A Contract Tracer on Her Overwhelming Job

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S1: When you pick up the phone, you do not want to hear Caylee Langtang on the other end, not because she isn’t kind she is, but because her job is to deliver bad news.

S2: I try and sound as nice as possible just because it is not the most pleasant thing to hear that you have coronavirus.

S1: So you’re telling them they have covered first?

S3: Yes, some people have been notified. I would say it’s like 50 50. Some people have been notified by their testing center or their clinic. Others have no idea.

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S1: Caylee’s a contact tracer. She works in North Dakota, a place where the infection rate has been soaring.

S3: How soon do you know if it’s going to be a good call or bad call, basically right off the bat you can tell by somebody’s tone of voice if they are not happy with you and they do not want to talk to you. You can tell right away.

S4: Some people cry, others get mad, say the virus is a hoax. But no matter how her patients react, Caylee has to keep calling them day after day to see how they’re doing.

S3: The whole time I’m trying my best to change their mindset, I’ll make a couple jokes when it’s appropriate, I’ll ask them about their life.

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S1: Have you met someone who’s changed in the course of this, someone who started out as resistant to what you had to say and then gradually became less so?

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S2: Yes. As soon as you asked me that, one person came to mind. And unfortunately, they are one that passed away. I mean, they were not happy with me at all. They were they didn’t think that this was a big deal. They didn’t think that they needed to be concerned.

S5: It was a cold. It was just a virus.

S6: And then as things progressively got worse, then that’s where it came in of, OK, this might be real or what do I do? Or the constant calling and questioning of is this OK? Should I go in? Should I go in? Should I go in? And yeah, I mean, unfortunately, eventually they did go in and they didn’t leave the hospital alive. It must have just gutted you. It did. Yes, that was one that I didn’t hear from for a while. And then I kept trying to reach out and wasn’t hearing anything, ended up being able to contact family and got told that they were on a ventilator. And then that was basically the sign that I got out of this isn’t going to be good. This is this is going downhill.

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S1: The first thing Kayleigh does when she starts work for the day is check for death notifications in the state computer system. If one of her patients has passed away, she doesn’t want to keep calling them, but those notifications can lag behind. So then she double checks, reads the obituaries. That’s how she learned this person passed away. After her first contact died, Caylee made a promise to herself that she would not keep count, adding a bitterly cold like she was flattening people into some kind of statistic. Her work is strangely intimate.

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S3: She tries not to lose sight of that, especially the people that I have personally gotten to know or I should say personally, but have been more connected with I will call their family and just say, you know, I’m so sorry for your loss and this is horrible. And I’ll send flowers or a letter or something like that. And there’s been multiple times that I’ve been told that my name is all over their house. I mean, the family goes to clean out belongings and my name will be on a bunch of different notes and different questions to ask. And their whole mindset at that point was to call me back.

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S7: Is that what you anticipated when you became a contact tracer?

S8: Not at all. No. I anticipated maybe a couple deaths that I would have been involved in or would have been a part of. But the volume of deaths that are coming in and the amount of deaths that I have been a caseworker for is very unexpected.

S7: Today on the show, Caylee’s job is essential and gutting and getting harder every day, but she’s one of the few people gathering clues about how this pandemic is spreading. So I asked her to tell us what she’s learned. I’m Mary Harris. You’re listening to what next? Stick with us.

S1: I want to give listeners who aren’t in North Dakota a sense of what it’s like there right now. I just wonder, like if I landed in Grand Forks, which is where you are tomorrow, would I know there was a pandemic on? Like what I see people in masks or would it be kind of business as usual?

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S9: For the most part, it’s business as usual. The only difference is you will see masks at like Wal-Mart or Target. You’re required to have face masks on in almost every store at this point, especially now that our county and city has a mask mandate. But in general, I mean in apartment buildings, I mean, for example, my apartment building that I live in, we’re supposed to have masks on in the hallways and anywhere like that. And you won’t see people doing that.

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S1: Have you seen people disagree about masks?

S9: Not my neighbors. Know what I would say. The biggest thing that I have seen is as silly as it is, is that Wal-Mart actually and I’ve seen a lot of people getting into heated yelling matches with the Wal-Mart employees, saying that they don’t need to wear a mask. It’s stupid. It doesn’t work. Why would I need to do it to my right to not wear a mask?

