PITTSFIELD — Every morning, Kayla Donnelly-Winters has a date with a database. Once online, she runs a report on newly confirmed coronavirus cases in Pittsfield.
"When the case comes in, I'm on the phone," she said, as she hurries to identify to whom those people may have spread the virus. "I like to do it immediately. What if they go to a picnic that day and expose people?"
For nearly three months, Kayla Donnelly-Winters, Pittsfield's public health nurse manager, has worked with her peers in Berkshire County to find the "close contacts" of people confirmed to have the virus, racing to alert them that they, too, may be infected and infectious.
Today, they speak with pride about their success in halting a rise in cases — and stand ready to pounce on new clusters, as restrictions are eased during this week's second phase of restarting economic activity.
Contact tracing, as it is known, is seen as a pillar of that reopening.
In March and early April, public health nurses like Donnelly-Winters and Nancy Slattery, who represents a variety of local towns, worked nearly around-the-clock. "When it first hit, we were totally blown away by the magnitude of the numbers," said Slattery, who works from an office at the Berkshire VNA. As of Monday, she had tracked 214 people in the towns of Adams, Alford, Hinsdale, Lanesborough, Monterey, New Marlborough and Sheffield.
To date, the disease has killed 41 people in Berkshire County and infected 575.
While the nonprofit Partners in Health took the lead statewide on contact tracing, public health officials in all of the county's 32 communities made the phone calls and follow-up credited with preventing a continued rise of infections.
"We're used to taking care of ourselves — and we took care of ourselves again," said Laura Kittross, director of the Berkshire Public Health Alliance. "That's ideal, because nurses here know the community. They're not going from a script. They can be flexible and adaptable."
And being local helps nurses get through. "When they see a 413 number, they're more likely to answer it," Kittross said of the people nurses are trying to reach. "Stopping things before they got out of hand."
The alliance, through the work of registered nurse Leslie Drager and others, handles contact tracing for 20 local towns.
Emilie Jarrett supervises cases in two towns as director of the Community Health Association of Richmond and West Stockbridge. Mount Washington handles its own cases, said Kittross.
The alliance picked up responsibility to monitor public health for an additional 10 towns after the demise in late winter of the Porchlight VNA agency, she said; the alliance will add coverage for Otis come July.
Long before the novel coronavirus, local public health officials were required to track and report dozens of infectious diseases, from flu to diptheria to meningitis. In March, they began using the MAVEN database (it stands for Massachusetts Virtual Epidemiologic Network) to share information on confirmed cases of the new disease, COVID-19.
The state rushed money to the problem, enabling people like Donnelly-Winters to staff up at the Pittsfield Health Department to handle the demand not only for contact tracing, but to educate and advise people caught up in the pandemic.
By keeping it local, these efforts appear to have overcome what some feared would be public resistance to questions over the phone about the coronavirus. Donnelly-Winters and Slattery say people they've called have been concerned and helpful.
The calls start with the "index" case — the person ID'd in MAVEN, usually by a lab, as having a positive test result.
"People tend to be upset and really scared," said Donnelly-Winters. She said she works to reassure people and guide them on how to monitor their symptoms and conditions. "There is an element of emotional well-being that I'm looking out for."
But she must move, and quickly, into reconstructing that person's recent contacts. Often, there are few, given precautions people have taken. To be counted as a close contact, a person needs to have been within six feet of an infected person for 15 minutes or longer.
Berkshire Medical Center has played a central role in the effort, nurses say, by taking on the task of calling people identified as contacts to undergo tests. Donnelly-Winters would relay cases to the BMC team. When test results arrived back, positives prompted a new round of calls.
Local health officials work back in time with their subjects, figuring out the onset of symptoms — and the time frame through which contacts need to be identified. Kittross said officials work to list all close contacts in the 14 days before a positive test or the appearance of symptoms. "It can be quite an investigation to reach people," she said.
One of the top questions is where the person works. If it is in health care, or in a group home, the effort goes into overdrive.
In March, Slattery and Donnelly-Winters say, new cases came in a rush. Slattery recalls getting four or five new cases a day and juggled 30 at once in the first weeks of the pandemic.
Rather than having people hang up on her, she says her calls went through. "People are worried and conscientious and trying not to infect other people," she said. The county's rural nature may have helped. "Because we live in the boondocks, we are able to isolate better than others."
But the Berkshires was the state's first location for what's known as community spread. Early March, Kittross recalls, was dicey. "It was a lot of working seven days a week around-the-clock to get things done. It was pretty scary because we didn't expect it."
About three weeks ago, Slattery and other public health nurses could breathe a little easier. "We leveled out completely," she said. "We plateaued — knock on wood."
Looking ahead, the advice public health nurses are getting from Dr. Daniel Doyle at BMC is to watch for clusters of infection.
"We're still seeing little pockets," she said. We'll be able to tell in a couple of weeks if our numbers start to rise."