Coronavirus contact tracing programs in the United States have slashed ambitions as cases spike in the winter, but New York City has looked into its $ 600 million tracing initiative.
The city hired more trackers over the holiday season, and by early March hit its goal of reaching at least 90% of people who test positive, a mark it hasn’t hit since Thanksgiving. Last week the number reached 96%.
Overwhelmed research programs elsewhere have weathered the wave by switching to robocalls, limiting the types of cases they track down, or telling those infected 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 worrying viral variants.
“This is the danger zone, where we cannot let our guard down,” said head of contact tracing, Dr Ted Long.
Yet considerable challenges remain. Less than half of those who test positive name anyone they may have been 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.
After suffering the nation’s deadliest coronavirus wave last spring, New York City mounted what appears to be the largest contact tracing effort in any US city, now numbering around 4,000 plotters and a budget of $ 582 million for this fiscal year and the next. An additional $ 184 million is budgeted for services like voluntary hotel stays for people who cannot self-isolate at home.
Screening 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 surpassed 6,000 a day.
Since then, the number of daily cases has dropped by about half. Yet the city’s five boroughs have infection rates in the country’s richest 2% of counties. Long argues that the city’s research program has helped limit the increase 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.
Taking 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 extent – maybe not full-fledged contact sharing, but at least a willingness to stay home” and respond to The surveillance.
Some infected people report that they were already in quarantine and therefore had no contact. Others simply don’t give names, saying they have personally called their contacts and felt they don’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 testing positive. Every day, calls, texts, or both to monitor her and her two children, who tested negative.
Gelman briefly stopped answering calls. She also withheld some names of people she had been in contact with prior to the onset of her symptoms, for reasons such as people’s immigration status.
“You are always wary because you put people’s names on a list,” said Gelman, who said he informed all of his contacts before a tracker called him.
Long said the city now plans to let one person answer for a family.
“But I support 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, other state and local governments have decided to scale back their research efforts.
In Philadelphia, tracers were so stretched they only tried to reach half of new cases in early February – and fewer of late as most staff have temporarily moved on to help call centers and immunization 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 City did not need to take such action, Long said.
Still, some other public health experts have doubts about US contact tracing efforts.
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 is going to 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 University of New York. He argues that resources can be better spent on addressing immunization disparities, among other strategies.
Philadelphia-based epidemiologist Carolyn Cannuscio saw contact tracing reach its limits as she helped run the Penn Medicine program. The holiday wave has forced tracers to focus on cases deemed to be at high risk of spreading, although tracers have since resumed trying to reach all of her patients who test positive.
Still, 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 to look for contacts’,” she said.