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?Freddy Gray:With technology and particularly those kinds of things here is a question of, "Wow. You know where I've been. Or, you know who I've been around." And those are just some of the built in sensitivities that you have to honor and some people are very uncomfortable about providing that intimate insight into their personal lives and professional lives.Speaker 2:You're listening to Further Together, the ORAU podcast, join your host, Michael and Jenna, as they discuss all things ORAU, through interviews with our experts to provide innovative, scientific, and technical solutions for our customers. They'll talk about ORAU's storied history, how we're impacting an ever changing world and our commitment to our community. Welcome to Further Together, the ORAU podcast.Michael:Welcome to Further Together the ORAU podcast. Good morning, Jenna, how are you?Jenna:I'm doing well. How are you, Michael?Michael:I'm doing great. Thanks. We have a really interesting topic, this episode, related to all things COVID-19 which the entire world has been talking about. It seems like forever now, but five months anyway. We're going to be talking about, in this episode, contact tracing. If I can say that correctly.Jenna:Say that five times fast Michael.Michael:Exactly. Contact tracing.Jenna:Yep.Michael:With us today, we have Freddy Gray, Julie Crumley, Rachel Vasqunez and Jennifer Burnette from our health communications marketing team. And they're going to tell us really quickly who they are. And then we're going to jump in with some questions.Jenna:Welcome.Michael:So Freddie, I'll let you start. If you don't mind, tell us who you are and what you do.Freddy Gray:Sure. No problem. Thank you. And thank you for asking us to do this. So good morning, everybody. My name is Freddy Gray and like Michael said, I'm the director of our health preparedness and health communications and response programs within the health energy and the environment program. I've been at ORU for about 27 years. And our program supports our work with the CDC, the Center for Disease Control and Prevention in identifying and trying to look for ways to mitigate the surge of patients on the healthcare system.Michael:Thank you, sir, Julie.Julie Crumley:Sure. This is Julie Crumley and I have been with ORAU for about eight years and focus on evaluation and assessments, in particular of late, for public health healthcare emergency and response activities. And thank you for having me.Michael:Thanks for being here. Rachel?Rachel Vasqunez:Good morning. I'm Rachel Vasqunez. I am a project manager at ORAU and I'm happy to be here. I worked in public health and been at ORU for 11 years.Michael:Thank you for being here and last but not least Jennifer.Jennifer Burnette:Hi, Jennifer Burnette here. I'm also a project manager at ORU. Have a background in public health and started working in public health preparedness and response back in 2013, particularly with a focus in medical countermeasures. So excited to be here.Michael:Awesome. Well, we're very glad to have the four of you with us today talking about a really important issue that we're hearing a lot about certainly in the news, but is very important from a public health perspective. We're talking about contact tracing. As states have begun the process of reopening for business, we're hearing quite a bit about contact tracing. Tell us what contact racing is.Rachel Vasqunez:Thanks for that question, Michael. This is Rachel. That's a very important question. Basically, public health professionals try to use science and data to protect their health of their communities. So contact tracing is a piece of that. It's a process, of course, that makes an attempt to identify people who have an infectious disease or an exposure to an infectious disease, such as COVID-19 and then uses resources to contact that person and then find out all the people that that person has come into contact with over the period that they may maintain they are infectious. So using that information, they help isolate those people. That's the basic framework of contact tracing.Michael:In the context of reopening businesses and government agencies and allowing some of the social distancing requirements to be lifted or adjusted as things are moving forward. Why is contact tracing so important, particularly right now?Rachel Vasqunez:Contact tracing is key to being able to, first of all, identify who has been exposed and then use that information to identify people that that person might have come in contact to so you can isolate those people so that they don't spread the disease farther. So we know with COVID-19 that there is a large proportion of people who are asymptomatic, who don't have signs and symptoms of the disease. So contact tracing would help identify people and ask them to isolate. So if they are symptomatic or they do have symptoms that they don't spread it throughout the community,Jenna:So what is our, meaning ORU, and in the group that we have on, what is our experience and expertise in contact tracing? How does it relate to ORU?Rachel Vasqunez:We at ORAU take a whole system approach. We really feel we have the capabilities to, first of all, help find people who can do contact tracing, and then help train those people to be able to perform the functions, because contact tracing is not just finding people and identifying their contacts, but it's more like being culturally sensitive. And you have to know some of the medical background and be able to speak about those things and then being sensitive. Because if you're telling somebody they may be exposed to as a disease, there are some sensitivity issues. So at ORU, I think that we really have the capability to help in all those areas.Jennifer Burnette:This is Jennifer. I would jump into that too. Even in smaller outbreaks in communities, like for instance, meningitis outbreak at a college, there's so many complexities with contact tracing that it's not just contact tracing that you have to look at, it's the whole system and everything that's involved in response to what's going on. And that's something that ORU has a lot of passive [inaudible 00:07:47] communities and states and local officials to help figure out the best path forward for those types of responses.Michael:So the work of contact tracing requires a lot of hands to be work. And you mentioned, very briefly, about finding people to do that. How do we go about that process of how do we find those people to do the contact tracing?Jennifer Burnette:When you're talking about responding to a public health emergency or any kind of emergency, there's