The New York Times - USA (2020-08-01)

THE NEW YORK TIMES, SATURDAY, AUGUST 1, 2020 Y A

Tracking an OutbreakCapitol Hill and Containment

“I think it’s easy to say contact
tracing is broken,” said Carolyn
Cannuscio, an expert on the
method and an associate profes-
sor of family medicine and com-
munity health at the University of
Pennsylvania. “It is broken be-
cause so many parts of our pre-
vention system are broken.”
Tracking those exposed is so far
behind the virus raging in most
places that many public health of-
ficials believe the money and per-
sonnel involved would be better
spent on other resources, like in-
creasing test sites, helping
schools prepare for reopening and
educating the public about mask
wearing. Some public health ex-
perts now believe that, at the very
least, testing and contact tracing
need to be scaled back in places
with major outbreaks. In some
places, they say the effort may
never succeed.
“Contact tracing is the wrong
tool for the wrong job at the wrong
time,” said Dr. David Lakey, the
former state health commissioner
of Texas who helped oversee the
Ebola response in Dallas in 2014.
“Back when you had 10 cases
here in Texas, it might have been
useful,” said Dr. Lakey, who is now
the chief medical officer for the
University of Texas System. “But
if you don’t have rapid testing, it is
going to be very difficult in a dis-
ease with 40 percent of people
asymptomatic. It is hard to see the
benefit of it right now.”
Dr. Thomas R. Frieden, a for-
mer director of the C.D.C. who is a
strong advocate for robust contact
tracing programs, largely agreed
that it is impossible to do mean-
ingful or substantial contact trac-
ing with huge numbers of cases.
He noted that when testing results
lag as much as they have, it be-
comes almost impossible to keep
up with the high volume of in-
fected individuals and those who
have been in contact with them.
“At some point when your cases
are very high, you have to dial
back your testing and contact
tracing,” said Dr. Frieden, who
now runs Resolve to Save Lives, a
nonprofit health advocacy initia-
tive. “We may be in that situation
in some parts of the country to-
day.”
Others argue that contact trac-
ing efforts around the country are
still nascent, and many workers
fanning out in particular zones are
still too inexperienced to call it
quits. These experts contend that

tracking remains an important

mechanism that can help as flare-

ups continue over the next year

and beyond.

Crystal Watson, a risk-assess-

ment specialist at the Center for

Health Security at the Johns Hop-

kins Bloomberg School of Public

Health, said she had hoped more

contact tracers would be trained

and in place before states started

reopening. For now, she expects it

to be feasible only in Massachu-

setts, New York, North Dakota

and the District of Columbia.

Massachusetts, where the non-

profit group Partners in Health

leads the efforts, has done particu-

larly well.

Contact tracing has been used

as a tool for hundreds of years to

contain diseases like tuberculosis,

yellow fever and Ebola. A rudi-

mentary form was even used to

track the route of a syphilis out-

break in the 16th century. Coun-

tries like South Korea, Ireland and

Australia used the method to suc-

cessfully control the spread of the

coronavirus, too.

The C.D.C. has sent about $

billion in relief funds to states and

local jurisdictions for expanding

coronavirus testing and contact

tracing. A survey of state health

departments by National Public

Radio in June found they had

roughly 37,000 contact tracers in

place, with an additional 31,000 in

reserve for when they would be

needed. The work force — a mix of

government employees, volun-

teers and contract workers hired

by outside companies or nonprofit

organizations — still falls short of

the 100,000 people that the C.D.C.

has recommended.

The contact tracers, whose

training varies considerably in

length and content depending on

what state they are in, have strug-

gled to keep up with the rising

number of cases.

“The challenge is that we are

not dealing with ones and twos,”

said Fran Phillips, a deputy Secre-

tary for Public Health for Mary-

land, a state that has largely kept

the virus in check but still faces

over 900 new cases daily. For ev-

ery new case, there are several if

not dozens of people to contact, es-

pecially in large cities, which fur-

ther strains the system.

