CDC
With COVID-19 cases continuing to overwhelm hospitals, an Oregon nonprofit is helping counties up and down the West Coast do an essential job better: contact tracing. The Oregon Public Health Institute launched its Tracing Health program in the summer of 2020, training hundreds of new contact tracers and helping people exposed to the coronavirus get the financial help they need to be able to quarantine. Emily Henke is the executive director of the organization. She joins us to tell us more about this program and how it fits into OPHI’s overall focus on health equity.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud, I’m Dave Miller. With COVID-19 cases continuing to overwhelm hospitals, an Oregon nonprofit is helping to provide essential public health workers for counties up and down the West Coast. The Oregon Public Health Institute launched its Tracing Health program last summer. It’s training hundreds of new contact tracers, and helping people who’ve been exposed to the coronavirus get the financial help they need to be able to quarantine. Emily Henke is the executive director of the Oregon Public Health Institute and she joins us now. It’s good to have you on the show.
Emily Henke: Thank you so much, Dave.
Miller: So how did this program come to be?
Henke: About a year ago, 15, 16 months ago, as the pandemic was really increasing across the country and contact tracing was coming into focus as the intervention that we would use to control its spread, the Oregon Public Health Institute, which is the organization that I direct, and our partners at the Public Health Institute, which is another organization with a very similar name based in California, noted that our public health agencies had a really big staffing challenge in front of them. Some of them would have had to double their staff to meet the need for contact tracing, and save lives. And at the same time, we knew that that contact tracing had to be delivered in a way that would work for communities most impacted by COVID, and most impacted by health inequity. And I would say at that intersection of urgency and equity imperative, we created the Tracing Health program. Tracing Health started as a contact tracing service for public health departments. Today, we work like you said in health departments up and down the west coast, as well as with some clinic partners. And we provide contact tracing services, focusing on primary language services where we can, hooking up people with supportive resources so that when we ask them to stay home, they can actually do that. And we also support vaccine outreach and other pandemic response efforts as well.
Miller: What are the different kinds of jobs that you’re actually training people for? Because you’re talking there about seemingly different aspects of the public health response or responses to this pandemic. And my understanding is that they’re actually tied to different job titles.
Henke: We have about 400 staff currently working in Oregon, Washington, and California. And those are staff who are delivering public health services, like contact tracing and case investigation. There are also resource coordinators who are setting up people with the financial support to stay home. But we also have epidemiologists, data analysts, people who are making all of this work in the background, including our training team, and our workforce development team, supporting our efforts to keep people in the public health workforce pipeline after this is over. So it really runs the whole gamut. When you have 400 people working, you have a lot of people in different positions.
Miller: So say, for example, in Washington County. Am I right, that that’s one of the places where you have one of the bigger footprints?
Henke:Yes.
Miller: So are the people that you’ve trained and have made available for Washington County, are they employees of Washington County? Or are they connected to your nonprofit?
Henke:They’re connected to our non profit. So they’re employed, like I am, by our organization. And that has been such a fantastic part of this work is getting to work alongside them. Before the pandemic, the Oregon Public Health Institute was a staff of three or four people. And today in the Pacific Northwest, in Oregon and Washington, we have about 150 dedicated to pandemic response. So we work as employees of the Public Health Institute, but we work alongside our county partners.
And a lot of our staff are from the communities where they’re working. That’s been another wonderful aspect of what we’ve been able to do is employ people who are members of the communities that we serve
Miller: 150 right now in Oregon. Where are you actually operating? In addition to Washington County?
Henke: So, we’re 150 across Oregon and Washington. We work in Washington County, Oregon and we also work in Clark and Skamania Counties, just across the river, and in Spokane Regional Health District, which is of course in Spokane. We’re looking forward to soon being able to bring additional support to other counties in Oregon with COVID-19 case investigation, in the hopes that we can alleviate a little bit more of that local burden of the global pandemic.
