The job was emotionally grueling — no one wants to get a phone call from us, and people sometimes cried or yelled or called us names. But it felt as though we were making a real difference. If the state health authorities could track the coronavirus, then we could limit spread. Before we knew it, new cases in North Dakota rose into the hundreds, then the thousands. On Oct. 22, our managers told us to stop asking our cases for their contacts. There was no longer any point.
In recent weeks, North Dakota has had the most new cases per capita in the country. Our hospitalizations have doubled since last month. We have the world’s highest death rate from covid-19, the disease caused by the coronavirus. Things got so bad, so fast, that we’ve surrendered one of our key weapons against the pandemic: Test and trace went by the wayside. Even if we had enough staff to call up everyone’s workplace and contacts, there are so many new infections that it wouldn’t be very effective. At this point, the government has given up on following the virus’s path through the state. All we can do is notify people, as quickly as we can, that they are infected.
This is a dramatic change in our responsibilities. Previously, when we called someone who tested positive, we’d launch into questions. We’d ask for demographic information, their health and clinical history, where they work and where they had been. We set them up on the state’s monitoring system to fill out daily email surveys about their symptoms. (Older populations often had trouble with the system, and I called some people every day to help record their progress.) We’d ask when their symptoms started and calculate how long they’d been infectious. We’d compile lists of everyone they’d come into contact with, socially or in their workplaces. Then, we’d notify those people, too, and get them set up on the monitoring system.
Now we run through each call as efficiently as possible. We ask the basic demographic questions, but unless the person is pregnant, we don’t gather any history. Unless their job is in health care, or they work in or attend the K-12 school system, we don’t notify their employers. We tell them about the email survey, urge them to warn the people they’ve been in contact with, and offer our phone number for any questions.
That’s it: We have to trust, or pray, that they will follow through. My co-workers and I were trained to investigate cases and trace contacts; the general public doesn’t have that expertise. It’s upsetting that we’re leaving that work to them. Many states already tried relying on “personal responsibility” to contain the coronavirus. Now people are dying, and we’re putting even more of the burden on individuals?
My own life is an example of how quickly the pandemic has spiraled out of control. In mid-October, my parents, who are in their late 40s, received a positive test result a few days after I’d visited them for a weekend. Their cases were relatively mild, thankfully, and they recovered — but even after all the questions I asked them, they couldn’t figure out where they got it. Back at school, when I started experiencing symptoms — a fever, a horrible headache, a faded sense of taste — I kept working from my off-campus apartment. When I told my managers that I wasn’t feeling well and it could be the coronavirus (though I’d tested negative), they told me to keep up with my remote shifts as best as I could. The case volume was so high that my team needed all hands on deck.
Even with less paperwork and no contacts to call, my job has only gotten harder. On one call, a person will tell me that their whole family is sick — the mom and dad, all five kids — and they are absolutely miserable. On another call, a relative will pick up and say that the person I tried to reach is already in the hospital and may not make it. The next person might shout, saying it’s all a hoax. In general, though, it seems as though people have grown more accepting when they are told they are sick. The news doesn’t surprise them much: After all, the coronavirus is everywhere.
What began as a 15-hour-a-week position is now a round-the-clock job. My phone buzzes constantly with calls and texts from my cases, reporting symptoms and asking questions. Legally, I’m not allowed to give medical advice, but I direct them to the right services and sources of information. Mostly, I just try to listen. Some people, when they are sick and in isolation, just want to talk to someone so they don’t feel so alone.
For months, it seemed as if we were relatively safe here — that the pandemic would hit big, busy places in New York and California but might not reach us. Instead, the current wave has swallowed my state. This is what an emergency looks like in North Dakota: Every day seems to break a record for new infections. Even if hospitals have open beds, they don’t have enough staff; the governor recently proposed allowing health-care workers who test positive to continue working in covid-19 units.
Last weekend, when North Dakota finally got a mask mandate, our whole team celebrated the news. Then reality set in: Schools are still open; restaurants are still open. The state prides itself on how much it expanded its testing capacity, but the positivity rate is so high — nearly 15 percent — that there are surely cases we’re not detecting. So many tests are coming back positive that we can’t keep up. Some people don’t know about their positive result until a week after their test. By the time they hear from us, they may have spread it to countless others.
I look up every case I’ve had who has passed away. I’ve spoken to, and cried with, some of their families. I wonder whether I was the last person they spoke to before they were intubated. I read their obituaries. This is my way of reminding myself: This was a person. Deaths usually lag behind caseloads. I’m scared that, soon, I won’t be able to keep up.
When North Dakota first lifted its restrictions in May, I remembered feeling scared at how bad things might get. But at least in the spring, the pandemic response felt like a big, countrywide, team effort: Do your part, stay home, wear a mask. Now everyone’s exhausted, and the tools that were effective don’t work anymore. Every time I hang up, I just hope for the best — that people will make their own calls, that they will take care of those close to them.
It’s terrifying that it has come to this.
As told to Post editor Sophia Nguyen.
This story has been updated.