all kinds of levels of skill sets that you might bring into the emergency from volunteers who are just interested in handing out water or doing whatever they can to help to much more specialized individuals who are doing epidemiology work and running the response at a higher level, things like that. So with contact tracing one of the, I think, biggest barriers, particularly, because we have an estimated a hundred thousand plus contact tracers needed across the country, is that it can't just be necessarily that person that's handing out the water, you need a little bit more of a specialized skillset, and there are a couple tiers or levels of skill set that might be needed.Jennifer Burnette:And ORU has a background in working with universities and other groups across the country to place specialized skills depending on what the company or federal agency is looking for. So we have a good mechanism for that, that we think we can help place some of these people and get them the skillsets that they need. We have a [inaudible 00:09:46] system, we have certified recruiters. Our [inaudible 00:09:50] system is all encompassing as far as being able to recruit, manage and coordinate those individuals as well.Michael:Awesome. And then of course, once you have the people, once you find them, they have to be trained. What does that training piece look like?Jennifer Burnette:Training, I think, one of the biggest things, it's not just going to be some off the shelf training that's going to work for every community. When you think about community, we're not just talking a local, small community, it could be, we may be talking about different states or even the contact tracing approach is going to be different across different countries. So one of the biggest things we would look at with training is trying to make sure it's unique and tailored and specialized to what that community needs. Particularly, if you look at, there will be different approaches for a rural or frontier town compared to an urban city, they're going to have different technology access, they're going to have social distancing requirements, their environments are different. And so taking all of those things into account when we're looking at developing a training that's really going to be useful and effective for the people who are in those environments.Michael:We thought about that. That's really interesting. The thought of really the training has to be... Really the contact tracing itself is going to be tailored depending on where you are, what the environment is, what social distance requirements look like.Rachel Vasqunez:I imagine that makes it so much more difficult too, having to tailor it to each individual area.Jennifer Burnette:Right. And Rachel mentioned, I think it was Rachel mentioned earlier, and Richard, you could talk a little more about this. The people that you're dealing with as well, there's all these nuances and people are scared. You have to remember that they're individuals too. So there's that whole component as well, that needs to be trained. And you have to go in there understanding that you have to work with compassion and it's not just drilling down a checklist, that kind of thing.Michael:So there's a level of empathy involved as well.Rachel Vasqunez:Definitely. You need to keep mind of, if you were in this position, how would you like to be approached for this issue? So having the interpersonal and cultural sensitivity skills and be really good at empathy and communicating while maintaining your empathy is really important.Michael:How long can the period of contact tracing last? I suppose it depends on the situation, but is there a beginning point and an end point? Does it depend on the numbers of cases that are still being determined, all of that information?Rachel Vasqunez:Contact tracing, as I said, it is a process. So you have to look at how your community is doing and sees the health of your community, are the cases decreasing. And then we've seen throughout the world, some countries have relaxed shelter in place restrictions, and then cases have emerged again. So you really have to look at how your community is doing before you can decide if there's a starter and as end.Michael:That makes perfect sense. So how can we, being ORU, help public health officials analyze their data, capture lessons learned, all of the important things that go along with contact tracing and what happens next. And, I guess, ultimately making decisions about continuing to move forward and reducing social dismissing requirements and that sort of thing.Julie Crumley:This is Julie, I'll start on that one. So I think that evaluation and the assessment, that's really something that occurs throughout the cycle of activities. So not just at the end, but really starts at the beginning really during the planning phase. And so all the way through the response and recovery and just like a cycle. So essentially that might look like, evaluation wise, needs assessments, assessing plans and capabilities, process evaluations, how well are a variety of activities being implemented? Outcome evaluations, how well are they doing? And then improvement and quality improvement, and then repeat.Julie Crumley:So I think that for contact tracing in particular, it looks at things like, how well did a variety of activities happen. So be it the training that we spoke about the actual contact tracing efforts, different individuals and staff and looking at how well activities are happening to assess group facilities or one on one individual households, things of that nature, different populations like somewhat Rachel was speaking to with the cultural aspects. And then the analysis, does the surveillance and analysis and being able to identify what is working well and what maybe needs some adjusting. Adjusting, and even things, activities changing up a little bit to improve abilities to do contact tracing and to improve the time that it takes to do that so that we can reduce the spread.Michael:Awesome. So obviously there's a lot that we're looking at to make those very important decisions. If you were making a pitch to a local or state or federal government official about our contact tracing capabilities and our ability to help them out, what would you tell them?Freddy Gray:Hey, Michael, this is Freddy. I can jump in on that one and then other people can chime in. I think this is really a fascinating question because first off I tell them, thanks. I tell them public health people, thank you. They've done an outstanding job in a very challenging and difficult environment. It's the differences between preparing for an event and actually living in the