The Head of Cuyahoga County's Contact Tracing Efforts on Thanksgiving Spread, Your Friends' Instagram Pictures and Vaccines

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A couple of weeks ago, Romona Brazille, the director of prevention and wellness for the Cuyahoga County Board of Health, was overcome with emotion during a regular press conference on the county's current battle with the coronavirus.

“When we first started to see cases around 400, 600, 700, and then finally more than 1,100 cases in a day, I cried, because I realized what it would mean for our community. And despite everything you're doing, it wasn't going to be enough," Brazille said through tears on Dec. 4. “We're trying to reach everyone we can, and I knew when I saw those cases that we would have to start to triage. And for me personally, as a nurse, it's horrifying, but it's been necessary in the current situation that we're in. Just in November alone, we have received more than 15,000 confirmed cases, which is approximately 55% of the cases we have received since the beginning of the pandemic.”

It might have been the first time she broke down publicly, but it was far from the first time she broke down at all. It's just that all the other times had been in private.

"Oh, the first time was probably back in March, really early on," Brazille told Scene. "It was probably when I was thinking of all the healthcare workers in hospitals who didn't have enough PPE."

Now, the waves of emotion arrive for the people who will not be reached by the county's contact tracing efforts, and the people they might infect.

"Early on, the thinking was we have to get to everybody as soon as possible," Brazille said. "After November, it's an understanding that we're going to have to figure out how to target the worst outcomes, how to target the people who may spread it where we would see really bad outcomes, the people who are maybe around a lot of other people."

Contact tracing, once imagined (at least in a version of the United States with competent leadership, accurate rapid testing and widespread respect for advice given by science and public health experts instead of sports bloggers) as a way the country could begin to safely reinstitute something approximating normal life while keeping the virus at bay until a vaccine arrived, has changed since the spring.

Because of the sheer volume of cases, the county can't get to them all. And when they talk to people who have tested positive, the efforts to track where they were and who they might have exposed to the virus aren't so simple. In many cases, the exposure is obvious and singular. In others, people haven't just been to work, or to one bar. For some contacted by the county's contact tracers, they've been to work, a restaurant, a bar, a family get together, a wedding, and a backyard gathering. And in places with multiple infections, the scope of community spread means it's impossible to tell whether coworkers were exposed in the workplace, for example, or exposed via family members who were positive and just happen to work in the same office.

But there are common themes.

Cuyahoga County doesn't publicly release any of the details or data associated with the contact tracing efforts, but in interviews those who have tested positive continue to mention event gatherings, workplaces and yes, restaurants.

"But, do I know because someone went to this restaurant that that's where they were infected? So there might be several people who were all at this restaurant, but did it come from the server? Or their dinner table? It's very difficult to say. Is it a place of transmission? Probably. We've seen it based on evidence of sitting so long together, not wearing a mask, talking and laughing. It's possible," Brazille said."

And lately, those interviewed have mentioned Thanksgiving holiday gatherings.

Though the post-Thanksgiving surge in many states hasn't reached what public officials had feared because Americans seem to have taken heed of warnings and largely decreased travel and limited gatherings, plenty of folks still got together with non-household family members in group settings in late November. Incredibly sad stories aren't hard to find, including those of families who took everything seriously all year but made an exception this one time and lost someone to Covid a few weeks later.

Locally, "It's been a mixed bag," according to Brazille. "We've definitely had people discuss Thanksgiving. But, December has been really difficult; the numbers have been all over the place, with the backlog from the anitgen tests. We're not seeing the same rapid trend up like in November, but we're averaging 760 cases a day in the last week. That's a really high number."

That, combined with what we've long known about how the virus spreads, gives her the same gut reaction so many have when they scroll through the news and see stories about packed Warehouse District nightclubs or suburban bars with close to 100 people drinking with no distancing, or when they scroll through their social media feeds and see packed wedding dance floors or maskless indoor gatherings of many, many households.

"When I see that stuff, I mainly just think there's a good chance someone in that group has [the virus]. I think, Wow, they're having a really great time, and whether or not they'll find out this really great time was with someone they didn't know was sick, and now more people will get sick," Brazille said. "I had a friend post something and I was like, Why? It looked fun, sure. But, Why. And a few weeks later someone close to that family passed away from Covid. It's heartbreaking."

For those that have contracted the virus and for those that have been in close enough contact with those people to receive a call from the county's health department, the reception has been a mixed bag as well.

There are those who believed and still do that the pandemic that's killed 320,000 Americans is a hoax, that steps to contain the virus amount to tyranny.

Reports from early this year in Erie County noted that not only were more than a dozen people who tested positive refusing to stay home and quarantine but that, "The department also is running into people who refuse to help with contact tracing efforts designed to find out who might have been exposed to COVID-19. Some, in fact, have cursed at the health department workers and refuse to answer questions."

"We've had cases where people say, I don't know why you're calling me, this is a hoax," Brazille said. "But, you're the person who was sick. You're the person who went and got tested. We didn't make this up. But in general people who are the actual case are easier to talk to than contacts. For contacts, it's out of the blue. People weren't telling them they were positive and were exposed, they were just passing along numbers to use, and we're not disclosing that it was Joe, and you don't know, because Joe doesn't want you to know. Then they're mad. How did you get my number, or, I don't believe you. But for actual cases, there are a lot of times they are grateful to hear from us. They're scared. They're along. They just want information and someone to walk them through it to understand it."

That same education, albeit on a far wider and more important scale, is now happening with vaccines. Doses from both Pfizer and Moderna are now in the process of being distributed and administered to at-risk populations in nursing homes as well as healthcare professionals, some of the latter whom have said they will not take the vaccine. Among the general public, the number of those who will, at least initially, pass is also high and concerning.

In a recent survey of Tampa-area hospital employees, an astounding number expressed wariness of the vaccine and said they'd pass, according to a story from the Tampa Bay Times.

"[One] company’s recent survey of employee attitudes about the new vaccine found the most support among higher qualified employees, including physicians and physician assistants. Caution was higher among employees such as nursing assistants and phlebotomists," the paper reported.

Nationwide, polls now show somewhere between 50-60% of Americans intend to get a vaccine as soon as its available to them, which is higher than it was in September but pretty far off from what's needed to put the pandemic to bed: Dr. Anthony Fauci has said 75-80% of Americans would need to get the vaccine for life to return to normal by the end of 2021.

Romona Brazille sees those polls, and she sees the memes and social media posts, and, "I see a whole lot of unqualified opinions about it."

"The challenge now is getting out there and getting people to accept it. Getting vaccinated and getting enough people vaccinated is the only way out of this," she said. "We have other public health interventions, but ultimately it's going to be the vaccine."

And when all that work is done and this thing is actually over?

"I'm going to Hawaii," she said. "And I'm going offline for awhile."

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