POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”

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Gov. Phil Murphy, speaking during a Friday news conference, said New Jersey has run into trouble in its efforts to contain the coronavirus because of contact-tracing problems. Murphy made the announcement as he revealed 313 new coronavirus cases and 13 more confirmed deaths were reported (you can watch it here, below).

The update comes as the number of cases rose to 188,817 and 14,112 confirmed deaths have been reported. Read more: NJ Coronavirus, School Reopen Updates: Here’s What You Need To Know

Murphy said more than half of the people contacted through contact tracing have refused to provide information and “this is highly disturbing, to say the least.”

Murphy suggested that the lack of participation in providing information to contact tracers may have slowed efforts to track the virus and ultimately quarantine people to reduce the spread.

The number of people not picking up the call is 19 percent, and the number of people not providing contacts is 52 percent, said Health Commissioner Judith Persichilli.

“It is essential that residents join with the contact tracers in containing this disease,” Persichilli said. “Contact tracers are calling with lifesaving information that will keep you and your loved ones and our communities safe and healthy.”

It also could explain why New Jersey has had a hard time recently in keeping its transmission rate below 1.0, which is considered too high. That means every person with the coronavirus is spreading the disease, on average, to at least one other person.

After weeks of having a rate around 0.82, New Jersey’s rate is currently at 1.04. (A)

“The tracing approach is built on a simple idea: When someone tests positive for the new coronavirus or becomes sick with COVID-19, you find all the people the infected person came into contact with, because they, too, may be infected. Then you help them quarantine for two weeks—almost everyone who becomes sick will show symptoms within 14 days—so they do not accidentally spread the virus any further. The goal is to stop the chain of transmission, says Emily Gurley, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, who has created a free online course to train contact tracers…

Large-scale contact-tracing programs in places such as South Korea and Germany have been instrumental in suppressing the novel coronavirus, SARS-CoV-2. Within days of detecting its first case on January 20, South Korea created an emergency response committee that quickly developed wide-scale virus testing, followed by an extensive scaling up of the nation’s network of contact tracers. Germany similarly committed resources to mobilizing a tracing workforce. In both countries, cases have dropped dramatically.

By contrast, tracing efforts lag in the U.S., where COVID-19 cases hit record highs in mid-July and which leads the world with more than 3.7 million infections and more than 140,000 deaths. The country has no national strategy for contact tracing, says Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials (NACCHO). Instead “the federal government has said to states, ‘do as you wish,’” she adds. According to news reports, this week the White House moved to block $25 billion for tracing and testing in the latest pandemic relief bill being considered by Congress, contending that states already have funding.

Yet many states do not have the money to start large tracing programs. In fact, state public health departments across the U.S. were drastically underfunded even before the pandemic. Since 2008, local health departments have lost close to 25 percent of their employees.

The result is a patchwork of programs with insufficient money and uneven implementation. NACCHO estimates that, given national levels of confirmed cases, the nation needs at least 100,000 contact tracers. And that number would cost local, state, territorial, Native American and federal public health agencies at least $3.7 billion. So far, however, no federal dollars have been specifically allocated to contact tracing “or to any federal contact tracing programs,” Casalotti says…

The next action that comes after a tracer has identified a potential infected person—getting that individual to adhere to quarantine—has proved exceptionally difficult in the U.S. For stopping the spread of a virus, however, isolation is absolutely key. “You can do the contact tracing all you want. But if you’re not also providing these support services people need to isolate, it won’t work,” Madad says. No one is going to quarantine for 14 days if that means losing a job and income or abandoning caregiving.”  (B)

“The countries where contact tracing has worked best set up their tracing systems before cases exploded, and as cases grew, they hired more tracers. The U.S. has not done this. In June, when states were in the throes of reopening, only seven states and Washington, D.C., met the Centers for Disease Control and Prevention’s recommendation of 30 contact tracers per 100,000 residents, according to an NPR analysis. According to the latest data from Test and Trace, an organization that grades states on their testing and tracing capabilities, only seven states are currently considered “fully prepared to test and trace.” States meet this threshold if they have a test-positivity rate of 3 percent or less, provide test results in two days or less, and employ five to 15 contact tracers per positive test….

