease within a population. Since BU’s campus-wide coronavirus surveillance program got underway in July, routine screening of the BU community has helped identify positive coronavirus cases early. After a positive result, it’s a race against time for BU’s contact tracing team to figure out who else might have been infected. 

“Contact tracing is really about trying to break the chain of transmission,” says Madison Sullivan (SPH’21), BU Healthway’s public health liaison.

A close contact is defined by the Centers for Disease Control and Prevention as someone who was within six feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period. But real life isn’t always so clear-cut.

“What they were doing can be a factor,” says Dillon McGuire (CFA’19), a BU Healthway contact tracer. “If someone was singing or exercising, something where there was a lot of extra respiratory activity involved, that might be a situation that would require a second look.”

“That’s kind of the art of contact tracing,” says Sullivan, “looking at a regular interaction and asking the right questions to identify that, yes, that was a point of exposure.”

BU Healthway employs 29 contact tracers and 4 contact tracing supervisors, a number that has almost doubled since their efforts got underway in August. The BU contact tracing team has attracted staff from a variety of backgrounds. Among the bunch are BU alumni, School of Law and School of Public Health students, as well as journalists, research assistants, and data analysts. Most of BU Healthway’s contact tracers work 20 hours each per week, rotating shifts so that the contact tracing team is on call 12 hours a day, 7 days a week, addressing cases as soon as they come up. 

On a slow week, BU Healthway’s contact tracing team might investigate between 50 and 60 cases, a number that can get closer to 80 or 90 during the periods after a long weekend or holiday breaks, when more positive cases tend to surface. A contact tracer’s day involves just what you would expect: a lot of phone calls and a lot of hard conversations. 

“First of all, when someone is told that they’re positive, a lot of things are going through their head,” says Landsberg. “Could I have made somebody sick? Whether that’s a loved one or a friend, it’s somebody that you care about. And that’s a scary feeling.” 

McGuire, who studied theater arts at the College of Fine Arts, credits his success as a contact tracer to the skills he developed in his theater classes, the emphasis on empathy in particular. “It’s important to make someone feel like they’re not just a case that we’re working on, but a person that we’re reaching out to to check in with,” he says.

Sometimes the conversations with people identified as close contacts can be even more sensitive than talking to someone who has already been diagnosed positive. “Breaking the news to them is hard,” says Prerana Gaitonde (SPH’21), who is working as a contact tracer while pursuing a master’s of public health, “because they may feel fine, they may not have any symptoms at all, but they will now still need to be in quarantine for 14 days, which means they can’t see their friends, they can’t go to class.”

So far this semester, BU’s contact tracing team has made calls to roughly 1,500 members of the BU community, including positive cases and their close contacts. On average, someone who has tested positive for COVID-19 ends up having 4 to 5 close contacts, but the team has had cases with over 15 close contacts linked to a single positive case. Getting these close contacts into quarantine and away from the rest of the population is crucial to staying ahead of outbreaks.

“The most important tool a contact tracer can have is their ability to connect with others,” says Landsberg. “When a rapport is developed and trust is established, the case investigation is significantly more thorough and honest.” 

BUs contact tracing team has other tools in their kit, as well. BU’s Information Services & Technology developed a custom contact tracing database that the team can use to search a student’s classmates, teammates, and on-campus roommates. Additionally, the electronic medical records of BU community members are embedded with contact tracing software modules that the team uses to connect positive cases to their contacts. These digital tools have proven essential to identifying potential close contacts quickly, but the team also uses the old-fashioned tools of pen and paper, as well as campus maps, to help them visualize connections between potential contacts and trace their movements around campus.

So how successful have BU’s contact tracing methods been? “We are continuing to identify more individuals as close contacts who then turn positive,” says Judy Platt, director of BU’s Student Health Services. “That means we’re doing exactly what we want to be doing. We don’t want anyone to turn positive, but if we’ve already put that person in quarantine because they were identified as a close contact, that reaffirms that we’re doing it right.”