Contact tracing generally

works best, public health experts

say, when a disease is easily de-

tected from its onset. That is often

impossible with the coronavirus

because a large percentage of

those infected have no symptoms.

“When you have a situation in

which there are so many people

who are asymptomatic,” said Dr.

Anthony Fauci, the director of the

National Institute of Allergy and

Infectious Diseases, at a recent

Milken Institute event, “that

makes that that much more diffi-

cult, which is the reason you

wanted to get it from the begin-

ning and nip it in the bud. Once

you get what they call the loga-

rithmic increase, then it becomes

very difficult to do contact tracing.

It’s not going well.”

Perhaps most harmful to the ef-

fort have been the persistent de-

lays in getting the results of diag-

nostic tests. Often by the time an

individual tests positive, it’s too

late for the health care workers

tracking that person to do any-

thing.

“It’s a race against time,” Ms.

Phillips said. “And if we have lost

days and days of infectious period

because we didn’t get a lab result

back, that really diminishes our

ability to do contact tracing.” In

Maryland, like many states, some

labs are taking as long as nine

days to turn around results. “We

are getting some assurances from

national manufacturers this lag is

short term,” she said. “I am not

confident.”

In contrast, when sports teams

and staff of the White House test

people constantly, with fast turn-

arounds, contact tracing is instant

and effective.

Even as health care workers

leap over these hurdles, they are

also finding that it can be difficult

not just to reach people who were

potentially exposed to the virus

but to get them to cooperate.

Sometimes there is no good phone

number, and in the cellphone era,

unrecognized numbers are often

ignored; 25 percent of those called

in Maryland don’t pick up. Others,

suspicious of contact tracers or fu-

eled by misinformation about

them, decline to cooperate, a stark

contrast with places like Germany

where compliance with contact

tracers is viewed as a civic duty.

In Florida’s Miami-Dade

County, contact tracers employed

by the state have reached only 18

percent of those infected over the

last two weeks, according to May-

or Dan Gelber of Miami Beach;

many of the others were never

even called. Mr. Gelber wrote a

letter to Gov. Ron DeSantis on

Monday decrying the state of the

program.

“You think it’s a natural situa-

tion where people will say, ‘Oh of

course, I’ll cooperate,’ ” Dr. Fauci

said. “But there’s such pushback

on authority, on government, on

all kinds of things like that. It

makes it very complicated.”

In Seattle, tracers found 80 per-

cent of the people they reached

were not in quarantine, even if

they had symptoms. And there is

little appetite in the United States

for intrusive technology, such as

electronic bracelets or obligatory

phone GPS signals, that has

worked well for contact tracing in

parts of Asia. Although Ameri-

cans are free to cross state lines,

no national tracing program ex-

ists.

“We need federal leadership for

standards and privacy safe-

guards, and I don’t see that hap-

pening,” said Dr. Luciana Borio, a

former director of medical and

biodefense preparedness at the

National Security Council.

Many epidemiologists believe

fixing the program in the United

States to combat and contain the

coronavirus outbreaks is essen-

tial.

“We have to start by supporting

people in getting tested, which

means making it easy enough for

those exposed to someone or has

symptoms to just show up and not

worry about a doctor’s order,” Ms.

Cannuscio said. “People in the

Covid era have a hard time telling

you what day it is.”

Dr. Joia Mukherjee, the chief

medical officer at Partners in

Health, the group in charge of the

Massachusetts effort, outlined the

principles her group insisted on:

Tracers must come from the hard-

est-hit communities and be able to

speak Spanish, Haitian Creole or

whatever language the communi-

ties do.

Every tracer must be paid, not a

volunteer. And Massachusetts

had to put in enough money to let

the tracers “support” anyone ex-

pected to self-quarantine.

“We ask: Do you need food? In-

fant formula? Diapers? Cab fare?

