Linda Vail does not want to take anybody to court.
But the Ingham County Health Officer has had to send out some warning letters to young people who refuse to cooperate with contact tracers.
“We still run into the occasions where people just flat out refuse to talk to us, refuse to give us information on their contacts,” says Vail. “And honestly, at that point, I just send them a warning letter that basically tells them that they have to. And then we can take them to court if that becomes a problem.”
When somebody tests positive for COVID, those results are sent to the county health department. Health workers then try to contact the person who tested positive, and identify any close contact they may have had with others.
Depending on when that was, they’ll also try to reach those individuals as well and inform them they need to quarantine. When it’s successful, contact tracing can effectively track and contain the spread of a virus. When it isn’t, more people are at risk.
But Vail says as the COVID cases in her county have skewed younger, they’re encountering more people who don’t return phone calls or flat out refuse to cooperate.
Oakland County’s medical director, Dr. Russell Faust, says his team is having similar problems.
Between May and June, Ingham County saw the number of COVID-19 cases in the 20-29 age range jump by 400%. From June to July, the number of 0-19 cases increased 50%. And during that same period, Vail says, her team went from meeting or exceeding state benchmarks for contact tracing (for instance, the rate of cases where they successfully get an interview within 24 hours of receiving a positive test result) to falling behind.
It’s entirely possible that would have happened, regardless of the age of the people health workers were trying to reach. Contact tracers everywhere, from New York to California, say they encounter mistrust, confusion, and even hostility from people of all ages. Christina Zilke, a contact tracer in Washtenaw County, says they’re not having any issue doing contact tracing with young people.
But Vail and her team are trying to adapt their contact tracing methods for a younger generation. They do follow-ups and check ins via text now. They worked with the phone company to set up an outgoing caller ID that says “Ingham County Health Department” for the contact tracers working from home on their cell phones. And when it comes to college students in the area, Vail says they’re already working with Michigan State University.
“They have a little bit more leverage with their students,” Vail says. “Some are on scholarships, and different sorts of things. And it's like, ‘No, you really do have to really do have to cooperate with the health department.’”
Not just dance parties on the lake
“Making it confrontational is never a good way to go with our clients,” says Nicole Bongers. She’s a social worker at the Corner Health Center in Ypsilanti, where the mission is “providing judgment-free, affordable health and wellness care” to young people. And she says, you have to understand where they’re coming from.
"It's always, how do you find what they care about? How do you stand alongside them, get on their side and say, ‘Okay, how do we solve this together?’ That's always the approach that works best.”
Viral videos of young people having 4th of July blowouts in Cass County, or news coverage of graduation parties that lead to outbreaks, are giving the public the wrong idea, says Dr. Tammy Chang. A family physician and researcher at the University of Michigan, her team runs “My Voice,” an ongoing public health poll of young people.
The data she’s seeing paints a very different picture.
“The majority of the young people are not only following the guidelines, but the reasons why they said they were following the guidelines...is because they care about the health and well-being of others,” Chang says.
Bonger says her clients are sometimes at greater risk of contracting the virus, even if they follow all the guidelines.For those in high school, even if they have a driver’s license, they often don’t have a car and need to take a ride share or the bus to work, she says.
Without a high school degree, they’re doing jobs where it’s all but impossible to socially distance - behind the counter at CVS, stocking shelves at the grocery store, or being an aid in a nursing home.
Not working isn’t an option either, in some cases, when they’re relied on to help pay their family’s bills, especially at a time when another family member may be out of work right now.
And then at the end of that day, they’re told they can’t see friends, despite being at a developmental stage when connections with peers are crucial, says Nike Griffin, a behavioral health manager at the Corner Health Center.
“They're desperately trying to find ways to see their friends, because they're feeling so socially isolated,” Griffin says. “And the social isolation leads to depression and anxiety and often can go further and lead to thoughts about suicide...So I think we’re forcing them to comply with rules that are designed for adults to understand.”
Even for young people who are adults, social distancing can seem like a luxury that’s out of reach.
"It's a bit of a nightmare,” says Steven Mace, 29. A graduate student and instructor at the University of Michigan, Mace lives in a co-op house that had 12 people living in it when the pandemic began. One of their housemates is dating a doctor, who tested positive for COVID in the spring.
“It was an intense Zoom call, because at the time we were zooming each other from different bedrooms of the house [to social distance,]” Mace says. Everyone quarantined, he says, but there’s still a lot of turnover among the residents that they can’t control.
“Yeah, we're imagining it's going to be a horrible semester,” he says.
Megan Kubit, 24, is just now recovering from COVID-19. She believes she got it at an outdoor memorial service she and her boyfriend recently attended. Everyone was socially distanced and wearing masks, she says. But days later, the pastor called to say someone at the service tested positive.
Kubit got tested, just to be safe, and was stunned when the results came back positive. Over the course of several days, she spent more than 2 hours on the phone with a contact tracer from the Benzie-Leelanau Health District. Her symptoms were mild, but she did have a stuffy nose, a sore throat, and blisters on her hands.
She ended up needing to quarantine for several days. “My parents were able to bring me food and drop it off. And my friends would call me, and my brother and his girlfriend dropped off puzzles and things to do. So I felt pretty lucky,” Kubit says.
Using young people to help with contact tracing
Young people want to help fight this virus as much as anyone, Chang says. But they’re not getting enough clear messaging about who contact tracers are, and why they’re calling to ask personal information, she says.
“Who is going to know it, and what are you going to do about it?” Chang says.
Which is why one of the first messages she says contact tracers have to get across to young people is: no matter what you tell us, you are not in trouble.
“If there's any perception that contact tracing results and negative consequences for the student and or the people that they were with, that's gonna be really tough for us,” says Angela Beck, an associate dean for student engagement and practice at the University of Michigan School of Public Health.
She’s developing the contact tracing team for the university, just as thousands of students are starting to arrive back on campus.
“There have been some questions about, ‘Do we have enough capacity to contain the spread of students, and especially groups of students, [who] choose not to follow the risk mitigation behaviors that have been laid out?” Beck says.
Which is why they’re recruiting students from the School of Public Health to do some of this contact tracing themselves - both because they need the manpower, and because they hope the student-to-student interaction will build trust.
Beck says they’re also having students help write the scripts these contact tracers will use.
“What I think might sound good, might actually not be how they interpret it,” she says. “So we’re still working on refining it over the next week or so.”
Contact tracing will also be a key part of figuring out who needs help, Beck says, from a place to stay while they quarantine, to grocery delivery, to follow ups to make sure a student’s symptoms aren’t getting worse.
“So this whole system of testing, tracing and containing the spread of that virus through quarantine and isolation measures really has to work together smoothly,” she says. “But communication and trust is really the foundational piece of it.”