Thread by @celinegounder

@nycHealthy took a beating in the @nytimes over the weekend: nytimes.com/2020/06/21/nyr… It's a bit more complicated. Got an inside (but on-the-record) look at NYC's #contacttracing data today, along with @mlipsitch, @T_Inglesby, @dsallentess, @Farzad_MD, @drJoshS, @trvrb & others.

Here's a link to where you can find NYC's #coronavirus #COVID #contacttracing data: nychealthandhospitals.org/test-and-trace…
No one is reporting this level of detail. We *need* this level of transparency to learn and do better.

Here are some of the challenges and lessons learned so far:
-- ~27% of contacts of infectious cases are kids.
-- Many people don't have working phones. It's a bit like working in global health... we gave people SIM cards & phones.

-- It's harder to do contact tracing for #COVID #coronavirus than for #HIV and #TB in part because we don't have a treatment (in contrast to HIV) or cure (in contrast to TB) to offer.

-- What could we offer to incentivize people to engage in #contacttracing? FOOD (#1 request). Paid leave (being away from work &/or a positive test could mean losing their job). PPE.

-- Few of the #COVID #coronavirus contacts agree to go to hotels to isolate. This is similar to what my patients at the hospital say. They just want to go home. So how do we make it safe for them to isolate at home?

-- Another big challenge is trust. Contact tracers, esp those going door-to-door, need to be from the affected community. People trust people like them. 50% of the staff hired to do contact tracing are from the hardest-hit zip codes. 👏👏👏

-- When hiring at health depts is "first in, last out," it's hard to hire to match neighborhood, race, ethnicity, language, etc. Govt jobs are among the few that provide a living wage, job security, benefits & union protections. That's a good thing.

-- What if we had a right to a living wage? Jobs with health/safety protections? Not just in govt jobs, but across the board? What would the impact be on how we hire? Who we retain? This applies to health depts... police depts... and much more.

-- 22% of #COVID #coronavirus contacts in NYC have symptoms. This is HIGH. This means many of the contacts are infected by the time they're reached by the contact tracers. Many of those already infected will be a-/pre-/mildly symptomatic. 22% symptomatic is thus VERY HIGH.

-- 22% of #COVID #coronavirus contacts in NYC have symptoms. This also is HIGH because many of the contacts (27%) are kids. Kids on average have no/fewer symptoms. So 22% with symptoms is VERY HIGH.

-- And what does that mean? We're reaching #coronavirus contacts too late. This isn't a criticism of @nycHealthy. This is a reflection of how hard #COVID is to control.

-- #COVID #coronavirus is highly infectious. Lots of a-/pre-symptomatic spread. Contact tracers need to find contacts as early as 2 days BEFORE they develop symptoms to prevent onward spread. By the time they know of a case (i.e. patient zero in that chain), it may be too late.

-- It's a really hard job, but still worth doing.
-- @nycHealthy is working hard to try to reduce loss to follow up of contacts at each step in the process:

-- NYC is now doing 30K #COVID #coronavirus tests per day. Aiming to get to 50K tests per day soon.
-- NYC is increasing # of testing sites across the city. I was surprised to hear that @CityMD is such a big player.

-- NYC is also rolling out mobile testing vans in #COVID #coronavirus hardest-hit neighborhoods.
-- & is working with big employers to implement worksite testing.

-- But #contacttracing remains really, really hard. Hard, but worth doing.
-- @paulmromer's thoughts re: universal/mass #COVID #coronavirus are seeming more & more necessary.

What would universal/mass #COVID #coronavirus testing look like?
-- First we need a good point of care test. Something like @QuidelDX's test, but more sensitive. quidel.com/sites/default/… (see page 17)

-- Then, how do we get everyone to get tested?
-- We need to think back on the days of #HIV #AIDS. A positive #COVID #coronavirus test could mean losing housing or a job.
-- People need a REASON to get tested. Not just that they're protecting others. What does this mean for THEM?

-- Another challenge is going to be communication.
People were already confused by re: masks.
First: don't hoard / wear masks. Healthcare workers need them (N95s).
Then: Wear a cloth/surgical mask. It partially protects you. It's mostly to protect others in case you have #COVID.

-- Communication on testing has also been confusing.
First: Get tested!
Then: Don't get tested! We don't have enough. Stay home if you're sick.
Then: Come to the hospital if you're sick & get tested.
Then: Go to drive-thru & other testing sites if you're sick.

-- Then: If you've been in contact with someone who has #COVID #coronavirus, you should get tested.
-- Then (maybe): We should all get tested.

-- This is super confusing to the lay public & will require a lot of preparation and clear communication as to why our message is "changing."

BIG PICTURE? @nycHealthy is ahead of just about anyone else in the country. They've hired ~3000 contact tracers. They're being transparent with their data. They're analyzing the data & improving processes along the way. THAT'S the public health approach. //

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