The city hired more trackers during the holiday wave and hit its goal of reaching at least 90% of people who test positive in early March, a level it hasn’t reached since Thanksgiving. Last week the number reached 96%.
Overwhelmed tracing programs elsewhere have weathered the wave by switching to robocalls, limiting the types of cases they trace, or asking infected people to simply contact their contacts themselves.
But New York remains committed, saying the tracing helped curb the city’s second wave and is all the more needed now as vaccination campaigns rush to overtake the spread of disturbing viral variants.
“This is the danger zone, where we cannot let our guard down,” says head of contact tracing, Dr. Ted Long.
Yet considerable challenges remain. Less than half of those who test positive name anyone they may have exposed to the virus. Some stop responding to a storm of follow-ups to make sure they stay isolated.
There is debate among public health experts as to whether local governments should reduce contact tracing and focus more on immunization.
Some very active vaccination clinics are far from communities of color. Doses are not being distributed at a level that reflects the greatest dangers of COVID-19 for people in these communities. Epidemiologist Camara Phyllis-Jones breaks down the problem and says “we can dismantle this system”.
After suffering the nation’s deadliest coronavirus outbreak last spring, New York City has put together what appears to be the largest contact tracing effort in any U.S. city, now with around 4,000 tracers and a budget of 582 million dollars for this fiscal year and next. An additional $ 184 million is planned for services such as voluntary hotel stays for people who cannot self-isolate at home.
The search for those infected was easier in mid-August, when the city had around 200 new cases a day. It became a monumental effort in mid-January, when new cases exceeded 6,000 a day.
Since then, the daily workload has dropped by about half. Still, the city’s five wards have infection rates in the top 2% of counties nationwide. Long argues that the city’s research program helped limit the outbreak to significantly fewer new deaths per person than in the United States as a whole.
Tracer Jessica Morris said that “it was very intense for two and a half months straight” during the wave.
Subjected to calls to make and reminders to answer, trackers tried to compress their conversations without skipping important information. “I have mastered the art of breaking the ice very effectively,” she said.
Although responses vary, Morris said she was “generally able to move on to some degree – maybe not full contact sharing, but at least a willingness to stay home” and respond to follow-up.
Some infected people report that they were already in quarantine and therefore had no contact. Others simply don’t name names, saying they personally called their contacts and felt they didn’t need the city’s involvement.
The city’s research efforts can be intense.
Emmaia Gelman, a graduate student in New York City, said contact tracers called her about 70 times after she tested positive. Each day brought calls, texts or both to monitor her and her two children, who tested negative.
The Centers for Disease Control and Prevention is updating what they define as “close contact” with someone who has tested positive for COVID-19.
Gelman briefly stopped answering calls. She also withheld some names of people she had been in contact with before her symptoms appeared, for reasons such as the immigration status of the population.
“You’re always suspicious because you put people’s names on a list,” said Gelman, who said she informed all of her contacts before a tracker called her.
Long said the city now plans to let one person answer for a family.
“But I maintain our persistence,” he said. “One of the hallmarks of our program that I’m proud of is that we’re a bunch of people who won’t give up.”
Faced with their own pushes, some other states and local governments have decided to back down on their research efforts.
In Philadelphia, tracers were so stretched that they tried to hit only half of the new cases in early February – and less recently, as most staff have temporarily switched to vaccination call centers for help and to distribution, Public Health Department spokesman Matt Rankin said.
Chicago began automating calls and asking recipients to notify their own contacts in December, conducting in-person interviews only in groups and for cases deemed a priority, according to Department of Health spokesperson Alyse Kittner. . Automation allows the city to reach over 90% of those newly diagnosed, she said.
New York did not need to take such steps, Long said.
Still, other public health experts have doubts about contact tracing efforts in the United States.
A new study of 300 people who had antibodies to the virus found that 60% had no idea they had been infected, making it unlikely that the tracers would know either. The study, which has yet to be reviewed by other scientists, also found that less than 18% were asked about their contacts.
“Contact tracing is not a tactic that will work well, given the speed, scale and stealth with which this virus is spreading,” said lead author Denis Nash, professor of epidemiology at the City. New York University. He argues that resources could be better spent on addressing immunization disparities, among other strategies.
Carolyn Cannuscio, a Philadelphia-based epidemiologist, saw contact tracing reach its limits as she helped run the Penn Medicine program. The holiday season surge has forced tracers to focus on cases deemed to be at high risk of spreading, although tracers have since restarted trying to reach all of her patients who tested positive.
Nonetheless, she said tracing remains valuable and could help answer questions such as whether people who have been vaccinated can transmit the virus.
“We shouldn’t just give up and think, ‘Now is not the time for contact tracing,’ she said.