If you get a phone call from Lloyd Kimble, be prepared—this could take a while.
He might start with something like,“Where did you have breakfast? Who did you have breakfast with? Where did you have lunch? Who did you have lunch with?”
That’s not all. He wants to know about your roommates, co-workers, social interactions. (Though if you are following the shelter-at-home rules, you shouldn’t have many, if any).
“Who’s in your life on a daily basis, and we ask about how much time do you spend with them on a daily basis?” says Kimble, a former Navy man with a background in psychology. “The only thing we’re concerned about is who’s been exposed to you, who needs our help.”
Kimble heads the Shelby County Health Department’s investigations team.
These days, he’s tracking down and notifying people who may have been exposed to someone with COVID-19. Maybe it was a family member; maybe a complete stranger.
An outbreak of any communicable disease, sometimes tuberculosis or measles, usually starts with a vigorous effort to track it from person to person, or what’s known as “contact tracing.”
It takes some sleuthing on the part of the investigators like Kimble to “leave no stone unturned” with their line of questioning.
Some trips down memory lane are longer than others.
“The day you started exhibiting symptoms: we start two days before that,” says Kimble. “So if a person started exhibiting symptoms on a Tuesday, we would go back to Sunday, and that’s when our interview would begin.”
A call from Kimble’s team almost certainly comes with instructions to quarantine or isolate for 14 days, often at a moment's notice. Their mission is to starve the coronavirus of new hosts by getting contacts who have been exposed to a positive case sequestered as quickly as possible, even if a person is asymptomatic or didn’t actually contract the virus.
Investigators wade through lists to discern which encounters add up to close contact, or about 10 minutes of exposure. Casual interaction, such as passing people at the grocery store, isn’t a primary concern.
“That is a place that maybe a person has maybe caused a little exposure, but it’s a small amount of exposure,” Kimble says. “Usually when people are shopping, and that sort of thing, they’re moving. They’re not staying in one place with any one person.”
When it comes to spreading disease, employment and other habits are major indicators. Kimble, who worked on Shelby County’s very first positive COVID-19 case in early March, says some patients can rack up as many as 100 contacts in a short period of time. Healthcare providers, for example, often have a dizzying number of interactions.
“It depends on what your life is like,” Kimble says. "If you lead a very sedentary lifestyle, you don’t do a lot, you may have as few as half a dozen contacts. If you’re retired, you may not have a lot of contacts.”
Health officials are counting on shelter-at-home orders to curtail people’s social encounters. Still, coronavirus cases are on the rise in Tennessee. Some 1,000 people in Shelby County were under quarantine orders as of last Friday.
This week, the number of local cases is nearing 2,000.
To try and stay ahead of the disease, the Health Department has shifted employees to the investigations unit. It’s received more funding to pay for overtime and can tap volunteers for extra help.
Kimble says getting people to open up about details of their lives—sometimes reserved for diary entries—takes a special touch. “The powers of persuasion” don’t hurt either.
“Some people are intensely private, and they do not trust you,” Kimble says.
"You know how important this is what you’re doing," he adds. "The patient doesn’t, the contacts don’t. They just know you’re just an intrusion on what they’re doing that day.”
As the state and county look to re-open the economy, officials say rigorous contact tracing will be a key component in order to keep the sick or exposed out of the workplace.
Every single county in Tennessee is actively contact tracing to some extent, the state Health Department says. Shelby County Director Alisa Haushalter recently said that nearly 80 percent of the local cases have been closed—that is, fully contacted.
If someone in quarantine develops symptoms of COVID, such as fever or cough, the department begins a new race to notify that person’s contacts. There is not enough staff to call every quarantined person daily, so sometimes reporting those symptoms is an honor system.
“If someone does not follow an isolation or quarantine order, we actually can take them to court to mandate that they adhere to the order,” Haushalter said at a press briefing on April 10. “Thus far, we’ve had very minimal reports that people did not remain quarantined. I can assure you, people called us fairly quickly when someone breached quarantine so that we could address that relatively quickly.”
Some countries, such as South Korea, turned to smart phones to trace people’s movements in the days before they became infected with COVID.
Companies such as Apple and Google are working on apps that would alert people if they came in close proximity to someone who has tested positive. Even though developers have promised that data would only be used for current public health purposes, privacy advocates remain concerned.
Some countries have even used electronic surveillance to alert authorities if someone breached quarantine.
Kimble doesn’t anticipate digital surveillance via cell phones mustering public acceptance.
“Of course this is brand new, but I...don’t see that,” he says. “Some countries can get away with that, I don’t know that we’re that country.”
Instead, even on his longest days—sometimes 12 hours—Kimble will continue to do it the old fashioned way: starting with a call.
“Our job [is] letting people know why you’re calling and how important it is, and how we really need your help,” he says.