Miller: How much case investigation is actually happening now? Over the Last 18-19 months, we’ve heard varying levels that the basic model seems to have been when cases are low enough, there are enough public health resources that counties or the state, if they’re helping out, they can actually dig deep enough, they have enough time to really make a number of calls. But when cases go up and when it seems like when you’d want it the most, there simply aren’t enough resources to actually do robust tracing. Where are we right now?
Henke: You’re so right, I can’t speak to the exact number of case investigations that are happening day by day in the state. But what I can tell you is that when cases do surge, like they are right now, even though it seems like maybe we’re over the most recent peak and on the downhill side of that now, aspects of the, the case investigations and contact tracing get jettisoned, and we focus instead on the highest priority cases, like outbreak investigations in congregate facilities.
I think that maybe the easiest observation to make, even if you have no data analysis background whatsoever, if you’re looking at the epi curve, which is just the chart that shows how many cases we have over time, the easiest observation to make about COVID in Oregon and the United States is that it’s characterized by peaks and valleys. I think one of the hardest lessons that we are continuing to learn in Oregon’s COVID response and across the nation is that we need to staff at levels that can support the peak at all times. That’s something that we are hoping to be able to help with. That’s a tough sell, because people look at that and say, well, what are you going to do with all of these staff in a valley?
Miller: That was my next question. Because, let me make sure I understand actually what your argument is. I think what you’re saying is not just that we should have enough staff for the peaks until this pandemic is done, but all the time. Is that what you’re saying?
Henke: That is what I’m saying. And I would say also that there is no shortage of other public health and equity work to be done in the state of Oregon, to support our equity goals, our health goals for the communities in Oregon. There are many, many other places that staff who are trained to support contact tracing, case investigation, other COVID response, could plug in.
Miller: What are examples? Because it seems like what you’re saying is you’re plugging holes currently that should have been filled by a more robust and a more well funded public health system, in the state, or federally, to the extent that we can even talk about a federal public health system. This really is something that falls to states and then really to counties.
So let’s talk numbers first. To what extent are you arguing that our public health system, just in Oregon, at the county levels, to what extent do you think it’s underfunded?
Henke: I’m not sure if I’m prepared to talk actual numbers, as in dollars. What I can tell you is that our public health department partners have been working so hard for the last 18 months to control this pandemic. And that we have been able to help them out a little bit, and it’s still not enough, because we were starting with a system that was underfunded and under-resourced. And then a pandemic hit.
We need to see greater funding, long term sustainable funding in public health, not just for a few years from the federal government to respond to the pandemic, but on an ongoing basis. And that’s not only the ticket out of a pandemic, but it’s also the ticket to the vibrant, thriving communities that Oregonians deserve.
Miller: So if you’re training right now and putting into place contact tracers or case investigators, what kinds of things might those people be doing when and if we ever get to the other side of this pandemic? What other jobs might they do on a daily basis?
Henke: Sure. Let me start with what they’re doing now, when cases are low. Right now they are, in Washington County, for example, doing a lot of vaccine outreach. Early in the year, when the vaccine was just becoming publicly available to a select few people, we stood up a vaccine information line, where members of the public could call to get information about the vaccine or even to schedule an appointment. And the phone menu has a greeting in 11 different languages. So our team was able to support that when cases were a bit lower.
This summer, they took to the streets, boots on the ground, knocking on doors, encouraging people to come out to some mobile vaccine clinics. Standing up booths at local events, being a resource for vaccine information, and also appearing at those clinics to welcome people and help them find their way through in the language that works for them. I think that there are so many places this workforce could plug in. One of the things we talk about in public health is not only that we have a workforce shortage, but that we have a workforce that must diversify at the same time that it grows if we’re really going to improve health equity.
So there are so many places they could plug in. Climate change, opioid crisis, environmental health. So many places where connections to community are going to be what makes health equity achievable in the state of Oregon.
Miller: How many languages do the people that you’ve brought on board to do this work speak?
