Barnstable County comprises the fifteen towns of Cape Cod, Massachusetts: Barnstable, Bourne, Brewster, Chatham, Dennis, Falmouth, Eastham, Harwich, Mashpee, Orleans, Provincetown, Sandwich, Truro, Wellfleet, and Yarmouth. It has a population of roughly 212,000, 1/3 of whom are over the age of 65. The elderly portion of this demographic is increasingly difficult to access from a health communications standpoint, considering the present movement towards computer-based information dissemination. Amongst many unique challenges, the COVID-19 pandemic revealed an existing “digital divide”, separating a younger, technology literate population from an aging population who depends on television and newspaper media as well as landline phone communication.
On February 1, 2021, Massachusetts Governor Charlie Baker announced the start of Phase II of the initial COVID-19 vaccine rollout in Massachusetts. Citizens aged 75 and older became eligible to receive coveted vaccine after almost a year of isolation. This news was much anticipated, however, any relief over eligibility quickly turned to anxiety, frustration and a feeling of helplessness fueled by insufficient vaccine supply, frenetic messaging and a glitchy, poorly designed online vaccine registration system.
Prior to the official vaccine rollout, one of Barnstable County’s newly elected commissioners, Mark Forest, recognized the community’s need for a lifeline, or rather a “helpline”, amidst the ever-increasing volume and complexity of information related to the pandemic. The situation was evolving daily (as it had been for some time), with information exploding out of the federal government, the state, media outlets, research institutions and public health entities. Case numbers, prevention strategies, response tactics, vaccine development; it was difficult for even health officials to stay on top of and the public was bemused.
At first glance, Commissioner Forest’s suggestion was deceptively simple. The County would utilize its extensive body of retired and working medical volunteers, the Cape Cod Medical Reserve Corps (CCMRC), to establish a phone-based COVID-19 helpline. The concept of a phone number for people to call and have their questions answered did not seem new or innovative at first glance. And with an accomplished body of healthcare professionals at the County’s disposal, we had qualified people to staff it. So, we set to work.
The first task was to speak with Barnstable County’s IT Department. Fortunately, long before the pandemic, the County had instituted a cloud-based virtual work environment, which replaced traditional phone lines with internet-based telecommunication via Office365 and Microsoft Teams. This had allowed for a seamless transition to remote work for most County employees in early 2020, when lockdown measures first went into effect. It would also, ultimately, become the core technological tool for starting a pandemic-adapted virtual call center, with “one stop shopping” for information management and remote volunteer communications.
Leading up to the Helpline’s launch, it became clear that we had several tasks to overcome. First, was volunteer recruitment. We needed knowledgeable, information seeking healthcare professionals who would feel comfortable speaking with the public about medical topics, without overstepping into the territory of medical advice. Second, our IT department had to purchase an appropriate amount of Office365 licenses under the County’s Microsoft contract, to properly onboard volunteers and allow them access to the call center. Third, the volunteers had to be trained remotely to install the software on their personal home computers and utilize it for email, file sharing, group chats, daily virtual meetings and finally, taking calls from the public.
Once the virtual IT infrastructure was in place, we had to develop a system of information management and file sharing to facilitate communication between staff, volunteers, and IT support. All participants were given access to a “Helpline Group” on SharePoint, which housed a hub of COVID-19 resources that could be updated regularly and transparently by approved members of the group through integration with Microsoft Teams. Further, all members could access “channels” organized by topic within Teams to chat with each other instantly and cooperatively, in real-time as calls were taking place. Large-scale trainings were held on weekends, with participation from over 20 Cape Cod Medical Reserve Corps volunteers and the additional support of County staff, who volunteered their time to fill in as back-up and answer the lines as needed.
The initial two-hour training for the Helpline took place remotely on Microsoft Teams, with a total of 50 participants. Full-time staff members from the Barnstable County Department of Health and Environment served as project leads. The Department’s Health Communications Coordinator, newly assigned during the pandemic, conducted the trainings and served as Department liaison to the Helpline volunteers with assistance from the County’s Public Health Nurse and Health Department Deputy Director.
On January 19th, 2021, after only two weeks of planning, recruiting, and training, Barnstable County officially launched its COVID-19 Helpline, available to the public five days per week, from 8 am to 4 pm. On the first day, in the first hour alone, we received over 300 phone calls predominantly from elderly citizens. We had scheduled two volunteers per four-hour shift, and quickly realized that would not be enough. The point of the Helpline was to provide the community with live phone operators to answer questions in person, not long hold times and voicemail boxes. So, we course corrected and held more trainings, for yet more volunteers. County IT staff adjusted the call center settings to maximize call flow and manage wait times. By the end of April 2021, almost three months exactly following the inception of the Helpline, our staff and volunteers had taken nearly 58,000 calls; equating to over 3,500 volunteer hours. It’s important to note that Microsoft Team has built-in mechanisms on the back end that allowed us to track these analytics.
In the end, and not without irony, it was the innovative use of technology that facilitated the Helpline and helped to close the “digital divide” for our elderly citizens, allowing them to access the services and resources they needed during a time fraught with anxiety, in an unfamiliar technological environment. The Helpline continues in limited capacity to this day, with a pared-down team of volunteers and contributions from full-time staff.