In late March and early April, Martha’s Vineyard was in an unprecedented lockdown, with restaurants and retail stores closed, workplaces shuttered, streets empty and travel sparse.

For the most part people were staying home. And nearly all the Island’s early cases of Covid-19 reflected that, with public health officials reporting small numbers of close contacts — the term for someone who spends more than 15 minutes within six feet of an individual who has tested positive for the virus.

Fast forward three months, and that has completely changed, as case numbers rise, and everything from Main street businesses to movie theatres start to reopen. The number of close contacts has grown exponentially as well.

“In the beginning, I would say in the first months or so, we were having no contacts on most of our cases, just because everyone was following the guidelines and lockdown so well. So it made it very easy,” said Lila Fischer, a public health nurse who is a leading coronavirus contact tracer on the Island. “But now that people are going to work, going on vacation, traveling out of state, it definitely has made things a lot more complicated. And I would say a marked increase in the number of people who we have had to contact.”

In an interview with the Gazette, Ms. Fischer, who along with Lori Perry is responsible for the lion’s share of contact tracing, explained the arduous but crucial process of tracking down the 91 close contacts for the Island’s recent spate of asymptomatic cases. Both Ms. Fischer and Ms. Perry are public health nurses with Island Health Care, a federally qualified community health center that contracts with the Island boards of health for contact tracing.

While contacts for early cases were mainly household members — if there were any at all — recent cases have had close contacts that include entire work places, shifting the focus for health agents from families to the public, and creating new challenges for trackers.

And where early cases had an average of one to two contacts, some recent cases have had between seven to 10 contacts apiece, Ms. Fischer said. Tisbury health agent Maura Valley confirmed this week that two restaurants — Nancy’s and Little House Cafe — have had employees test positive, and other contacts have been traced to workplaces as well.

Ms. Fischer also provided new background and insight into the spread of the virus on the Island, saying that nearly all cases reported

on the Vineyard have been traced to travel or time spent on the mainland. She estimated the number at over 90 per cent.

“Not all, but most, have been off-Island,” Ms. Fischer said.

The contact tracer’s goal, broadly speaking, is to stop the spread of the virus before it starts. Ms. Fischer said she feels, at least so far, that she and Ms. Perry have been largely successful, despite an increasing asymptomatic case load that includes nine cases in the past week. Ms. Fischer attributes both the increase in case numbers — and the increase in contacts reported — in large part to the Island’s unique, comprehensive asymptomatic testing site at the high school.

“Now that we have asymptomatic testing on the Vineyard, it’s really a wonderful thing because it allows us to get to those people who may not have even known that they are sick, and contact them to make sure that they aren’t getting sick,” Ms. Fischer said.

When an individual tested positive for the virus back in April, it was likely that the person was showing symptoms of the disease and got tested at the Martha’s Vineyard Hospital. Three months into the pandemic, with testing criteria and availability greatly expanded, that is no longer the case.

All but two of the cases reported in the past six weeks have been asymptomatic, meaning patients didn’t know they had the virus before they got a call from Ms. Fischer of Ms. Perry. That means their contacts didn’t know they had been near someone with the virus either.

“For some, it was a surprise,” Ms. Fischer said. “They may have mild symptoms that they may not have known were associated with Covid-19. But it was definitely a surprise.”

While the vast majority of contacts have been compliant and cooperative in sharing information, Ms. Fischer said the biggest challenge has been cutting through the stigma of a positive test and what it portends.

“Stigma is one stumbling block that has made people more reticent,” Ms. Fischer said. “I just try to create a culture of understanding . . . that by communicating with contact tracers you are contributing to the stop of spread of Covid-19.”

Ms. Fischer said certain demographic groups have been more difficult to trace, and yielded more contacts than others, particularly those under the age of 30. The Island has now had 13 people test positive in that age group, the most of any demographic.

“Early 20s is probably the most difficult demographic to trace,” Ms. Fischer said. “That’s naturally the time in life when you would be out in the world. So that’s definitely the area where I’ve had the most contacts.”

Testing positive also means staying home, a difficult reality for any young, low-wage workers struggling to get by in the height of the summer season. Ms. Fischer said working with those individuals has taken an emotional toll on her as well.

“My heart really goes out to these people who are having to miss work and take that on, especially when the environment they are going to return to may be a hostile one,” Ms. Fischer said. “That’s really hard to watch people go through.”

Responding to questions about where people who have tested positive on-Island contracted the disease, Ms. Fischer said all but one of her cases could be traced to travel or time spent off-Island. She said demographically the cases included seasonal residents, workers arriving for the summer, or residents who had taken shorter trips to the mainland — generally to places with a high density of cases, like New York or Boston.

She said she has not yet had a day-tripper or short-term visitor test positive for the virus on the Island.

She said the fact that the virus has not been spreading throughout the Island community is a positive.

“I think what’s so telling about the information is that we are doing a really good job as Islanders with social distancing,” Ms. Fischer said. “We are following the rules and protecting our community really well. Because of the work that we are doing, we are stopping the spread before it has a chance to go further than our household, which is amazing.”

Ms. Fischer had never conducted contact tracing before she started her job with Island Health Care two years ago. But she said it is a role she has been privileged to play — and one that only increases in importance as the pandemic continues.

“It’s gratifying, and it’s really affirming when you’re able to work with people and help them in this time,” Ms. Fischer said. “And to connect with other humans who are suffering, and try to help them.”