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S1: It’s just sad. Yeah. And we should we should be explicit that, you know, North Dakota didn’t really lock down in the way other states did and managed to avoid big outbreaks in the spring. But now is seeing this tremendous surge. And your governor just put in place a massive mandate like in the last few days.

S5: Yes. And the actual mask mandate for the state, each individual county has the authority to basically overrule that, which to me seems bizarre. I know of at least one specific county in North Dakota that they said we’re not enforcing it. I mean, this might be an executive order by the governor, but we’re not going to enforce it.

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S1: Do you think sort of avoiding a shutdown in the spring and and the lack of consequences then sort of lulled people into this sense? That will be fine?

S2: Yeah. Yeah. No, I yes, we were locked down until May 1st of this spring. And then at that point, once, May 1st came around, everything opened up business as usual. It was fine.

S5: And I remember I had panic attacks.

S2: If I’m going to be completely transparent about opening back up because I knew that it wasn’t going to be good. I do understand the economic side of things. I do understand that small businesses have to survive people’s livelihood. I mean, waiters, waitresses, bartenders, whatever it would be. I understand that.

S3: But I knew that it wouldn’t be great for the virus.

S1: How did you know that?

S3: I just basic science, as bad as it sounds, is studying nursing school graduate in the spring.

S1: Her classes have all moved online, but this semester she’s been doing weekly clinical shifts at the hospital in Grand Forks. So she’s seen the creep of covid from a couple of vantage points from her computer as a contact tracer, but also from the hospital as a nurse in training. So walk me through that. Like when you go from the outside world to inside the hospital, does it feel like you’re going to the moon or something?

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S10: Yeah, kind of, yeah. I mean, they’re struggling and it’s not it doesn’t have to do with necessarily. Oh, there’s not rooms. There’s not beds. It’s the staff. I mean are the staff is so run down and struggling then you come back out and it’s like a whole different world because outside it seems like oh no cares in the world it’s all fine. And you go in the hospital and I mean, nurses are being floated to all different types of floors that they’re not supposed to be in. But it’s they have to because there’s no staff to help the people. And most of the floors are full of people that had covid and now they no longer are infectious with it. But now they have the repercussions of it, whether it be strokes or pneumonia or blood clots in their lungs. It’s horrible.

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S1: Kaili trained up to be a contact tracer back in the spring, but it took the state until August to hire her. Kaili says the work started off pretty manageable. She put in fifteen hours a week call people who tested positive for covid. She calls these people cases.

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S11: Every time you call the case, you had to get their contacts and you close contacts. And I mean, just to be abundantly clear with it, it’s any. Ed, within 15 or within six feet of for 15 minutes or more, I mean, at one point where one of you didn’t have your mask on. So if both of you had your mask on, that’s fine. But if you didn’t, we need to listen. And would you just get a list of numbers at the beginning of the day like here, people to call you up? So we would get assigned cases and then you’d call the cases and you would go through the whole interview. Eventually towards the end, you would get to that contact list and saw that contact list. They would give you you’d give them the definition who fits who in your life fits this criteria at that point? Then you would get their names and their phone numbers. And then once you get off the call with the case, you have to call every single contact and call those people and let them know that they need to isolate or we call it quarantining because it’s a little bit different rules. But quarantine for at least 14 days.

S1: And then if you found a positive case when you called those contacts, would you then be contact tracing that person to see you were just reaching out to more and more people?

S11: Yes, you have. So if I ended up calling one of the contacts and the contact is like, oh, yeah, well, I’m already a positive case, like, I’m already positive. So then at that point, since I already have them in the system, I would basically be assigned to them and then go through their interview, get their contacts and then contact all those contacts. It’s just a lot of time on the phone.

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S5: It is. But you said in the beginning it was manageable. Yeah. Yeah, no, it was. And it was it was doable. And it was it wasn’t terribly hard.

S6: I mean, it’s not it’s very systematic.

S1: When did you sense the job changing and getting ramping up?