The logistical testing delays are exacerbated by quirks of the American health-care system that are making it even harder for people to get tested and quickly quarantine. Many people can’t get paid leave from work unless they provide proof of a positive COVID-19 test. So if Aunt Sally is feeling sick but her test results haven’t come back yet, she might be required to report to work or forfeit her paycheck for the day. “If that test isn’t showing up for a week, then they’ve already been exposing people for a week,” said another Texas contact tracer, who asked to remain anonymous, because she’s not authorized to speak with the press.

It’s likely that the first time many Americans heard the term contact tracing was this spring. Before that, some public-health departments were little more than two people and an old computer, having lost a quarter of their workforce through aggressive budget cuts since 2009. Because the U.S. has had such an enfeebled public-health system for so long, the public doesn’t trust public-health workers at a time when it’s crucial that they do so. When called by a department they’ve never heard of and asked for a list of all their friends, Americans could be forgiven for thinking, Who the hell are these people?..

These trust issues have become especially pronounced in the Black and Hispanic communities, two populations that have been disproportionately affected by COVID-19. Black and Hispanic people are more than twice as likely as white people to get COVID-19, and are more than four times as likely to be hospitalized with it. Several experts told me that wariness of the government in these communities has been exacerbated by the Trump administration’s public-charge rule, under which immigrants might jeopardize their green card if they accept public benefits. “If the word gets out in a community, ‘Don’t talk to the government, because we are worried the government will do bad things to us,’ then you don’t have trust,” John Auerbach, the president of Trust for America’s Health, a nonprofit that promotes public health, told me…

People have more trust in public-health workers when local health departments, governors, and the president speak with one voice. But some officials have downplayed the virus, some have taken it seriously, and others have ignored it entirely. Other than claiming that the U.S. has gotten “good at” it, Donald Trump hasn’t said much about contact tracing. But perhaps his actions should speak louder than his words: When someone in the White House gets sick, the executive branch traces all of that person’s contacts.” (C)

“Public health is called public health for a reason, says Emily Gurley, an infectious disease expert at the Johns Hopkins School of Public Health: Strategies like contact tracing can only be effective if the community cooperates.

However, there’s no one metric by which to judge a successful contact tracing effort, says Gurley. “You don’t have to be perfect to have an impact,” she said. “And just because cases are still going up doesn’t mean you’re not having an impact, as well.”

If a community tests only a few people, but reaches 100% of respondents, they may be less effective at stopping transmission than a community that identifies all the local cases through testing but only reaches 40% of them by phone. And response rates don’t reflect the efficacy of each interview. Picking up the phone is one thing; giving out a list of close contacts is another.

But contact tracers do need all the responses they can get, and, crucially, as many honest, comprehensive interviews as possible. To safely lift lockdowns, the COVID-Local guide recommends cities ensure they’re reaching 75% of each positive patient’s close contacts within a day of testing…

Like mask-wearing, which became fiercely politicized despite evidence that it significantly reduces transmission of disease, attitudes towards contact tracing have been muddied by misinformation and mixed messaging. …

This resistance varies by region and by state, Waters says, but it tends to line up with political differences. “A large proportion of the population views not participating in contact tracing as aligned with their political tribe,” he said on a panel at the Disease Prevention and Control Summit last month. 

But contact tracing pushback isn’t just about politics. Even as coronavirus disproportionately impacts communities of color, trust in the federal government is lowest among Black people, and reports show that some Latinx communities are wary of getting tested for the virus and more fearful of seeking medical help because of fears of immigration enforcement….

Already, one promising contact tracing tool in the U.S. has been stymied by privacy fears. In April, Apple and Google introduced a plan to facilitate contact tracing by allowing people who tested positive to send out an anonymous ping via the Bluetooth connection that most smartphones have, to alert anyone who had come into close contact with their device in the previous few days. Despite privacy and anonymity assurances, surveys showed that people were wary of their location being linked to their health information…

In part because health officials understand this reticence — and in part because of coordination and technical issues — the U.S. has yet to roll out widespread app-based testing, as many other nations in Europe and Asia have, and the Apple and Google API has yet to be adopted at scale. Even officials from Singapore and Iceland, where sophisticated contact tracing apps were part of an early coronavirus response, advocate a hybrid approach. Pairing targeted phone alerts with traditional human “disease detectives” who call on the phone can capture the widest swath of the population, they say.