event. So preparedness is basically like Julie and others alluded to, you look at to develop your plans, how am I going to approach this potential activity or event? And then I need to train people to identify their roles so that they know what the expectation and what their role would be during an event. And if there's not an event go on, you create this simulated exercise or an activity that gives you a fake event, so to speak, so that you can test to make sure that the plans are accurate and that they can be achievable and that people understand their role.Freddy Gray:And then as those are going on, you evaluate the success of that or opportunities to improve those plans. And the end you make the changes based on the assessment and evaluation. And if you make changes to the plan, you have to retrain people to now what their new role is and what the plan is going to cover. And in order to effectively look to see if that's going to work, you retest it with another fictitious scenario. You reevaluate, you retrain. So it's this cycle. What we're dealing with today is our, air quote, simulated event is an actual real response with real consequences that are immediate. And that's what makes things so different in a response, particularly one like this, where you can't see it, there's not any vaccination, there's not any really medical countermeasures, and there's high rate of exposure and infection.Freddy Gray:And so it makes it challenging because in a preparedness arena, you have time to make those changes and incorporate and talk through it and strategize and identify the obstacles and gaps and come up with innovative solutions. Here, you got to do it by the fly in some senses, if the plans are not in place. And so that's what makes this such a big challenging event. And so we're grateful to public health because they're really doing a phenomenal job. And I think it was somebody, Jennifer, I think had said, I think there's supposedly roughly around 25, 2,600 contact tracers around the United States and to elevate that to a hundred thousand plus, my gosh, that just demonstrates the level of effort that's needed in order to get their hands around who's been potentially exposed, how you remove them and put them in quarantine, so to speak, until we make sure they're not infectious and not going to be exposing other people. So it's really a big, big challenge.Michael:It is a big challenge and that's a lot of people to ramp up in pretty short order.Jennifer Burnette:Absolutely. This is Jennifer. Just to tag off of that, I've had a few conversations with former colleagues that I worked with in Oregon. And I really think you say pitch, but really, like Freddy said, they're all still in the middle of the response. They're working really hard. What we're looking to do is just have genuine conversations with them, ask genuine questions about what they really need and could use help with. We can estimate and do our research and all of that to determine what we think they may need help with, but what it comes down to is really talking to them about what's going on in their state or their community, and figuring out the best way to support them. And that's one of the, I think, strong things about ORU's capabilities is that we have that ability and a strong history of working with stakeholders and all different types of groups within the community to bring that together and determine the best path forward.Rachel Vasqunez:I'll just mention really quickly, and this doesn't really tie in. But I think we'd be remiss not to mention the talk about smartphone contact tracing and apps. I know that's a big method that's being discussed to try to utilize technology for contact tracing. And just going back to everything we talked about, that's absolutely a mechanism that can help support us. But there's so much more to contact tracing and all of the things that go into that and the wider response, keeping in mind that more holistic approach that just asking someone to hit some buttons on a smartphone isn't maybe be enough to turn the tide in what we're looking for.Michael:Right. That whole area is fascinating. Just the idea of something that you carry with you every day could be helpful in making those connections of who you've been around, who may have been exposed or has tested positive. That sort of thing.Rachel Vasqunez:It definitely is. And it's not particularly new, per se either, ORU did some work a while back on text messaging protocols for other types of public health emergencies, basically follow up STEM medical countermeasures, and making sure people are getting the countermeasures that they need, if they have to go back and have more than one vaccine, all of those things. So it's not necessarily a new concept, just in a place now where technology can only potentially support those mechanisms to help public health do what they need to do.Michael:Right.Freddy Gray:And Michael, this is Freddy.Michael:Yeah.Freddy Gray:I think that that in and of itself makes this an increased challenge because with technology and particularly those things, there is a question of, "Wow, you know where I've been, or you know who I've been around."Michael:Right.Freddy Gray:And those are just some of the built in sensitivities that you have to honor, and some people are very uncomfortable about providing that intimate insight into their personal lives and professional lives. And then some communities, it may be challenging for us to see in Oakridge and Knoxville and everything, but there are multiple, multiple counties and states that are more from a rural or a frontier that the technology is just not available to the degree that it's available here as well. So you've got a lot of complex issues that you've just got to... It's not a one size fits all, so to speak.Michael:Sure. That makes perfect sense. I know we could talk about this particular issue a lot more, but I want to thank you all for helping us better understand what contact tracing is, how it works, all that goes into it because, as we've said, it's a very complicated and complex issue. And we have folks right on our staff who have the capability and understanding of how all that works. So thank you all for sharing your knowledge about this topic with us and thank you for being with us.Freddy Gray:Thank you.Rachel Vasqunez:Thank you.Jennifer Burnette:Thank you.Speaker 2:Thank you for listening to Further Together, the ORAU podcast. To learn more about any of the topics discussed by our experts visit . You can also find us on Facebook, Twitter, and LinkedIn at ORAU and on Instagram at ORAU Together. 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