Answer your freakin’ phone.
That’s the message contact tracers are trying to get through to people they’re calling who have tested positive for the coronavirus that causes COVID-19. One public service announcement tweeted out by the state Health Department shows two iphones side by side, one with an incoming call from “Your Ex” and another from “NYS Contact Tracing”—with instructions above one “Don’t Pick Up” and above the other, “Please Pick Up.”
Close to 100 percent of those in New York City who tested positive and shared an accurate number upon intake have been picking up the phone. And people appear to be getting used to sharing information of those they might have exposed: of those who complete interviews, about three-fourths provided tracers with information for their secondary contacts.
But getting people to pick up the phone has been just one of several challenges facing the city and state contact tracing programs. Hiring and training people, getting the technology to work, and getting different agencies to exchange information smoothly has been difficult.
Leaders of both programs say they had to ramp up their systems quickly and have had to fix problems as they emerged, but they’re already making progress.
“We stood up in a matter of a few weeks, an organization with thousands of people, from scratch—the I.T. infrastructure, the management infrastructure, the training infrastructure,” said Dr. Ted Long, a physician and administrator at the Health and Hospitals Corporation who is running the city’s Testing and Tracing Corps. “We didn't want to lose even one minute to get this up and running for New York City.”
But some experts say the city’s program, which got underway at the beginning of June, should have started much earlier. One veteran epidemiologist for the city faults the Health Department for not doing contact tracing at the peak of the outbreak.
“Yes, the numbers were overwhelming, and, yes, they would only have reached a fraction of the people infected, but that still could have provided useful information that potentially could have slowed down transmission,” the insider said, withholding their name to speak candidly about debates within the Health Department and de Blasio administration.
“We should have been a lot further along with this many, many weeks ago,” said Dr. Irwin Redlener, director of Columbia University's National Center for Disaster Preparedness. “Like with testing, we weren't prepared—and we're still not prepared to do either of those tasks sufficiently, to make sure that people are tested and to have a robust, effective contact tracing system.”
Many public health observers—including the chairs of the state Assembly and Senate health committees—have criticized Mayor de Blasio for handing over testing and tracing efforts to the public hospital system from the city Health Department, which works closely with the Centers for Disease Control and Prevention and is well regarded internationally for its ability to contain outbreaks. Dr. Denis Nash, who has worked for both agencies and is now a professor of epidemiology at the CUNY Graduate School of Public Health, said there has been a “disconnect between what we hear and what I think of as the larger public health goals of the contact tracing program.”
Nash said the city program, in its statements, is emphasizing how many people it’s reached, how many secondary contacts tracers have spoken with, and other figures, but is not speaking about patterns that can help inform both decision-makers and average citizens.
“What goes hand-in-hand with contact tracing is gaining epidemic intelligence,” he said. “Who's actually getting COVID now? And if contact tracing is reaching out to every single new diagnosis, shouldn't we be learning something about their likely mode of acquisition? And shouldn't we be telling everyone about that every few days, so that we can all do our part in trying to close the gaps in prevention?”
One newly-hired contact tracer cited problems with training and management.
“There's a lot of conflicting information,” a woman who identified herself as Dee told Dr. Long on the Brian Lehrer Show on Thursday. “There's our agency [Health and Hospitals], but then there's the contractor, and we have many different supervisors…and our training schedules are even a little bit short and hard to understand.”
Long replied that he was eager to hear more from her.
“We're fully committed to that,” he said. “I think there’s evidence of how things have improved, through your hard work, between the first two weeks and last week, has already been really, really encouraging.”
Outside New York City, individual counties run their own contact tracing programs, coordinated by the state Health Department. Several counties have complained about “heavy handed” guidance from Albany, according to one veteran observer, and are criticizing a contact tracing software program the state procured, called CommCare. Some have said they refuse to use it and threatened to completely go their own way.
“Local health departments have been responsible for contact tracing for decades and are very good at what they do,” said Sarah Ravenhall, executive director of the New York State Association of County Health Officials. ”So it is natural that some local health departments want to use a system that they believe is best suited for contact tracing in their communities.”
Ravenhall said counties share the same goals with the state of ensuring “that the work is done consistently, and the data is generally standardized.”
Larry Schwartz, Governor Andrew Cuomo’s point person on contact tracing, said he has not heard complaints and that any software or other problems are simply part of putting together a new statewide program so quickly.
“I think we're moving at the speed of light,” Schwartz said. “Like any new program, like any new technology, there's always a couple of problems and glitches…many of them have been resolved, and the remaining few are being beta-tested with solutions.”
Schwartz said the counties will need to fall in line or risk losing money to help pay for their expanded contact tracing obligations.
“In order to be eligible to receive federal funding, the federal government is requiring a unified surveillance system to be able to monitor and track the success of the program,” Schwartz said, recounting a recent conference call with county leaders. “I had zero complaints and zero anyone telling me that they're not going to participate.”