“It’s not too late for public health authorities to communicate better about this tech, what it entails and why it’s important,” said Kreps…” (D)

“Our local public health authorities haven’t skimped on sharing data tied to the novel coronavirus. Visit the dashboards on the Department of Health and Public Health—Seattle and King County websites and you’re liable to get dizzy from all the curves outlining the changes in cases, hospitalizations, and tests since the start of the pandemic.

But until recently, Washington officials had held out on publicly quantifying one area of our response to Covid-19: contact tracing, or the effort to identify and isolate people who have crossed paths with infectious hosts to curb the virus’s spread. Though we knew the state had struggled, both initially and later on, to reach cases and their close contacts, we couldn’t point to any numbers assessing the current state of our disease containment effort.

Now we know why officials weren’t exactly in a rush to divulge the details. On Wednesday, the DOH released a report that showed the department had fallen well short of its case investigation and contact tracing goals despite mobilizing an army of sleuths. The department had sought to reach 90 percent of cases within one day of a positive test result. During the weeks between August 2 and September 5, the state never topped 51 percent in that area. The DOH had also targeted an 80-percent connection rate with contacts 48 hours post-case confirmation. It hasn’t yet met that mark. “While we expect our outcomes to improve over time, this initial data shows we have work to do,” state secretary of health John Wiesman said in a press release.

Are those goals too lofty? Hard to say. Many states still haven’t published their contact tracing stats, and those that have often use slightly different metrics. Public Health—Seattle and King County’s latest dashboard doesn’t lend itself to an apples-to-apples comparison with the broader state data, either, but it does provide some more interesting bits. For example, 60 Covid-19 contact tracers currently work for the authority. In mid-July, when cases were rising again, the number was half that.

Since the local headcount bump, the county’s case interview performance has stabilized. Roughly 60 percent of positive cases get interviewed (not just reached) on the same day they’re assigned to a contact tracer. Still, thanks to the pre-symptomatic period and lags between symptom onset and testing, nearly nine days of viral shedding have typically passed by the time tracers speak with infected individuals. Not ideal.”  (E)

“New York Gov. Andrew Cuomo (D) was joined remotely by former New York City Mayor Michael Bloomberg on Thursday as Cuomo described efforts to develop and implement a comprehensive coronavirus contact tracing program in the Empire State.

Such a program, Cuomo said in his daily briefing, will “require, under any estimate, a tracing army to come up to scale very quickly,” which he said will be a vital part of any state efforts to reopen businesses and institutions.

Bloomberg, joining the briefing through a video link, described a contact tracing system as “one of the most important steps we need to take,” adding “when social distancing is relaxed, contact tracing is our best hope for isolating the virus when it appears and keeping it isolated.”

Bloomberg said his philanthropic foundation will develop the system in partnership with Johns Hopkins University, “the best public health school in the world,” as well as the organizations Vital Strategies and Resolve to Save Lives.

The former mayor said the City University of New York and State University of New York will help identify potential applicants for contact tracing jobs and that Johns Hopkins has developed an online training class that will conclude with a mandatory test.

“We’re not going to put up people there that don’t know what they’re doing,” he added.

Bloomberg also noted that the program will help develop a broader “playbook” for contact tracing through its efforts, saying “we will release that playbook publicly so cities and states around the country can use it and scan nations around the world. That way the work we do here in New York really can help fight the virus globally.”

Cuomo expressed a similar sentiment, saying of the state: “In many cases we’ve dealt with challenges first; we figure it out and then we work with other places to actually learn from what we’ve done.”

“I think this is going to be one of those examples,” he added. “It will also be a laboratory to put together the best system ever put together so we can share that with other governments, and that’s what Mayor Bloomberg does so well.”” (F)

“New York City’s ambitious contact-tracing program, a crucial initiative in the effort to curb the coronavirus, has gotten off to a worrisome start just as the city’s reopening enters a new phase on Monday, with outdoor dining, in-store shopping and office work resuming.

The city has hired 3,000 disease detectives and case monitors, who are supposed to identify anyone who has come into contact with the hundreds of people who are still testing positive for the virus in the city every day. But the first statistics from the program, which began on June 1, indicate that tracers are often unable to locate infected people or gather information from them.

