They were used to working with children: administering inhalers, checking blood sugar, mending scrapes and bruises. They were not infectious disease experts. They had never traced a virus.
But then the schools closed, and the children went home. And when the first confirmed case of the coronavirus landed in Revere, in mid-March, the school nurses were suddenly drafted into an ambitious plan: to track the virus and, they hoped, to loosen its deadly grip.
“It was like a personal mission,” said Adrienne Sacco-Maguire, a pediatric nurse at Beachmont Veterans Memorial School and SeaCoast High School in Revere who helped lead the effort. “It really literally consumed your whole life.”
As local boards of health struggled to contain the virus, school nurses across the state became part of a vast experiment, transformed into public health tracers and tasked with calling the sick, inquiring about their recent contacts, and seeking out those contacts to warn them before they exposed others.
With the nurses’ help, Revere began its contact tracing program on March 16, about a month before the state launched its own. The city remains a hot spot for the disease — it has about 2,700 cases per 100,000 people. But without the team’s early action, it could have been much worse, city officials say. The data collected by the nurses prompted the city to impose capacity limits at grocery stores and directives to limit the spread at senior homes.
“If we hadn’t taken those measures, we would be in a much more dire situation," said the city’s mayor, Brian Arrigo.
Contact tracing is essential to try to contain or mitigate a virus, and starting early is crucial, said Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center.
“You want to identify every single case by testing widely, and with every case you identify, you want to identify every exposed person by contact tracing,” Doron said. Such efforts have been hampered in the United States partly because there was not widespread testing at a national level; instead, a patchwork of state and local agencies did the best they could.
The Revere nurses started the semester with very different plans.
Marina Stasio, a school nurse at Abraham Lincoln elementary school, had given birth in January. She planned to be home with her newborn son into April. But when she was asked to join the contact tracing team, she didn’t hesitate.
“I can’t be on the front lines, obviously,” said Stasio, 30. But “I’m a nurse. I want to do what I can do for this pandemic.”
All 13 of the nurses, who were being paid by the school district but no longer had any patients, soon agreed to become contact tracers. Stasio returned from maternity leave a month early and got to work, making calls when her newborn was sleeping or when she could quiet him in her arms.
Every morning and afternoon she and the other nurses received a list of new cases that were reported to the state. They called from their personal cellphones, explaining they were working with the Board of Health. They asked about symptoms, where people had been, who they had been in close contact with. They tracked those associations, creating a map of the virus in the city.
Their homespun effort grew fast. The city’s public health nurse tracked the first few cases on a whiteboard in her office, said Kim Hanton, the city’s director of health and human services. But then another person got sick, and another. When Revere received emergency funding from the state Department of Health, the city used it to buy contact tracing software.
It was not easy work, and sometimes the calls were devastating. Their neighbors were getting very sick, and they had other stressors as well: They needed food and diapers for their children. They worried about rent. Faced with the extraordinary level of need, Stasio sometimes had trouble sleeping. One mother of three who had the virus called Stasio because she had run out of formula for her baby, a call that almost reduced Stasio to tears.
The nurses became resource directors for the city; sometimes they went grocery shopping themselves for patients they had never met. They worked seven days a week, from 8 a.m. to 8 p.m.
Many mornings Sacco-Maguire sent her husband, a former postal worker, out of the house with a stack of letters addressed to patients she had not been able to track down by phone. Her computer pinged with every new case, and the sound became familiar in her house, a continued hum through the night.
As the nurses entered information into the contact tracing system, city officials began to see patterns. Early on, they saw a cluster of infections at the Jack Satter House, a senior living building run by Hebrew SeniorLife in Revere. The city issued a directive at the end of March to quarantine all residents there in their individual units.
“Because of the contact tracing efforts, we were able to quickly identify this as a hot spot," said Dr. Nathalee Kong, a primary care doctor at MGH Revere HealthCare Center and chair of the Board of Health in Revere. The city also limited grocery stores to about 20 percent of their usual capacity at the beginning of April, based on data from the contact tracing efforts (A few days later, Governor Charlie Baker limited large grocery stores to 40 percent of their capacity).
Sometimes the nurses were stymied by residents’ fears of deportation. Revere has a large immigrant population, and some patients worried the information they provided about their associations would wind up in the hands of Immigration and Customs Enforcement, the nurses said.
“A lot of people, I could feel that they were holding back some information, in terms of very close contacts," said Connie Gannon, a longtime school nurse at the Staff Sargent James J. Hill Elementary School in Revere. “Sometimes people got a little protective."
The state launched its own contact tracing program in mid-April, with a virtual call center of 1,500 tracers — a much bigger, and more sustainable, operation than the 13 nurses racing to track the virus in Revere. Now the case load has dropped significantly in the city. The school nurses, who don’t typically work during the summer, aren’t getting many more new cases, though they are continuing to track the associations connected to their earlier ones.
The nurses responded with a mixture of frustration and relief when the state stepped in.
“It would have been nice if contract tracing was started from the very beginning when this whole pandemic broke out, not a month in,” said Stasio about the state’s program, called the COVID-19 Community Tracing Collaborative. But she was also glad that the state joined.
Even though they were working from home, the contact tracing took its toll on the nurses. Sacco-Maguire had begun walking along the beach by her house before dawn to ground herself, as well as practicing meditation twice a day to ease her thoughts.
Like Stasio, she had grown up in Revere and she knew some of the people she reached on the other end of the phone line. The first death she entered into the system was the mother of an acquaintance; their children had played basketball and softball together.
“I lived her mother’s hospitalization, her improvements, her deterioration," Sacco-Maguire said. “And I grieved with her death.”
The work, though grueling, gave her purpose, she said.
“I’m grateful that I’m able to do this,” Sacco-Maguire said. The pings on her computers have dwindled, but she still leaves it on at night, just in case.