Public Health Does What?!

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To say that it has been a weird time to work in public health would be an understatement. COVID-19 has completely shifted the day-to-day realities and priorities of health departments around the globe. And while everything has seemingly changed, the foundation of public health—what makes public health so vitally important—has remained the same despite it all.

Staff attending the Latino Health Forum (Oct 2019), pre-COVID.

As I sit here and reflect on my past three years with Skagit County Public Health, I’ve got to tell you, it has been one heck of a ride! I remember during those first few weeks learning (in astonishment!) all the things that public health is responsible for. After all, I had never worked for a government agency before. I knew that people visited their health department to pick up birth and death records or to get information about community resources, but I couldn’t have imagined the depth and breadth of the work that is done here at 700 S 2nd Street in Mount Vernon.

As I walked around the halls and met my new co-workers, I discovered the many divisions that make up our team: child and family health, communicable diseases and epidemiology, behavioral health and housing services, environmental health and food safety, senior services, and community health and assessment.

Of these, emergency preparedness and response was only one small (though critical) part of the puzzle. During a staff training one day, I learned a bit more about this division and was surprised to learn that all public health staff could be activated during times of public health crisis. At the time, I couldn’t fathom what this would look like. Now, a year into Public Health’s COVID-19 response, I can tell you exactly what this response is like!

When COVID-19 first appeared in Washington State last year, County leadership was the first to respond: Unified Command was established and plans were quickly put into place to mitigate risks associated with disease transmission.

Public Health staff working the COVID-19 Testing Site at Skagit Valley College on a foggy spring morning.

Our Public Health staff was activated—slowly at first, then almost entirely by the summer of 2020. On any given day in June or July at Skagit County’s COVID-19 testing site, you might have seen a hand-full of Public Health staff working to register people or help to administer tests—at times even jumping car batteries—whatever they had to do to get the job done.

Back at the office, a whole team of staff were called to conduct case investigation and contact tracing, conducting investigations seven days a week. Big plans for 2020 that had been on our work calendars were adjusted or put on hold to accommodate the ever-increasing demands of our COVID response.

More recently, with our vaccination initiative in full gear, we are in a much better (and sustainable) place. Our Vaccine Site at the Fairgrounds and Vaccine Hotline have been blessed by hundreds of hard-working and dedicated volunteers who show up every day to help get our community vaccinated. Our staff has also grown and changed, with an influx of new temporary and part-time staff that have been hired to conduct case investigations and to provide vaccine services at our clinic.

Case investigators staying cozy in their PJs on Thanksgiving Day.

As the numbers of vaccinated individuals in the state continues to increase, it begs the question: What will life look like after COVID? And even: What will Public Health look like if/when the demands of COVID begin to subside?

This week is National Public Health Week and is the perfect time to highlight the role of Public Health. Although our work has primarily been centered around COVID-19 this year, it is in no way all that we do.

Here is a quick look at some of the other things your local public health department does:

Behavioral Health Services

Public Health works with community organizations and coalitions, school districts, and regional partners to ensure that help is available to those in need, including access to mental health and substance use disorder treatment and recovery services. For more:

Child & Family Services

The Child & Family Health Division works with individuals, families, and the community to assure that all Skagit County children have the healthiest possible start in life, with particular emphasis on pregnant women, infants, and toddlers. Programs include the Nurse-Family Partnership, ABCD Dental, Parent Cafes, and Skagit Bright Beginnings. For more information:

Senior Services

Our Senior Services staff at the office are only the tip of the iceberg; this is a huge team! We have five senior centers in Skagit County and a robust Meals on Wheels and Senior Nutrition program. While many senior services have been put on hold due to COVID, the nutrition program has been instrumental to our crisis response. For more information:  

Developmental Disabilities Services

The Developmental Disabilities Program manages a variety of programs related to providing services to individuals with developmental disabilities, while also providing support for individuals and families and hosting community events and trainings to improve community awareness of developmental disabilities and inclusion.

Housing Services

Skagit County Public Health partners with local cities and nonprofits to provide humanitarian response, emergency shelters, rental assistance and supportive services with the goal of improving access to housing and reducing homelessness. Most recently, Public Health has made emergency funding available to those who have been impacted by COVID-19, and this funding can be used toward rental or utility bill assistance. For more:

Environmental Health Services

Environmental Health is easily the most diverse division that we have here at Public Health. From drinking water and food safety to the on-site sewage program and hazardous waste, our EH team is always super busy ensuring our residents are safe and healthy. For more:

Communicable Disease & Epidemiology

The shining star of 2020!  The Communicable Disease Program works closely with our healthcare provider partners to investigate notifiable conditions reported by health professionals, identify risk factors for disease, and provide education on how to prevent future infections. And we’re not just talking COVID-19! For more info:

Community Health and Assessment

Lastly, it is Public Health’s responsibility to think BIG: to analyze the data, identify the gaps, and propose new and innovative solutions. Public Health brings together a group of community leaders—called the Population Health Trust (PHT) —to solve Skagit County’s health issues that our community identifies. To learn more about the PHT, go to:

If you run into a Public Health employee this week, give them a big air-five! And next time you’re wondering what the heck Public Health does, please remember—we’re so much more than COVID!