S5: I guess there were more and more cases. And so it seemed like it got busier and busier. I mean, as soon as you finished one case, you had to go to another case and then another and then another. But I can say that when it changed drastically is when we were notified that we are no longer contact tracing and we no longer are contacting any close contacts. We are only calling cases. How did you get that notification? So we have weekly meetings that we have to go through. We have training to stay up to date, everything like that. And in our actual meeting, we basically got a notification from our manager saying, all right, the state has changed. We are no longer contact tracing us are now case investigators. You are now just talking to cases and getting their information and telling them that they need to contact their contacts and not us.

S1: How did everyone react when they got that news?

S5: I think some people were OK with it and it was like, OK, sounds good. That’s how it is.

S11: I was upset and maybe this is my own personal issue that I’m not trusting, but nobody wants to call their friend and be like, hey, sorry, I’m positive. And you need to quarantine for 14 days. I mean, it’s not a comfortable conversation to have with anybody, much less like your family or your friends. And when you’re telling your friends that it’s not as official or as serious, I think compared to when a state contact tracer calls you. So I think to me it was it was hard to accept. So it was like, oh, my heavens. Like, this is just going to make the numbers go up. More people aren’t going to call their friends or their family and tell them people aren’t going to want to break that news to their friends.

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S5: I mean, that’s it’s almost like in my head I can see how people would be embarrassed or be discouraged from doing that. And so it made me scared. I understood the reasoning behind it and why we had to switch to this. But it’s it scared me. Still does.

S1: But I wonder, too, if you felt like while the work was getting harder. You were also able to figure some things out through your job, like through your contact tracing, you could alert people, but then also begin to unravel the mystery of where someone might have contracted the virus or, you know, what kind of events might have spread it. Like there’s been this debate among some politicians and scientists about, you know, our small gatherings spreading the coronavirus. Is it something else? Is a big gatherings? Is it people without masks? Because the people what is it? And originally your job was about helping to figure that out.

S12: Mm hmm. Yeah. Where did you go? I mean, where you at a house party? Where did you go out to eat somewhere or did you just go to the office and your whole office has cases? I mean, it gave so much. It was almost like being Nancy Drew for the virus. I mean, you were going back and forth and trying to analyze everything.

S1: Was there a time when you were able to figure something out like, oh, it was the wedding or, oh, it was that dinner?

S12: Yeah, and it was a lot of it came down to working in offices, which is so weird to think of, but it would be oh, like the whole office. Everybody in the office is a case.

S5: I mean the most common thing I hear is especially with the fall time is people saying, well, I thought it was just allergies. And then I lost my sense of taste and smell and I decided to get tested and I was positive. And so by the time we actually get a hold of them and by the time we actually have a test from them, they’re already done with their isolation period. They’re no longer contagious, but they were around everybody else while they thought it was allergies.

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S7: After the break, why Cayley’s contact tracing job got a lot harder this fall. Back in a moment.

S1: So what is your job look like now? Because my understanding is that you’re still a contact tracer, you’re just not tracking down people’s contacts.

S5: Yeah, yep. So now it’s only cases.

S11: And so I, I mean, I wake up, I have some coffee, I have some breakfast log on and get a list of people to start calling and I’ll contact them, call them, get their information, get their monitoring set up so I can see how they’re doing, answer any questions, give them letters. Basically they’re called I need to isolate letters so they can show that to their employer if their employer needs proof that they cannot come into work and tell them, OK, like reach out if you have any questions, this is my phone number. You can call me. You can text me at any time. And if anything, we’ll talk to you on your last day of isolation.

S1: I wonder if you can talk about how your conversations have changed with people from when you started in August until now, because you said how it was a pretty manageable job in the beginning. You know, you log in and get phone numbers, talk to people. I wonder if the tenor of the conversations changed as more and more people became infected.

S6: Yeah, so it definitely did. People are more resigned now. You call them and you say that you have covid. And obviously the people are so upset. It’s still an upsetting thing to hear. But it’s everywhere.

S11: Every single place that you can go right now, if it’s at a gas pump, if it’s to Walmart or Target, if it’s just to your neighbor’s house to have a dinner, I mean, it’s everywhere. And so when you call people and you say you have it and one of our screening questions that we have to ask is, do you have any idea where you could have gotten this? And their answer is always honestly, it’s a mystery. And I have no idea. Nobody knows. I’ve had some of the safest people that they’ll say, I have been so careful. I have worn a mask since day one. I have not gone anywhere. I don’t go to restaurants. I don’t go to bars. I don’t go to parties. I don’t see anybody. I’ve been locked down and they still get it. It’s almost like a defeating thing to hear.

