As contact tracing declines in parts of the U.S., New York remains compromised

NEW YORK (AP) – U.S. coronavirus contact-tracing programs have lowered their ambitions as winter cases spiked, but New York City has leaned on its $ 600 million tracing initiative. .

The city hired more tracers during the holiday season and, in early March, it reached its goal of reaching at least 90% of people who test positive, a mark it had not reached since around Thanksgiving. Last week, the number reached 96%.

Overwhelmed tracking programs elsewhere have faced the wave by switching to robocalls, limiting the types of cases they track, or telling infected people to simply contact their contacts.

But New York remains committed, saying the tracking helped stem the city’s second surge and is even more needed now that vaccination campaigns are racing to outpace the spread of worrisome viral variants.

“This is the danger zone, where we can’t let our guard down,” says head of contact tracing, Dr. Ted Long.

Still, considerable challenges remain. Less than half of the people who test positive mention someone they may have exposed to the virus. Some stop responding to an avalanche of follow-ups meant to make sure they stay isolated.

There is some debate among public health experts about whether local governments should reduce contact tracing and focus more on vaccination.

After enduring the nation’s deadliest coronavirus surge last spring, New York City established what appears to be the largest contact tracing effort in any US city, now boasting about 4,000 tracers and a $ 582 million budget for this fiscal year and next. Another $ 184 million is budgeted for services such as voluntary hotel stays for people who cannot isolate themselves at home.

Tracking infected people was easier in mid-August, when the city had about 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 been reduced by roughly half. Still, the city’s five boroughs have infection rates in the top 2% of counties nationwide. Long argues that the city’s tracking program helped limit the increase to considerably fewer new deaths per person than the US as a whole.

Tracer Jessica Morris said “it was very intense for two and a half months straight” during the wave.

The trackers, packed with calls to make and callbacks to answer, struggled to compress their conversations without missing important information. “I have mastered the art of breaking the ice very efficiently,” he said.

Though responses vary, Morris said “she’s usually able to communicate to some degree, maybe not full-blown contact sharing, but at least willing to stay home” and respond to monitoring.

Some infected people report that they were already in quarantine, so they had no contact. Others simply do not mention names, saying that they personally called their contacts and felt that they did not need the participation of the city.

City tracking efforts can be intense.

Emmaia Gelman, a graduate student in New York City, said contact trackers called her about 70 times after she tested positive. Every day she brought calls, text messages or both to monitor her and her two children, who tested negative.

Gelman briefly stopped answering calls. He also saved some names of people he had been in contact with before his symptoms appeared, for reasons including people’s immigration status.

“You’re always cautious because you’re putting people’s names on a list,” said Gelman, who said she notified all her contacts before a tracker called her.

Long said the city now plans to let one person vouch for a family.

“But I keep our persistence,” he said. “One of the characteristics of our program that I am proud of is that we are a group of people who will not give up.”

Faced with their own surges, some other state and local governments decided to reduce their tracking efforts.

In Philadelphia, the tracers were so depleted that they tried to reach only half of the new cases in early February, and less lately, as most of the staff temporarily switched to help with call centers and vaccine distribution, said the Department of Public Health spokesman Matt Rankin.

Chicago began automating calls and instructing recipients to notify their own contacts in December, conducting in-person interviews only in groups and for priority cases, according to Department of Health spokeswoman Alyse Kittner. Automation is allowing the city to reach more than 90% of newly diagnosed people, he said.

New York City has not needed to take such steps, Long said.

However, some other public health experts are reconsidering 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, so the trackers are unlikely to know. The study, which has yet to be reviewed by other scientists, also found that fewer than 18% had been 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 spreads,” said lead author Denis Nash, a professor of epidemiology at the City University of New York. . He argues that resources can be better spent on addressing vaccination disparities, among other strategies.

Philadelphia-based epidemiologist Carolyn Cannuscio saw contact tracing reach its limits as she helped run the Penn Medicine program. The increased holiday season forced tracers to focus on cases considered high risk of spread, although tracers have since resumed their attempt to reach all patients who test positive.

Still, he said the tracing remains valuable and could help answer questions like whether vaccinated people can transmit the virus.

“We shouldn’t just give up and think, ‘Now is not the time to trace contacts,'” he said.

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