Expectations are clearly defined for individuals who receive a call from a COVID-19 contact tracer or case investigator. But who are the people asking the questions, and what do they experience?

Since the start of the COVID-19 pandemic, Virginia Tech Master of Public Health (MPH) students have served as case investigators and contact tracers in the New River Valley, Roanoke City, Alleghany County, and even beyond the region in Central Shenandoah. These essential roles, which support confirmed and probable cases and notify possible contacts of exposure, are key in limiting COVID-19 transmission.

According to the Centers for Disease Control and Prevention, case investigation is the identification and investigation of patients with confirmed and probable diagnoses of COVID-19. During an interview with a confirmed or probable case, the case investigator helps individuals recall everyone with whom they had close contact when they may have been infectious. Contact tracing is the subsequent identification, monitoring, and support of a confirmed or probable case’s close contacts who have been exposed to, and possibly infected with, the virus.

Case investigation and contact tracing require similar specialized skills. Both roles call for an understanding of patient confidentiality and medical terms, including principles of exposure, infection, infectious period, systems of disease, and more. In order to build and maintain trust with cases and contacts, individuals in these roles also must possess strong interpersonal, cultural sensitivity, and interviewing skills.

Teace Markwalter, MPH student and COVID care resource coordinator for the New River Health District, conducts both contact tracing and case investigations as part of her position. “I’ve developed skills in epidemiological interviewing, as well as data collection and management skills that are valuable as a state health department employee. I have also practiced health counseling and education,” Markwalter said. “I love being able to explain these public health concepts to individuals in the community.”

Effective communication has proven to be valuable in case investigators’ and contact tracers’ efforts to build trust with community members. “Health communication will be helpful pursuing any specific career in public health or any branch of medicine,” said MPH student Kendra Byrwa, a case investigator with the Roanoke City and Alleghany health districts. “I used to be hesitant talking on the phone or to people whom I did not know, but this position has helped me become more comfortable in a leadership-type role where I am an ambassador of important public health information.”

Sade Bowers, MPH student and case investigator with the Central Shenandoah Health District, agrees: “The verbal dissemination of public health information has been a big skill that I have been able to practice more with my case calls. Showing people through case calls that their local public health community is there to support them is incredibly valuable for establishing trust in the health department and the field of public health as a whole. Providing people with a direct line for receiving important public health information and giving them an opportunity to have their concerns or questions addressed can help the community feel like their voices are being heard.”

Because Hispanic and Latino populations continue to be disproportionately affected by COVID-19 — a disparity caused by a range of societal factors, including health care access, geography, and language barriers — students in case investigator and contact tracer roles have experienced these disparities firsthand.

Helping Latinx populations in the New River Valley, Roanoke City, and Alleghany County are two bilingual MPH students, Fernanda Gutierrez and Chloe Loving.

“I think that my biggest impact as a public health student during the COVID-19 pandemic has been to provide health information in Spanish to the Hispanic communities in our area,” said Gutierrez, who has served as both a contact tracer and a case investigator for the region. “Many people I called did not speak English and had little trust in the government, and I hope that by speaking to them in their own language, I was able to help them out and feel more at ease.”

A case investigator with the New River Health District, Loving has focused on working with Spanish-speaking communities. “A lot of these people speak little to no English, yet are constantly given health information in English,” Loving said. “Having someone who speaks their language allows them to be part of the conversation — instead of being talked at — and they can ask questions that would affect them. It is empowering for them to feel that they can communicate and get the information they need.”

Working in these roles doesn’t come without challenges, however. Many individuals responding to the pandemic, including case investigators and contact tracers, are experiencing burnout.

Ella Rak, a case investigator with the New River Health District, is pursuing both a Doctor of Veterinary Medicine and an MPH at the veterinary college. “Working full time as a case investigator while in veterinary school has been exhausting,” Rak said. “From a personal perspective, being involved in the pandemic response has taught me about taking time for myself and the challenges of work-life balance in a crisis that seems like it will never end. It is emotionally draining to move from consoling family members of cases who have died from COVID, to trying to convince community members that COVID is real. This is the reality of public health, and I feel much more prepared for whatever the future holds.”

Despite the challenges, students acknowledge that their help as contact tracers and case investigators has benefitted their respective health districts.

“As far as the impact my efforts have had within the organization I am serving, I feel my presence is helpful,” said Bowers. “The Central Shenandoah Health District has been understaffed for months, people have been stretched thin, and there have not been enough resources available to help these pandemic efforts run as smoothly as desired. As such, any additional person who can contribute to these efforts is crucial for battling employee burnout.”

As would be expected, these students have been guided by many professionals who have served as mentors and role models and have played a significant role in the students’ personal and professional development.

“The epidemiology team at the New River Health District has mentored me in epidemiology skills that I have had to develop over the last eight months to respond to the case investigation and contact tracing needs,” said Markwalter. “The health district director and nurses have shown me the importance of dedication and hard work, 24/7. Everyone involved has shown the value of selflessness and serving others by putting the community’s needs above what would be easier for them. The work doesn’t stay at the office or go away after 5 p.m. or on the weekends, and they all rise to the challenge every day.”

Byrwa said that “Every team member is great with communication across the team and also helping each other out if needed. The public health nurses and epidemiologists are very accessible and great to work with. The case investigator supervisor — 2020 MPH alumna Sarah Work — has been awesome to work with, as well. These collaborators always promote personal growth and allow case investigators to take on additional tasks and responsibilities as they deem appropriate.”

These students are aware that their hard work has considerable impact and value. “The most meaningful part of case investigating for me is when I feel like I was able to help give community members the tools to protect their loved ones,” said Rak. “Social distancing, wearing masks, and quarantining/isolating are all compassionate acts, and it means a lot to play a small part in making it possible.”

“Personal growth and professional development aside, I feel a sense of peace during such a helpless time knowing that I am doing what I can for my community,” said Bowers. “Being present to help both health department staff and members of the community who may feel very scared and/or sick is all that I could ask for if the nature of the pandemic is out of my control.”

Written by Hannah Menefee, Public Health Program coordinator