Much of Dr. John Flaspohler’s teaching at Concordia as an associate professor of biology involves infectious diseases and he’s always had an interest in public health, so at the end of spring semester he contacted Kathy McKay, the lead administrator for Clay County Public Health, and joined its summer team of five case investigators/contact tracers (CI/CT).
Clay County was gearing up to take on some of the case investigations and contact tracing the Minnesota Department of Health (MDH) had previously been handling. Most of the Clay County CI/CT effort was done by a team of local people with some experience in public health who normally have jobs unrelated to the pandemic.
Though he didn’t know much about the practical “on-the-ground” aspect of public health, Flaspohler had heard about contact tracing during the Ebola virus epidemic in 2014.
“I started training in late June and by July 1 was making phone calls to positive cases,” said Flaspohler. “Training consisted of reading MDH documents, online courses through Johns Hopkins School of Public Health, and most importantly through shadowing a couple of calls to cases made by my supervisor at Clay County Public Health.”
The database used by MDH and the information requested during a call can change frequently so the training was ongoing. Flaspohler was issued a Clay County laptop and cell phone and made calls from his home.
“The work was very interesting and very different from my Concordia job,” he said. “You really feel like you can make a difference, however small, in diminishing the number of cases in Clay County (and neighboring Cass County in North Dakota).”
The job required good listening skills, something he said he got better at with time. No two calls were the same.
“Most of the cases I called already knew they had tested positive, but occasionally I was the person first informing them of their positive test,” he said. “This could be an emotional experience.”
Flaspohler said he needed to engage with the person he was calling as an investigator and scientist but also with the thought process of a counselor, psychologist, sociologist, confidant, public health advocate, and concerned representative of local government.
“I found it exciting and rewarding, but hard work,” he added. “I only worked a few hours at a time, so I have great admiration for full-time MDH CI/CT employees.”
For Flaspohler, approximately 95% of the people he called were very receptive and willing to cooperate. Most, even young people, were symptomatic so they realized the impact the virus could have.
“Some were reluctant to name potential contacts or didn’t want to allow us to use their name with coworkers, but for the most part people understood the reasons we were asking for the information we requested,” said Flaspohler. “Only a small number of individuals refused the interview or expressed hostility.”
When Flaspohler worked this summer, Clay County was experiencing 0-15 cases/day, which was fairly manageable. But as of September, cases increased substantially to 15-50 cases/day which is more than Clay County Public Health can handle so MDH takes on a substantial portion.
“The overall pandemic response in the United States has been surprisingly fragmented and ineffective,” he said. “The problem in achieving rapid testing is still with us; in many cases, I spoke with positive cases 4-6 days or more after their test, which definitely impacts the effectiveness of our contact tracing goals. I believe our work had a positive impact on the scale of the pandemic, though at high levels of community spread CI/CT becomes overwhelmed and no longer feasible.”
He did see improvement in getting timely testing results in the three months he worked and hopes that continues.
“Science, medicine, and public health will see us through this pandemic, but only if we trust the wisdom of scientists, physicians, nurses, public health workers, and others who are doing their best under extraordinarily difficult circumstances,” he added.