This is part one of a three-part series on the evolution of Multnomah County’s COVID-19 response team. Be sure to keep an eye out for part two and part three.
‘People were scared and wanted information’: A system springs up to address an unfamiliar, spreading virus
In March 2020, there were many unknowns around the novel coronavirus, which quickly came to be known as COVID-19. Should people wear a mask, and if so, what kind? How does social distancing work if you live in a multi-generational home? Is it safe to go outside? Should I be stockpiling toilet paper?
Yet, during that uncertain time, there was no unified resource center where people could go to find information.
To respond to this need, Multnomah County set up the COVID-19 Call Center. On March 11, 2020, Chair Deborah Kafoury declared an emergency regarding COVID-19 and the first call logged by the Call Center was nine days later on March 20. Initially, the Call Center consisted of a small team of employees from the Department of County Human Services’ (DCHS) Aging and Disability Resource Connection Helpline.
“When COVID-19 hit, our colleagues in DCHS were one of the first to pick up the phone and ask us what we needed to help respond,” said Jessica Guernsey, Health Department public health director.
DCHS team members shifted some of their work to support the new COVID-19 Call Center on a part-time basis. Everyone believed the Call Center would demobilize after a few weeks. Bob, a lead with the Call Center since June 2020, recalls hearing they might receive a dozen calls a day.
“The very next week, we were seeing hundreds of calls every day. Testing came online and everybody wanted it,” he said. “I did not expect to be here more than a few months. I thought it would be over by the end of summer.”
Julie Hackett, the COVID-19 Call Center supervisor, described the response team as a three-part relay race to help people access services. The first part of the relay was the Health Department’s Communicable Disease (CD) case investigation team. Once an individual tested positive for COVID-19, a case investigator would contact them to provide public health guidance in their preferred language and ensure they understood how long they needed to isolate or quarantine, depending on their situation.
After this initial contact, the CD team passed the baton to the Call Center, which would work with the caller to assess their needs. With that step complete, the Call Center would refer them to a culturally responsive community-based organization (CBO) or the County’s wraparound service provider, Bienestar de la Familia.
The CD program has performed contact tracing for communicable diseases like measles and tuberculosis long before the emergence of COVID-19. Sara McCall, the CD team lead, explained that when her team first heard about an odd pneumonia in China in December 2019, they simply started folding it into the other ongoing communicable disease work.
“We started learning about COVID-19, putting it in our database, investigating and doing contact tracing,” said McCall.
“Our first case was Jan. 23, 2020. From there, the volume of cases rapidly increased as testing became more available and people were learning about it. And then we had to ramp up our team.”
Prior to COVID-19, the CD case investigation team had a staff of five. During the summer of 2020, the team, which was composed of contact tracers and case investigators, increased by 70 people in the span of two months. At its peak, the team had over 100 people.
The CD team had two functions: case investigation and phone triage. Every day, team members would answer questions from the public or take case reports from providers.
“In the beginning, our phone triage people were definitely overwhelmed; it was a brand new disease and people were scared and wanted information,” said McCall. “We could provide information, but we still didn't have a great mechanism to refer people to services.”
Early in the pandemic, when the goal was to defeat COVID-19, a case investigator would connect with an individual who had tested positive to determine their situation and identify their contacts. At this point, the initial person’s contacts could opt in for active monitoring, which involved a daily call or text for the remainder of each contact’s quarantine period.
While the CD team continued to focus on case investigation and contact tracing, the Call Center handled active monitoring. During their busier days, Call Center staff called between 40 and 60 people who had opted in for daily phone calls.
Even though active monitoring increased the team’s workload, people appreciated receiving the daily calls, Bob said. “People would tell me how nice it was to talk to me again, particularly some of the older folks who were dealing with the compounding issues of social isolation that came with the lockdown.”
Over 11 weeks between September and November 2020, the Call Center made 4,500 active monitoring calls. After Thanksgiving and another surge in cases, the CD team shifted resources to increase case investigation and outbreak response, which meant contact tracing would come to an end. Working in tandem, the Call Center switched their focus from daily active monitoring to helping community members access COVID-19 vaccines, which were approved by the FDA on Dec. 11, 2020.