Only 35 percent of the 5,347 city residents who tested positive or were presumed positive for the coronavirus in the program’s first two weeks gave information about close contacts to tracers, the city said in releasing the first statistics. The number ticked up slightly, to 42 percent, during the third week, Avery Cohen, a spokeswoman to Mayor Bill de Blasio, said on Sunday.

Contact tracing is one of the few tools that public health officials have to fight Covid-19 in lieu of a vaccine, along with widespread testing and isolation of those exposed to the coronavirus. The early results of New York’s program raise fresh concerns about the difficulties in preventing a surge of new cases as states across the country reopen.

The city has successfully done contact tracing before, with diseases like tuberculosis and measles. But as with much involving the coronavirus outbreak, officials have never faced the challenge at this scale, with so many cases across the five boroughs.

The city’s program has so far been limited by a low response rate, scant use of technology, privacy concerns and a far less sweeping mandate than that in some other countries, where apartment buildings, stores, restaurants and other private businesses are often required to collect visitors’ personal information, which makes tracking the spread easier…

Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.”

“For each person, you should be in touch with 75 percent of their contacts within a day,” he said.

He suggested that the poor showing stemmed in part from the inexperience of the contact tracers and insufficient hands-on training.

“This is a skill,” he said. “You need to practice.”…

Dr. Halkitis at Rutgers said he thought the low cooperation rate was likely due to several factors, including the inexperience of the tracers; widespread reluctance among Americans to share personal information with the government; and Mayor de Blasio’s decision to shift the program away from the city’s Department of Health.”  (G)

“HONOLULU (KHON2) — The head of the state’s contact tracing program, who took over just before a Department of Health leadership shakeup, has already made big inroads in overhauling the system. Dr. Emily Roberson spoke for the first time with Always Investigating. Under Roberson’s new system, the health department is now collecting key data that shows what kind of settings and activities are spreading COVID, and where and how it is being safely blocked…

“They are reaching out as soon as people test positive,” Roberson said, “to make sure they have the information they need in terms of education and to make sure we’re able to screen for any specialized follow-ups that may be needed.”

“First contact callers” are dialing up every positive person with 24 hours and screening for whether specialized follow-ups are needed.

“We have about 50% of the people we attempt to reach within 24 hours, either they have a bad number, they have no number or we are just not able to get them on the phone,” she said.

Of those they can reach, the callers sort the cases among eight specialized investigation teams led by a disease investigator and supported by the National Guard and a cadre of contact tracers.

Additional targeted support such as nurses, community workers, monitors and even translators can jump in when needed…

Roberson’s other overhaul efforts include changing the forms, scripts and procedures to rapidly collect more detailed data…

Now, Roberson tells Always Investigating that her team has collected weeks of data that gets down to business.

“It does include questions about gyms, personal care services, congregate settings, schools, correctional facilities and a whole bunch of information about that, restaurants for example, bars,” she explained.

“There are a lot of times where we might have clusters that involve a specific type of employee or a specific workplace, but when we really investigate them further we find out that the transmission is taking place outside of that location,” Roberson said, adding that social after-work parties, lunch-break hangouts, smoke breaks, or roommates who happen to work together becoming infected at home appear to be the actual source of spread.

“It could be there’s transmission happening technically around the work building but it’s not so much associated with the work itself, it’s more when you’re on your break, or you’re hanging out with your friends,” Roberson said. “Even though there were this many cases at this workplace, it seems everyone got it when they went to this party. It’s not a case where they put their customers or, in health-care their patients, at risk as much as people relax when they are with their friends and it’s spreading socially.”

That is consistent with what small businesses and organizations have been saying about their own contact tracing, finding off-work social spread, not on-the-job, in-store or in-restaurant where masks, barriers, distancing and sanitation regimes are followed to the tee.

“As a business, we’re already doing that, so we know it’s not coming from us,” Tina Yamaki, President of the Retail Merchants of Hawaii, said at the House economic hearing. “If a majority of the numbers are coming from funeral homes or private parties or care homes, we need to take that into consideration, too, instead of a full shutdown.””  (H)

“Washington state will join California and Oregon in soon launching a voluntary contact tracing application that Google and Apple jointly developed that alerts users if they have been exposed to the coronvirus.

