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A phone call from Sarah Swartz will upend your plans  —  at least for the next two weeks or so.

Swartz is a contact tracer in North Dakota — and often the first voice her patients hear, telling them they’ve tested positive for COVID-19, often within minutes of their lab results being reported.

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The calls come at all hours of the day. Swartz works with a case manager, who assigns a group of contact tracers to individual cases. They become a sort of coronavirus patient guide, helping people through the process of navigating their positive test result and being placed in quarantine. 

She tells people who test positive for COVID-19 what to expect, how to seek medical help if symptoms worsen and what it means to be in quarantine while the virus runs its course.

Swartz works from home, on duty whenever she's needed. The pairings with patients — who she’ll check in on over the course of several weeks — are mostly a matter of chance. 

"Whoever has the most immediate availability takes that case, and will immediately call that individual,” she said, “so it can be a turnaround of a couple minutes to 30 minutes from when that test result comes in." 

In North Dakota, contact tracers are part investigator, part coach: They help patients navigate the news that they've tested positive for COVID-19. But they also track down other people the patient may have come in contact with while they were contagious.

North Dakota Health Department reports that, on average, each positive case has about seven close contacts — each of whom a contact tracer often calls immediately.

"Or, if we have an outbreak,” Swartz said, “then it turns into a little bit more stressful situation where we need to be making 50 phone calls in a few hours.”

The goal is to contact everyone involved in a case within a day, said Brenton Nesemeier, a field epidemiologist with the North Dakota Department of Health who supervises contact tracers in the Fargo area.

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“The benefit of doing it very quickly is we are able to provide that education and gather those close contacts before even sometimes they develop symptoms so that they aren't spreading it to others,” said Nesemeier. “We want to get those contacts home and not out in the general public, as quickly as possible.”

People with a positive case are asked about all contacts in the 48 hours preceding the onset of symptoms or a positive test result. 

Swartz has worked on a few outbreaks involving dozens of infected people. 

Those are usually cases in which multiple people at a business have confirmed cases of COVID-19. It's Swartz's job to question each person who tests positive in order to find their close contacts. The people who test positive might live in North Dakota, or have been tested in Fargo but live in Minnesota.   

It's a challenge made more difficult because the pandemic has upended schedules and routines.

"You might mix up Tuesday with Thursday's schedule,” she said. “So we do little things to remind them of each day. And we'll say OK, what did you do Tuesday morning and what did you have for breakfast ... and then they remember they went to the bakery to get donuts."

Contact tracers need to educate — and sometimes reassure — the people they talk with. 

“The new cases are scared. They’ve heard in the news how bad it is,” said Nesemeier.  “We’re educating them on what to do, where to seek health care, providing education on why they need to stay home — and the importance of staying away from your elderly grandparents, your sick neighbor or your pregnant friend.”

They also offer practical advice, for example: Telling those in quarantine that they can’t go to the grocery store, but that it’s fine to be outside doing yard work. 

In the earlier days of the pandemic, Swartz was making daily calls to calling each person on her case list, to check for COVID-19 symptoms and to find out if they were maintaining quarantine. 

But now, a new electronic system sends an email to the people in her caseload every day, and contact tracers only call if a person’s response indicates that their health or quarantine situation has changed. 

That’s made the system more efficient, said Nesemeier, who estimates each contact tracer could handle 20 cases at one time. 

Swartz can't give close contact details about who might have exposed them to coronavirus, and while most people are cooperative, some challenge the validity of the test. A few have been angry and aggressive about being required to self-quarantine for 14 days.  

"I had an individual who made me cry one day," Swartz said. “They accused me of taking away their freedom and hurting their family, making it so that they're not getting an income anymore. That just really impacted me emotionally, to hear those words from somebody that I truly think I'm helping." 

The call left her upset for a couple of days, but she said she's had many more positive than negative contacts. 

Still, a flood of misinformation on social media is a constant source of frustration. She regularly pushes back against Facebook posts that downplay the risk of COVID-19 and sometimes publicly mock the work she does. 

"It hurts my heart to see all that false information, especially from friends and family that are sharing information that I know is false,” she said. “But it's also important for me to advocate for public health and show the importance of what I do."

Swartz recently graduated from North Dakota State University in Fargo with a master’s degree in managing infectious disease. She started working as a contact tracer a month before graduation. She’s one of about 60 current or recently graduated NDSU students with a public health or emergency management education who have been trained to help the state health department with contact tracing.

“Public health is very much all-hands-on-deck, and even if you specialize in something else, you can get pulled into a global pandemic situation like this,” said NDSU Public Health Department Chair Pamela Jo Johnson. “The current conditions demonstrate that we're going to need more public health professionals going forward, and this is a great opportunity to start attracting more people into this kind of work in the future.”

Swartz was hired as a contact tracer before she graduated from her master’s program, and expects to continue contact tracing as long as the coronavirus continues its spread. 

"I don't want a pandemic to ever happen again, but in my line of work, in my career, this is an amazing and incredible experience for me," she said. "It's hard work, it's time-consuming but I love it."

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