Unemployment insurance? And

we help them get it,” Dr. Mukher-

jee said. “That way people feel it’s

care, not surveillance.”

Dr. Marcus Plescia, the chief

medical officer at the Association

of State and Territorial Health Of-

ficials, said that despite the fail-

ures so far, it was too soon to sur-

render. States need more time to

build up a tracing work force and

the infrastructure to do it well, he

said, and Americans need to grow

more comfortable with the con-

cept, similar to becoming accus-

tomed to wearing masks.

Dr. William Foege, a former di-

rector of the C.D.C., said recently

that effective tracers should be

“psychiatrists, detectives and

problem solvers all at once,” and

that will also take time for many

who are new to the job.

But in the meantime, Dr. Plescia

said, even finding a fraction of

cases through contact tracing will

help slow the virus’s spread.

“We don’t have to strive for per-

fection on this,” Dr. Plescia said.

“It’s a heavy lift and it’s going to

take some time. We need to hang

in there and keep at it.”

TOOLS FOR PREVENTION

Donald G. McNeil Jr. contributed
reporting.

Maria Fernanda working on contact tracing in May in the offices

of the Florida Department of Health in Miami-Dade County.

LYNNE SLADKY/ASSOCIATED PRESS

Amid Testing Shortfalls, the U.S. Contact Tracing System Has Largely Failed

From Page A

Many officials believe

the money should be

spent on other efforts.

WASHINGTON — The White
House and Congress hurtled over
an economic and political cliff on
Friday, failing to reach agreement
to extend $600-per-week federal
jobless aid payments for millions
of Americans before their mid-
night expiration and risking a
backlash from voters amid a pan-
demic-induced recession.
Republicans and Democrats
heaped blame on each other for
the breakdown, even as they said
they would continue to try to
strike an agreement on a recovery
package that would restore the
benefits, which have become a
critical lifeline for laid-off workers
and the economy itself. But in al-
lowing the lapse, President Trump
and congressional leaders in both
parties were treading on political-
ly perilous ground three months

before the general election.
The relief package under dis-
cussion is almost certainly the last
chance Mr. Trump has to inject
fresh stimulus into the battered
economy before he faces voters in
November, with his political
standing damaged amid wide-
spread public dissatisfaction over
his handling of the pandemic. Re-
publicans, whose hold on the Sen-
ate majority is under threat, could
also pay a steep price for failing to
deliver relief to struggling Ameri-
cans, after waiting weeks to
present their own proposal and ul-
timately endorsing a deep cut to
the enhanced jobless benefits.
But the impasse also amounts
to a calculated risk for Democrats,

who have pressed to extend the

full $600-a-week federal unem-

ployment payments through Jan-

uary as part of a sweeping $3 tril-

lion recovery plan. They opted to

reject Republicans’ last-ditch pro-

posals for a short-term extension

or a continuation of the aid at a

lower rate, taking the position that

allowing the benefits to expire

was better than agreeing to an aid

proposal that they considered far

too stingy to meeting the needs of

a crippled economy and a continu-

ing public health crisis.

“We don’t have shared values —

that’s just the way it is,” Speaker

Nancy Pelosi of California said.

“It’s not bickering. It’s standing

our ground.”

Mr. Trump, who has been large-

ly absent from the talks on a re-

covery package, savaged Demo-

crats for the impasse, saying they

were jockeying for political ad-

vantage instead of working to find

a compromise.

“Democrats do not care about

the people of our country,” he said

at the White House. “It is a dis-

grace that they’re not negotiating,

but they’re only looking to play a

political game.”

As the two sides traded insults

from either side of Pennsylvania

Avenue, the economy hung in the

balance. The pandemic has oblit-

erated nearly five years of growth,

according to the latest govern-

ment figures, which came as the

tally of new claims for state unem-

ployment benefits exceeded one

million for the 19th consecutive

week. Economists have warned

that a failure to enact additional

federal relief could further devas-

tate American families and per-

manently damage an already

shuddering economy.

