Heartbreak and hope

If you are one of the 730 Henrico residents who has tested positive for COVID-19 since Dec. 5, one of the first Virginia Department of Health officials you hear from may be Giselle Rosas, a Henrico Health District contact investigator.

The Colombia born 39-year-old’s role is calling Henrico and Richmond residents who test positive for COVID-19, giving guidance on self-isolation, and collecting information about close contacts. She’s been in the position, which also administers to Richmond, since June, when the VDH started expanding its COVID-19 containment team.

“Stand-out moments for me are when people break down crying because they are scared,” said Rosas, who previously worked as an X-ray technician. “It gives it meaning. I tell them: ‘You have to be strong.’ I feel bad for people who do everything they need to do and with one small decision, they get infected.”

Testing labs send positive results to the VDH along with the contact information of the person infected. The COVID containment team’s outreach can make a significant impact in saving lives and helping those infected cope with the highly contagious virus, which can range from mild or no symptoms to severe illness and death.

Henrico has had a total of 9,440 COVID-19 cases as of Dec. 9, with 623 residents hospitalized and 266 Henrico residents’ lives taken by the virus – the highest fatality total in the region. Statewide, there have been more than 267,000 total cases, nearly 15,600 hospitalizations and 4,281 deaths. The VDH dashboard is showing a sharp upward spike caused by gatherings during fall and winter holidays.

Rosas spends anywhere from 25 to 45 minutes on each call, working with the infected person, reviewing where each has been and who they have been with, since those people will be contacted next. She provides those she speaks with guidance about what to do at home to isolate and how to keep themselves and those around them safe.

Rosas’ Spanish fluency is crucial in communicating clearly with the Latin American population here, which has higher rates of COVID infection and is in need of clear information about how to cope, how to quarantine and how to stay safe.

Rosas is just one of 543 case investigators statewide disbursed in the 13 health districts throughout Virginia. Her district provides outreach to both Henrico and Richmond city as well as Chesterfield at times because people’s lives here cross geopolitical boundaries.

With the number of infections rising daily, Rosas says most people have been grateful and appreciative of the information she provides, even though others aren’t.

“A lot of people don’t have symptoms but test positive. Some people are definitely rude,” said Rosas who has also experienced people refusing to take her call, hanging up on her and shouting at her.

Providing critical information
For many of the thousands of people in Henrico and Richmond who contracted the virus, speaking with an expert from the Virginia Department of Health COVID containment team is a lifeline to information and services they need.

But, Henrico and Richmond Health District COVID Operations Manager Joanna Cirillo said the team also understands that people who get a call from the office can be upset.

With more than 125 new cases reported in Henrico each day this week so far, Cirillo wants the public to know that the team impacts a great many people in the area. She urged members of the public to pick up a call from the VDH, because it’s important. It does not mean, she emphasized, that anyone is “in trouble.” And, she said, their personal information will not be shared with any other government entity.

“The first two or three days after infection, even if you don’t feel sick are the most infectious,” warned Cirillo, who is a communicable disease public health nurse. “The actual case investigators give a ton of information. We’re just here to help, we have resources.”

Despite the sometimes challenging moments, Rosas views her role in explaining to people how to manage and not infect those closest to them as “a pleasure to be a tool of the public.”

After information from one of the eight local pre-contact investigators is logged into a computer tracking system, Rosas speaks with an infected person, adds to the computerized file and then hands the case off to a contact investigator, who follows up with everyone the infected person may have been in contact with to explain that they should isolate themselves and get tested.

“Like many [Health Districts] across the state, we split up our calls by positive cases/case investigation and contacts/contact tracing,” said Lori Beck, project manager  for case investigation with the Richmond City and Henrico Health District.

Other staffers on the COVID Containment Team focus specifically on addressing containing the virus at facilities such as nursing homes, schools and industry or places of employment.

The case management team picks up the baton from there, helping infected people get what they need through agencies and social services, such as hotel lodging to help people isolate from family living in cramped quarters; food delivery, if people quarantining can’t shop; and even financial support, if time out from work means a loss of salary. Finally, the epidemiology team is in contact with the Center for Disease Control and health officials in other states if someone has traveled.