Henke: We have 50 languages represented on our team. It’s a deep bench of language capacity, because it’s one of the defining characteristics of our program. We think that in order for contact tracing to work and be most effective for communities most impacted by covid and by health inequity, we need to be able to deliver services in their primary language. Everybody needs equitable access to the information that they need to protect themselves and their families and stay safe. And at the end of the day, contact tracing is fundamentally a trust exercise. It is rooted in the ability to build rapport, and to ensure that somebody is deeply listening to you and providing information back to you. We find that’s a lot easier when we are able to do that conversation in a language that somebody prefers, and when our staff share the background of the people that they’re calling.
Miller: Say you have a Hmong speaking contact tracer, and they call somebody who doesn’t speak English but does speak Hmong, or we can come up with 49 other examples, I suppose. Is there data to show that you actually have a better ability to get people even to respond to a voicemail or respond to questions?
Henke: I don’t have data for that right now. I think in a lot of areas of COVID response, the research is still happening, the evaluations are still happening. I do have amazing stories from our staff, who tell me that they heard from a contact that it was the first call they had ever received from a government, from a non-profit, from whatever supportive service that was being offered, it was the first call they had received in their primary language without the use of an interpreter. Interpreters are super important. But if we can offer a service in somebody’s primary or preferred language, that’s a lot better.
Miller: You mentioned that you’ve been able to get people to work in Washington County in Oregon, and Clark and Skamania Counties in Southwest Washington, as well as Spokane County. Is it fair to say though that the counties that have been hardest hit recently by the coronavirus are, maybe for political reasons, less likely to ask for your help, even though they may really need your help right now?
Henke: You know, I would say that that has actually not come into play in the conversations that we have had with health departments that serve communities with higher degrees of the vaccine. hesitancy or barriers to vaccination, just lower rates of vaccination overall. The reasons that we find that those partners don’t approach us, or are unable to work with us, are funding. This is a very expensive intervention. This is a very human resource heavy approach. It’s necessary, but it’s expensive. So yet more reason that we need to see a better investment in public health, so that we can do the interventions that work at the scale that we need them.
Miller: Who is paying for the salaries of the 150 public health workers in Oregon and Washington?
Henke: It really depends on the county in question. Most of our counties are accessing federal support to support our partnerships with them. But they have other funding sources as well.
Miller: So even though it’s federal support, the richer counties are more likely to be able to access this support?
Henke: It’s a better question for the counties. My understanding is that some of them received direct federal assistance while others relied on some kind of secondary federal funds to be distributed to them.
Miller: I want to go back to the broadest point you’ve made, which is that we just need to make more of an investment in long term public health initiatives in our country, filtered from the federal government to states to counties. To what extent do you think that’s actually going to happen? Do you feel like you’ve seen what could be leading to a meaningful lasting change in the way people in this country think about public health? Or do you think that we’re going to go back to some version of the old status quo?
Henke: I think that we are on a pathway to success. But I don’t kid myself about it being a long road. I do think that the public health field, people like me, we have work to do around telling our story in a way that is compelling. And right now, we are up against some tremendous barriers around this information, and politics that kind of push us steps back on that pathway. But through this exercise, through this collective experience of COVID response, we have had the opportunity to tell our story more widely, and to connect with people.
A lot of people, for the very first time, have met their friendly local public health department in the last year and a half, because they got a call from someone like us, or from a public health staff, and learned that on the other end of that line, there was somebody who not only needed to give them some information and asked them to stay home, but was also a listening ear for them, was also somebody who perhaps shared the hardest day of their lives with somebody. And that’s real. We talk to people all the time who are very sick. We talk to people who are obviously in respiratory distress. We talk to people who have a loved one in the hospital or someone who has just passed away. We have been there alongside people as they go through the some of the hardest moments of their lives, and I think that that’s been an opening for some people to say “I heard from my public health department today, and that person on the on the other end of the line was a friend to me, in this time of loneliness and need.” I think that we can use that as a door to bring more people on to support public health, and help us get the support that we need from the public, from decision makers, from politicians, and make long term lasting change.
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