Discussions on contact tracing – methodically identifying individuals who have been exposed to HIV, tuberculosis or other infectious diseases to prevent its future spread – are a staple of many health profession education curriculums.
But rarely are students able to put it directly into practice as dozens of Oregon Health & Science University and Portland State University students have during the coronavirus pandemic.
Students from the OHSU School of Medicine and the OHSU-PSU School of Public Health have worked with state and county health officials in recent months to gather information about confirmed and potential COVID-19 patients. The data they collect are helping track and slow the virus’ spread in Oregon.
Teva Brender, a second-year medical student who has done contact tracing with the Clackamas County Public Health Division since May, welcomed the opportunity after OHSU made the difficult decision to cancel student clinical rotations in March.
“Through this work, I can tangibly help with the pandemic,” Brender said. “It feels good to really help on the front lines as much as I can as a second-year medical student.”
In lieu of in-person rotations, OHSU created several virtual electives including a COVID-19 epidemiology course taught by Paul Lewis, M.D., an associate professor of pediatric infectious diseases in the OHSU School of Medicine, who also stepped down as the Tri-County’s lead public health officer in January. A total of about 40 students have enrolled in three back-to-back sessions of the elective. And, concurrently, about 100 medical students also have signed up to be volunteer contact tracers for Multnomah County.
It was through Lewis’ class that Brender initially worked with Clackamas County to earn educational credit. He and two other medical students were later hired as temporary county employees to continue doing contact tracing through the end of June.
Four days a week Brender is assigned a list of new Clackamas COVID-19 cases to follow up on. He cold-calls each individual, introducing himself as being with the county health department, acknowledges their recent coronavirus positive result, and asks them a series of standard questions to understand when, how and where they got sick, as well as with whom they have had close contact since becoming sick.
“It takes some time to explain that if they’ve been within six feet of someone else for 15 minutes, that person could have become infected, too,” Brender said, adding he’s pleasantly surprised by how many people are open to speaking with him.
Practicing public health
Since March, about 12 graduate students also have helped the state follow confirmed COVID-19 cases through an emergency contract the School of Public Health has with the Oregon Health Authority. The public health students are paid to help the state, which oversees and supports coronavirus case management – including contact tracing – statewide. If a county has a rush of new cases and they don’t have enough local staff to respond, they call the OHA, and the OHA calls the School of Public Health for help.
Initially, the students did recovery calls or checking in on confirmed patients to track their recovery. But now they are increasingly conducting contact tracing as well. So far, public health students have been involved with about 1,000 cases statewide. The school’s contract with the state to help was recently extended through the summer of 2021, allowing for up to 30 students to work part-time should the need for their services grow.
Jennifer Ku, a third-year Ph.D. student studying epidemiology, is coordinating the public health students’ pandemic case management efforts.
“This work is very important,” Ku said. “COVID-19 is a new disease and there are a lot of unknowns. We’re still learning about the specifics of the disease, and it’s important to trace infected individuals to learn more and plan future steps.”
Valuable lessons
Jonathan Snowden, Ph.D., an assistant professor of epidemiology in the School of Public Health and of obstetrics and gynecology in OHSU School of Medicine, said the school’s OHA contract is helping the public through current challenges and also preparing for the future.
“To prevent disease, you need the sound, evidence-based recommendations that come from public health,” Snowden said. “Our students are participating in the creation of those recommendations. We’re also training the next generation of public health leaders. The field of public health is being renewed by this process of collaboratively responding to the pandemic.”
Lewis, the epidemiology course instructor, agrees contact tracing during the pandemic is a valuable lesson for medical students.
“My goal is that the students not only have excellent medical knowledge, but also develop excellent empathy and understanding for their patients and the challenges they face,” Lewis said.
Brender, the medical student working for Clackamas County, knows some of the patients he advises to self-quarantine simply can’t afford to not work for two weeks. When he becomes a physician, he now expects to be more respectful of his future patients’ social and economic situations as well as their medical needs.
In the meanwhile, Brender is hopeful, but concerned, about the future.
“I’m worried about the next shoe dropping,” he said. “The cases could spike again, or not. As we emerge from stay-at-home orders, we just don’t know. I am calling so many people who test positive but have no symptoms. Because they didn’t know they were sick, they probably weren’t as careful.”