The app will be voluntary and anonymously notify a user if they have been exposed to someone who tests positive, Gov. Jay Inslee said Thursday.

“You volunteer to share your information, if you desire, with the app, and you’re voluntarily notified should you desire that,” Inslee said. “And all of this is maintained with great privacy protections. We’ve insisted on that.”

Washington Department of Health officials have had mixed results when it comes to their contact tracing efforts, and while they have the adequate staffing to make calls in 16 counties that require their help, State Secretary of Health John Wiesman told reporters Wednesday, that their challenges are not unique.

“Other states have been experiencing the same kinds of issues with folks not returning calls or difficulty getting the phone numbers,” he said.

Ideally, contact tracing and case investigations are done at a local level, Wiesman said, and the majority of local health jurisdictions in the state are doing their own case investigations and contact tracing, or bringing on contractors to help. Last week, in Spokane County, 76% of COVID-19 cases were epidemiologically-linked, connected to one another through contact tracing or investigators identifying spread in a similar location.

A report from DOH shows that their case investigators made contact with about 65% of people with confirmed cases of COVID-19 for an interview.

Wiesman said the Apple-Google application product is forthcoming, and the department is working with the companies to identify some “pilot opportunities.””  (I)

“But state leaders remain guarded in their enthusiasm, recognizing some Oregonians may be unlikely to participate over privacy concerns and acknowledging equity challenges over who may access the technology. An unrelated symptom-monitoring project touted as a “game changer” by Gov. Kate Brown got shelved last month for failing to ensure enough participation among people of color.

“Knowledge is power when it comes to stopping the spread of COVID-19, and this pilot project will help people make informed decisions to keep themselves healthy, while still protecting individual privacy,” Brown said in a statement this week announcing the new technology effort.

“Oregon officials would not say where the technology will be available under the pilot, noting details are still being finalized. But the Oregon Health Authority is in talks with a university or universities about promoting the system for students, suggesting it could be available in Eugene at the University of Oregon, Corvallis for Oregon State University or in Portland at Portland State University.

The digital contact tracing system will be voluntary and completely anonymous, said Dr. Timothy Menza, a senior health adviser for the Oregon Health Authority.

It works by using Bluetooth signals from cell phones to record anonymized identifiers for cell phones that are in close proximity. The technology is able to determine roughly how close and how long the phones are near one another, with the federal government considering close contact as within six feet for at least 15 minutes.

That anonymized data would stay on an individual’s phone unless the person later tests positive for COVID-19, Menza said. At that point, the infected person would receive a personal identification number from the state or county health department after the COVID-19 diagnosis had been confirmed.

The person could then voluntarily enter the PIN into their cell phone, which would begin the process of uploading the anonymized Bluetooth data to a national server, Menza said. Other participants’ phones would regularly scan the national database to see if they’ve been in close contact with a confirmed coronavirus case – and if there’s a match the person would receive a notice on the phone about exposure and suggesting testing.

State and local health departments would not receive notice about exposures, Menza said. But people who are infected, or people who seek testing after receiving a notice, could voluntarily disclose that they are using the technology.

So-called proximity tracing applications do not take the place of traditional contact tracing by public health officials that involves detailed case investigations to determine the names of people who might have been exposed to a person with a confirmed infection.

But the technology does allow for more thorough tracing efforts, allowing notification among people whose identities might not be known to an infected person – such as someone who rode the same bus, ate at the same restaurant or attended the same party.

Proximity technology is controversial, particularly among some Americans who are unwilling to share personal data for privacy reasons and skeptical of the big tech companies offering the service. But it’s been embraced in some places, including Scotland, where a new app was reportedly downloaded 600,000 times.

Menza said proximity tracing apps have the potential to make a big difference if widely adopted. He pointed to research by the University of Oxford, which estimates that cases and hospitalizations could decline if just 15 percent of the population uses the technology.

Modeled for the state of Washington, that adoption level suggested a 15 percent decline in infections and 11 percent reduction in deaths.

“In that sense,” Menza said, “it seems pretty powerful.”

But that would require participation of more than 600,000 Oregonians, essentially the entire population of Portland.

“We’ll have to put in the work to make that happen,” Menza said.”  (J)


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