All of these staffers have gone through extensive training with VDH experts to learn facts about COVID from the CDC and Johns Hopkins University (which has been tracking the virus worldwide), as well as best practices from the VDH’s Sexually Transmitted Disease Containment Team.

One tool Virginia officials launched to assist with the process is the COVIDWISE app, an anonymous exposure notification app that doesn’t serve a role in tracking persons diagnosed with or exposed to COVID-19 but does, however, provide an augmentation role, according to Jeff Stover, executive advisor to the health commissioner.

“Traditional methods of contact tracing are critical to containing the spread of infection, but require an infected person to identify specific people and places where they may have had close contact,” said Stover. “Exposure notification technology can support these efforts by allowing citizens and public health authorities to help notify persons whom the infected individual was near but does not know or can’t remember having been around.”

Listening and showing compassion
Taylor Livelli, a contact-tracer (epidemiology team investigator) with the the Richmond and Henrico Health Districts, is one of 866 contact-tracers statewide. When Livelli calls Henrico residents, she imparts 14 pages of crucial information to them to let them know what to do to keep safe because they have been in contact with someone infected with COVID. During part of that conversation, she explains facts about the the virus and how quarantining works.

She also asks if the recommended two-week quarantine period is a long time for them to take off work, if they cannot work remotely. She explains that there is a VDH team that can help them approach that isolation with needs like filling out unemployment forms, dropping off food, picking up medications and assisting with household needs.

“The reactions are mixed,” she said of her 15 to 17 calls each day. “Some people understand, but it can be very upsetting. Some people are lonely, and they do struggle. Some people ask a lot of questions. It’s difficult to understand that if they’ve come into contact with someone with corona[virus] and then they test negative, they must complete the 14 days of isolation.

“It’s hard to say goodbye and hand them off to the next step, the navigators or the case management team, which will be constantly checking up on them to make sure that they can quarantine.”

Livelli is a recent graduate of Virginia Tech, where she majored in political science. She sought out her current job because of her combined interest in public health.

“I think the most important attributes of a contact tracer is confidence [about the subject matter]. You have to be a good listener,” she said. “Compassion is number one for me. If people are upset or don’t want to quarantine or isolate, you need to listen to why [and talk about those] circumstances.”

A passionate, experienced team
Navigator Erin Looby, a trained social worker, and her colleagues in the COVID-19 Navigation Unit take over from Livelli and the other contact-tracers. Before joining the VDH, Looby worked in health care, acute care and dialysis facilities.

By the time the navigators call people with the virus or those exposed, those people are expecting the call. Looby asks them what concerns they have about isolating themselves or quarantining.

She credits what she termed a passionate and experienced team of social workers with connecting Henrico residents on her call list with life-saving resources – food, medicine, and funds to pay rent.

“For some, they never thought they’d be in this spot,” Looby said. “For others, they had issues before the pandemic – like financial struggles and food insecurity – and for others, it’s the first time they’re asking for help.”

Looby and her team typically make 17 45-minute case management calls a day.

“The work is hard, because we are working with people on the brink of eviction, people whose parents or siblings are in the hospital. Today, I spoke with a woman whose husband [had a fatal case of the virus] and was coming off the ventilator, and she couldn’t be with him in that final moment. Sometimes what we do is offering to be that concrete presence and be that compassionate voice.”

Looby's team also has assisted in other types of help for those on her call list, including a family living with “tons of mold” in its residence, for whom her team facilitated mold remediation. That was one of a total of 1,240 referrals to this point, and the referral volume is increasing weekly as cases go up.

Looby’s team’s impact mirrors the community support in place and agencies set up to assist those in need, she said.

The Henrico team also is gearing up to expand to administer vaccines when they are available, according to Cirillo.

And there’s a steady need for more staffers – especially those who speak Spanish or have diverse backgrounds, according to VDH Epidemiology Program Manager Elena Diskin.

“We are actively hiring. Cases are surging so we are growing the teams,” she said. “The safest way to protect yourself is to stay home. If you can’t stay home, wear a mask and wash your hands.”