By Donald Gilpin

In Princeton’s battle to flatten the curve of coronavirus infections and to prevent the deadly virus from spreading over the past three months, contact tracing has been one of the Princeton Health Department’s most effective tools.

As restrictions lift, the town opens up, and Princeton residents venture from their homes into the streets, stores, and other public spaces, the Princeton Health Department’s team of contact tracers, expanded from 1.5 during “normal” times to its current group of 13, is prepared to combat any outbreaks that may occur.  The team includes volunteers, health department staff, municipal work staff, Princeton Public School nurses, and an intern from The College of New Jersey.

With only eight new COVID-19 cases in Princeton in the previous 14 days, as reported by the Health Department on Tuesday, as opposed to a 14-day total of 55 new cases during the height of the pandemic in the last week of April and first week of May, the flattening curve that can lead to a new normal, post-COVID situation is apparent. Contact tracing, says Municipal Health Officer Jeff Grosser, is a key component to help keep Princeton on track.

“With contact tracing you keep the cases low enough so that you can address them, treat them medically, and do the contact tracing you need to do with the team you have,” said Ann Marie Russell, a volunteer who has been working with the Princeton Health Department on contact tracing and oversight of the outbreak response at long-term care facilities. “Contact tracing helps Princeton manage COVID-19 cases at an ongoing low level, to prevent future surges, and to be able to reopen New Jersey as safely as possible.”

Emphasizing the necessity of sustained teamwork throughout the community, retired public health education consultant Francesca Calderone-Steichen, who has been working with the Princeton Health Department since April and has taken the lead on many local cases, noted, “The community has a critical role to play in damping this particular pandemic down.  Americans are great problem solvers and highly independent people, and we also like quick fixes, but we may not be able to do those things with this particular coronavirus, which is silent but infectious
inside people for up to 14 days.”

She continued, “This coronavirus requires us to cooperate with each other, to share the responsibility for stopping the spread by wearing masks in public places, by social distancing, and if you do get sick, by working with a contact tracer and remembering all your contacts so they can be traced so that they won’t add to the spread of the virus. It’s the only way we’re going to stop this thing unless and until a vaccine is developed. We have to work together.”

Contact tracing is a kind of detective work, an extensive process of investigation. All positive COVID-19 test results are required to be reported to the New Jersey Department of Health’s (NJDOH) communicable disease reporting system. The local health department receives daily information from the NJDOH, and for any positive test results, the contact tracers move into action — on the phone.

“We call each case,” said Russell. “These are long calls, communicating lots of information.”  The contact tracers ask for information, name, and phone number, about anyone the infected person has been in contact with recently. They will ask about the immediate household, as well as anyone else who has been in the house, and anyone else the quarantined individual has been with for more than ten minutes or within six feet. 

The contact tracers write down that information, contact those people, ask about symptoms.

“We keep all that information confidential,” Russell pointed out.

Any close contact must quarantine for 14 days from the time of the last contact with the infected person. The contact tracer also discusses support services — like food or housing (particularly in situations where individuals might have to share a bathroom or bedroom and can’t segregate themselves) — that may be needed to complete the quarantine. “We make sure they have the ability to quarantine,” Russell said.

The contact tracer also talks about symptoms, asking the infected or exposed individual to monitor symptoms, particularly serious ones like shortness of breath or pressure on the chest, where talking to a doctor or nurse would be needed. 

“Contact tracers ask questions almost everyone can answer, about their symptoms, for example, but I think my greatest challenge is to get patients to really think back to who their contacts were, when they were around them, what were the general dates, etc.,” said Calderone-Steichen. “This is the hard part of contact tracing because folks have been sick, often very sick, so sometimes they genuinely don’t remember, but sometimes they don’t want to say because they don’t want to get friends and/or family members ‘in trouble.’” 

She went on to emphasize the importance of confidentiality to the whole process.  “Names, addresses, and phone numbers are never passed along to anyone else,” she said. “Ever. What you tell a contact tracer stays with him or her. What your contact tracer is looking for, specifically, is a thread of past and current contacts who can be traced back, tested, and potentially isolated for a while to protect the health of the community. Where that contact thread came from remains forever anonymous. Please help us do our jobs. Provide us with your contacts and know that we will protect you, the anonymous source.”

Contact tracing is not a new medical strategy. It has been used to help control epidemics of EBOLA, HIV, tuberculosis, and others. It remains an invaluable tool for overcoming viral outbreaks and, in this case, allowing the economy to open up again. 

Michael Bloomberg, who is helping to lead the contact tracing effort in New York City, where he formerly served as mayor, noted in a statement, “One of the most important steps to take to reopen the economy as safely as possible is to create a system of contact tracing. When social distancing is relaxed, contact tracing is our best hope for isolating the virus when it appears — and keeping it isolated.”

Calderone-Steichen, who worked for the Princeton Health Department and other local and state health departments before retirement, came on board this spring as a volunteer, when the Princeton Health Department started getting flooded with too many cases all at once, which is typical for a pandemic.

Grosser described a situation in late April where the Princeton Health Department, with only four full-time employees, was hitting a serious work overload. Grocery stores and other retailers needed guidance, the long-term care centers needed more attention, and, with about 30 new cases each week, the contact tracers could not keep up with the need to call hundreds of people. “That can be debilitating for a health department,” said Grosser, but with reinforcements from the municipality, the police department, the school nurses, and volunteers, the team grew to 13.

“We were able to call all of the contacts,” said Grosser. “And that’s when you are getting contact tracing done, going through each step that an infected person has made.” 

Grosser warned about the challenges of reopening. “More people will be coming into contact with each other,” he said. “The contact tracers will be the best tool to manage the reopening, to reduce clustered outbreaks as cases start to pop up.”

Grosser expressed his excitement in welcoming “a tremendous number of volunteers from the community,” and he noted the health department’s eagerness to provide training for contact tracing.  He emphasized, in particular, the value of a number of retired medical professionals who have brought their expertise into the mix in volunteering their services.

Grosser urged the public to be not fearful, but careful as they leave their homes and venture out into Princeton. “Keep prevention in mind,” he said.  “The public has learned a lot about public health. Be mindful of the ongoing mission to combat disease and make sure we continue on the right path.”

As the curve flattens and the COVID-19 pandemic moves into stages 2 and 3, Grosser was happy to report that the major complaints fielded by the Princeton Health Department this week have been two perennial concerns: high grass and poison ivy.