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S1: It’s heartbreaking to be the one to give that news and then to just hope that they’re OK when I imagine sometimes that’s the call to like you call someone and they have kids, they have a partner and everyone’s in the same situation.

S6: Yeah. The hard thing is when you’re calling a mom who I’ve had single moms to three kids and all the kids are sick and she’s sick and she’s miserable. And then I’ve had families of five with mom and dad are sick and all the kids are sick and miserable and they just don’t know what to do. And immediately what comes to my head is what happens if one of these parents have to go into the hospital? How much strain is that going to put on that poor family dynamic? Because one of the parents is in the hospital and nobody can go and see them?

S12: Obviously, that’s not something that I share with the cases. I don’t want to scare them. I want them to remain as calm as possible. But I think at this point, people, when they get told they have coronavirus, that’s one of the fears that come into their head.

S1: You and your own family were exposed to covid in the last few weeks, is that right?

S12: That is correct, yep. My parents both were cases.

S5: I actually had seen them.

S13: So I was exposed. I was a contact I needed to isolate, which I did, and then basically kept calling them. I mean, I called them every day just to check in. My father has some health conditions and so I was very worried about that. My mom was OK if she was doing fine, but it was concerning. I ultimately started getting some symptoms and that was even concerning some like here we go. Oh, no.

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S1: OK, did you ever talk with the people you were contact tracing about your own sickness or your parents’ sickness?

S12: Yes, the ones that I were that I was closer with, if it had come up and they were really struggling and they were really upset about being in quarantine, I would say, look, I get it. I’m in quarantine right now, too. I know it’s a huge wrench in the plans of life. I was able to say, you know, my own parents are going through it right now. I understand your fears and we’re here. We’re going to get through it. We’re in it together, as cliche as it is at this point.

S1: There’s this logic of individual responsibility that when I look at what happened in North Dakota, it just kind of suffuses all of the decisions, especially from government, where the governor held off on a major restrictions on people and and as you said, put some loopholes in the restrictions he did put out there. I wonder if you would pinpoint. Something or someone that’s failed here.

S6: I feel like the government for North Dakota is failing, it’s not going well at all, there’s not enough economic support for businesses to actually shut down when they should. I mean, we we finally have this massive mandate, but it’s it’s too late for that. That will help the spread.

S5: Of course, masks work, but the amount of people that are sick, it’s like putting a Band-Aid on a bullet wound right now. I mean, it’s it’s sad because I don’t think the health and well-being of other people are being prioritized.

S6: And what scares me even more is what’s going to happen when this is all over. What do you mean by that? We’re going to have so many people that have passed away and so many people that are traumatized, whether it be from being sick themselves or people that have had family members pass away that passed away by themselves alone or if it’s health care workers or frontline workers in general.

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S5: And so it scares me is what are we going to be left with?

S1: It’s a little startling to hear you speak like this, when we got on the phone, you had this manner that I very much think of as like a nurse manner, very efficient, happy, chipper can do. Any time I’ve been in a hospital, I feel like I’ve met someone like you and they’ve made my experience better.

S6: Mm hmm. But it sounds like it sounds like this has pushed you to an edge.

S10: Yeah, I would say that goes for a lot of people at this point, you put on the strong face and the smile and all of that, but I think it’s important to also recognize the pain that’s behind this and the tragedy and. I mean, all of the ugly sides of it, because there’s a lot of ugly sides to it, and if people don’t hear about that and they don’t talk about that, nothing is ever going to be done. Nothing’s ever going to be understood.

S7: Kelly Langtang, thank you so much for joining me. I’m really glad you’re healthy. I’m glad your parents are healthy, too. Yes, well, and I hope the same for you guys all on your show as well. Cleeland Langtang is our final year of nursing school and working as a contact tracer in Grand Forks, North Dakota. She says she’s going to keep doing that contact tracing job until it’s not needed. And that’s the show What Next is produced by Daniel Hewitt, Alan Schwarz and Mary Wilson with an assist from Frannie Kelley, we are led by Allison Benedikt and Alicia Montgomery. I’m Mary Harris. You can go find me on Twitter. I’m at Mary’s desk or you can just stick around this feed. I’ll catch you back here tomorrow.