Still, a deal to produce such a

package appeared no closer.

Senate Republicans waited un-

til Monday — days after workers

in several states received their

last unemployment benefit pay-

ments — to unveil their $1 trillion

relief proposal, and even then re-

mained deeply divided on its con-

tents, with many preferring no ac-

tion at all.

Democrats, who pushed their

$3 trillion stimulus plan through

the House in May, have rejected

Republicans’ efforts to buy time

for negotiations with a short-term

extension of the unemployment

benefits. Sensing that they have

the upper hand in the talks given

the likelihood of substantial Re-

publican defections, Democrats

appear reluctant to offer many

concessions.

In the absence of much common

ground, the two sides resorted to

finger-pointing in dueling news

conferences on Friday. Ms. Pelosi

charged that the administration

officials who had huddled in her

Capitol Hill suite the night before

had no grasp of the gravity of the

pandemic and its mounting toll.

Mark Meadows, the White House

chief of staff, blamed the Demo-

crats for the impasse, saying they

had rejected four proposals that

would have maintained the bene-

fits for a brief period.

A weeklong extension of the

benefit, Ms. Pelosi said, would

only suffice had there been a

broader agreement within reach

and an additional few days were

needed to cement and pass such a

deal.

“What are we going to do in a

week?” she said. “We anticipate

that we will have a bill, but we’re

not there yet.”

Despite the bitter talk, there

were glimmers of efforts to break

through the logjam. Ms. Pelosi is

set to host Senator Chuck Schu-

mer of New York, the minority

leader, Mr. Meadows and Steven

Mnuchin, the Treasury secretary,

for a rare meeting on Saturday

morning in her office on Capitol

Hill, according to an aide familiar

with the plans. The House post-

poned the start of its monthlong

August recess until a deal was

struck, and on Thursday, before

the Senate adjourned until Mon-

day, the procedural wheels for

passing legislation had begun to

creak forward.

But the stalemate could already

be taking its toll. The sudden re-

duction in buying power that

comes with the loss of the en-

hanced unemployment insurance

benefit is likely to cause the eco-

nomic slowdown to worsen, a

blow that comes as the chair of the

Federal Reserve, Jerome H. Pow-

ell, warned that the recovery un-

derway in May and June was slip-

ping and other economists offered

dour predictions of little job

growth and stubbornly high un-

employment.

“The danger is that the econ-

omy stalls, and that we have dou-

ble-digit unemployment for

months and months and months

until a vaccine arrives,” said Mi-

chael R. Strain, an economist at

the conservative American Enter-

prise Institute. “That creates a sit-

uation where the roots of eco-

nomic weakness grow stronger

and grow deeper, and you start to

have systematic and structural

problems in the economy, over

and above the need to partially

close due to the coronavirus.”

On Capitol Hill, lawmakers who

support another sweeping infu-

sion of federal money across the

American economy, including

many who are facing difficult re-

election contests in November,

said that a failure to strike an

agreement would be unaccept-

able.

“Congress has to rise to the cri-

sis — it is too serious,” said Sena-

tor Susan Collins, Republican of

Maine. “If we can’t work together

in a bipartisan, bicameral way, in

the midst of a persistent pandemic

that is causing such harm to peo-

ple’s health and to the economic

stability, then we will have failed

the American people.”

Jim Tankersley, Michael Crow-

ley and Zach Montague contribut-

ed reporting.

CONGRESS

House Speaker Nancy Pelosi is set to meet with President Trump’s chief of staff and the Treasury secretary on Saturday morning.

STEFANI REYNOLDS FOR THE NEW YORK TIMES

$600 Aid Payments End,

But Negotiations Go On

By EMILY COCHRANE

Jim Tankersley, Michael Crowley
and Zach Montague contributed
reporting.

Treading on politically

perilous ground three

months before the

general election.

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