For information about Skagit County Public Health’s divisions, please visit:

Case Investigation and Contact Tracing

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Reports from the front lines of Public Health

Over recent weeks, you have likely heard media reports that expanded COVID-19 testing, case investigation and contact tracing are the main tools in combating COVID-19. These efforts are also necessary to safely launch Governor’s Inslee’s phased Safe Start re-opening of Washington’s economy. You probably have an understanding of what is involved in testing, and may know that drive-thru testing has been launched in Skagit (click here for details). But you may wonder: What exactly is case investigation and contact tracing? I called Skagit County Public Health’s Community Health Worker Graciela Ibarra and Public Health Nurse Ian Capron to hear what it’s like to be on the front lines of these efforts.

What is case investigation?

Skagit County Public Health staff contact people who test positive for COVID-19 to provide important guidance and complete detailed interviews. Guidance includes how to safely isolate at home after testing positive or developing symptoms, as well as ways to access resources. Interviewing is a methodical process in which answers are pieced together to create a detailed history of where the interviewee has traveled, eaten, slept, and bathed. These questions focus on other people who may have had close contact with the person interviewed and who are at risk for COIVD-19 infection.

Asking personal questions, especially with someone you just met over the phone, can be a delicate process. Ian notes that people’s responses are “on a continuum.” Graciela adds that people “usually understand this is needed to keep them and others safe.” They may be hesitant to share the names of family members or coworkers. “We reassure them no one has done anything wrong. No one is in trouble or being punished.”

As you have likely concluded, case investigation requires a special skill set – a mixture of calm understanding and a steady focus on the goal of reaching all at-risk contacts. Investigators have to make certain that interviewees are heard and respected while ensuring that people who were possibly infected are identified.

What is contact tracing?

In contact tracing, the same investigation process is repeated in reaching out to those contacts who may have become infected as well. The number of contacts can add up fast and reside throughout the community. However, Ian notes, “Since Stay Home Stay Healthy began and people started physical distancing, the new cases and contacts tend to be in clusters within families or in the community at job sites of essential services.” One success of distancing is this narrowing of where exposures are occurring.

How do case investigation and contact tracing work?

Ian sums it up best: “Case investigation and contact tracing are our bread and butter. It’s the most proactive thing Public Health can do about COVID-19.”

One clarification before we go further: the difference between isolation and quarantine. Isolation refers to when a person separates themselves from others following a positive lab test or when they have symptoms consistent with COVID-19. Quarantine is for people who have no symptoms but have been exposed to the virus and could develop the illness in the 14 days after being exposed. Some people may quarantine and later become ill while others may not.

In short, case investigation and contact tracing:

  • Identify the spread of COVID-19 within the community.
  • Prevent further spread of COVID-19 within the community through reduced contact from people infected with the virus.
  • Provide people who are confirmed to have COVID-19 with guidance on how to successfully isolate so they can keep loved ones, neighbors and other community members safe.
  • Provide people who have been exposed to the virus with guidance on how to quarantine so they can help others stay safe.
  • Linkage to health care which can result in early diagnosis and care to those who need it.

High points and challenges in the day of case investigators and contact tracers

As you might imagine, the workdays of investigators and tracers might have several high points matched by ongoing challenges. The highpoints are obvious – at the end of each shift, public health staff know they have pushed backed against COVID-19 and prevented transmissions of the virus. They hear thanks from the public for the hard work and for keeping people safe.

The challenges tend to involve pre-existing issues affecting interviewees, such as lower income, a lack of resources and prior health conditions. These issues cause disproportionate hardship from COVID-19. Graciela describes a household in which ten family members live together but have only one bathroom, making risk of infection high and isolation all but impossible. Fortunately, Public Health is leasing a motel where people can isolate while other family members can safely quarantine, shortening the amount of time people are exposed to their sick family member. Ian points out that this temporary housing option enables “families to do the best they can” when facing COVID-19.  

Other difficult situations involve quarantine in which some household members work in critical infrastructure and can continue to go to work as long as they don’t have symptoms. Other people in the household have jobs that aren’t in these essential service industries. They cannot work during quarantine, even if they show no signs of illness. The difference in financial impact between those who are working and those who can’t seems unfair and can result in friction. This disproportionate impact is not unlike what is happening in our county and country overall, where the social distancing necessary to save lives results in harsh economic losses to some and little financial impact to others. Needless to say, working right in the middle of such a polarizing issue can be very difficult for investigators and tracers.

Skagit success

Early on, Skagit County Public Health realized case investigation and contact tracing was where it needed to invest its time and effort. The investigation/tracer team expanded quickly by cross training a large number of staff to do this critical work. Ian describes his co-workers’ efforts as “unbelievable,” as they set aside the work they were used to doing and took on a new job for the betterment of the community. This team enables Skagit to do a rare thing in Washington State – contact tracing not only with people diagnosed with COVID-19, but also with close contacts who have also developed symptoms (also referred to as probable cases). More contact tracing strengthens our outreach and ability to prevent spread. Skagit County Public Health also upped its outreach to businesses. Some larger statewide and regional employers have expressed great thanks, noting they had not experienced outreach from public health agencies elsewhere. Working directly with employers is key to promoting on-the-job safety for local workers.

A contact tracer’s advice

When I asked for what guidance they may have for the community, Ian pointed out that some people who later are diagnosed with COVID-19 “thought they just had allergies or a cold. Don’t ignore any symptoms, especially if they get worse,” adding, “but call your doctor first before you go in.” Graciela advises, “Listen to your body. See what it’s telling you. But if you are diagnosed with the virus, don’t let the disease take control of you. Look at media that is positive instead of all the negativity. Let yourself heal.”

More contact tracing info

Want more contact tracing info? Check at the Centers for Disease Control and Prevention webpage at: