{"id":1417,"date":"2020-07-01T18:26:35","date_gmt":"2020-07-01T18:26:35","guid":{"rendered":"http:\/\/council.nyc.gov\/data\/?page_id=1417"},"modified":"2022-09-12T14:48:09","modified_gmt":"2022-09-12T14:48:09","slug":"contact-tracing","status":"publish","type":"page","link":"https:\/\/council.nyc.gov\/data\/contact-tracing\/","title":{"rendered":"Contact Tracing"},"content":{"rendered":"<div class=\"row\">\n<div class=\"columns large-6\"><img decoding=\"async\" src=\"http:\/\/council.nyc.gov\/data\/wp-content\/uploads\/sites\/73\/2020\/07\/Contact-Tracing-A-Primer-2.png\"><\/p>\n<p><a class=\"button\" style=\"margin-bottom: 0;\" href=\"https:\/\/council.nyc.gov\/data\/\">Data Team Home <i class=\"fas fa-map-marked\" aria-hidden=\"true\"><\/i><\/a><\/p>\n<\/div>\n<div class=\"columns large-6\">\n<h2>What is contact tracing?<\/h2>\n<p><span style=\"font-weight: 400;\">Contact tracing is the process of<\/span><a href=\"https:\/\/www.who.int\/publications\/i\/item\/contact-tracing-in-the-context-of-covid-19\"><span style=\"font-weight: 400;\"> identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission. When systematically applied, contact tracing will break the chains of transmission of an infectious disease.<\/span><\/a><span style=\"font-weight: 400;\">&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">An important component to the success of contact tracing is community engagement. Contact tracers must understand the needs of the community that they are serving, which includes languages spoken, literacy, cultural customs, agency, and stigma.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For contact tracing to be successful, there needs to be cooperation between communities and public health departments. The success of any contact tracing program depends on everyone pitching in to help.<\/span><\/p>\n<h2>Successful examples<\/h2>\n<p><span style=\"font-weight: 400;\">Contact tracing, aka \u2018partner notification\u2019,&nbsp; has been successfully used to control the spread of ebola, SARS, MERS, smallpox, and sexually transmitted diseases.&nbsp; <\/span><span style=\"font-weight: 400;\">In the case of STDs, contact tracing is extremely effective.<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2870583\/#ref018\"><span style=\"font-weight: 400;\"> It is particularly useful for uncovering asymptomatic cases, thus providing a way of treating individuals who would otherwise continue to unknowingly spread the disease<\/span><\/a><span style=\"font-weight: 400;\">.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While there are challenges to tracking a disease that is spread via airborne respiratory droplets, this same principle can also be applied to Covid-19. Contact tracing can identify individuals before they show symptoms (pre-symptomatic) or asymptomatic individuals who may be unknowingly spreading the infection.<\/span><\/p>\n<h2>Conditions for Success<\/h2>\n<p>Contact tracing is effective when we have:<\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Enough staff from the target communities to reach out to everyone who is sick<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The number of cases is low enough that you can trace and reach all contacts<\/span><\/li>\n<li><span style=\"font-weight: 400;\">People contacted listen to recommendations<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<hr>\n<div class=\"row\">\n<div class=\"columns large-8\"><img decoding=\"async\" src=\"http:\/\/council.nyc.gov\/data\/wp-content\/uploads\/sites\/73\/2020\/07\/Contact-Tracing-Process-1.png\"><\/div>\n<div class=\"columns large-4\">\n<h2>Contact Tracing Process<\/h2>\n<p><span style=\"font-weight: 400;\">Contact tracing in NYC is run by Health and Hospitals (H+H) as part of NYC\u2019s <\/span><a href=\"https:\/\/www.nychealthandhospitals.org\/test-and-trace\/\"><span style=\"font-weight: 400;\">Test and Trace Corps<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As of Oct. 19 the Corps employed <\/span><a href=\"https:\/\/hhinternet.blob.core.windows.net\/uploads\/2020\/10\/test-and-trace-data-demographic-data-20201019.pdf\"><span style=\"font-weight: 400;\">3585 contact tracers and community engagement specialists<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Every person who is identified as sick is put in touch with a contact tracer. The contact tracer then works to identify their contacts and ensure they have the resources they need to remain isolated while carrying the disease.<\/span><\/p>\n<\/div>\n<\/div>\n<hr>\n<h2>Why it works<\/h2>\n<div class=\"row\">\n<div class=\"columns large-6\">\nContact tracing becomes especially crucial as we attempt to reopen in any particular region such as New York City. Reopening will allow more individuals to come back into contact with each other. Unchecked, this would allow COVID cases to begin to grow exponentially again.<\/p>\n<p>Preventing this scenario will require a number of different measures like maintaining social distancing, wearing masks, and washing hands. Contact tracing also plays a key part. If we allow certain phases of reopening to proceed but continue to see a decrease in the number of new cases after two weeks (the approximate lag between infection and hospitalization), we will know intervention methods are working.<\/p>\n<p>COVID-19 is particularly difficult to contain because those infected go through a <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe2009758\">pre-symptomatic period<\/a> in which they show no visible signs of infection but are still contagious.&nbsp; Best medical research suggests that the average individual will become symptomatic approximately <a href=\"https:\/\/www.acpjournals.org\/doi\/10.7326\/M20-0504\">5 days<\/a>after infection. However, there is some evidence that individuals become infectious (able to infect others) around <a href=\"https:\/\/science.sciencemag.org\/content\/368\/6490\/489\">3 days after infection<\/a>. Individuals may also be the most infectious <a href=\"https:\/\/www.nature.com\/articles\/s41591-020-0869-5\">before or right when they begin to show symptoms<\/a><\/p>\n<p>Effective contact tracing can allow us to identify these pre-symptomatic individuals while they are still infectious and before they show symptoms. Identifying these cases and ensuring they have the required services to isolate will help stop the spread of COVID-19.<\/p>\n<p>COVID-19 also appears to have a high fraction of infected individuals who never show symptoms &#8211; in other words, <a href=\"https:\/\/www.bmj.com\/content\/369\/bmj.m1375\">asymptomatic infections<\/a>. Proper contact tracing can help ensure these individuals are identified even though they don\u2019t feel sick, thereby preventing them from spreading the virus indiscriminately.<\/p>\n<\/div>\n<div class=\"columns large-6\">\n<p>There are a few metrics used to measure the success of a contact tracing program. These include the proportion of contacts reached (given by cases that had contacts). Ideally, all cases would have no contacts or few contacts, because the program would be supplemented by social distancing measures, and contacts would be caught quickly enough that they didn\u2019t have the opportunity to spread the infection.<\/p>\n<p>As contact tracing becomes more robust and effective, the proportion of cases who were contacts themselves increases. This indicates that the program is effectively controlling spread.<\/p>\n<p>Other simple metrics of success include:<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Percentage of cases that were contacted within 24 hours of case report<\/span><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.ncsddc.org\/wp-content\/uploads\/2020\/06\/covid-contact-tracking-playbook.pdf\"><span style=\"font-weight: 400;\">Percentage of contacts that were notified and quarantined within 24 hours of outreach<\/span><\/a><\/li>\n<\/ul>\n<p>All of this success requires community buy-in. According to Resolve to Save Lives, an initiative of Vital Strategies led by the former head of the CDC and DOHMH, Dr. Tom Frieden, communication with the public is one of the key factors in a successful test and trace program.<\/p>\n<p><a href=\"https:\/\/contacttracingplaybook.resolvetosavelives.org\/checklists\/communications\">Communication efforts should be partnered with community members, available in appropriate languages and should allow for feedback from communities to ensure their effectiveness.<\/a><\/p>\n<\/div>\n<\/div>\n<hr>\n<h2>Superspreading<\/h2>\n<div class=\"row\">\n<div class=\"columns large-6\">\n<span style=\"font-weight: 400;\">When trying to understand how COVID spreads, we often assume that everyone comes into contact with, on average, the same number of people. In real life however, people can differ in their number of contacts depending on, for example, what kind of job they have or how they spend their free time. This has implications for how COVID-19 is spread and for contact tracing.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There is some evidence to suggest that \u2018superspreader\u2019 events, where one individual with many contacts is responsible for infecting a large (~6+) group of others, may be one of the <\/span><a href=\"https:\/\/www.researchsquare.com\/article\/rs-29548\/v1\"><span style=\"font-weight: 400;\">main pathways for spreading coronavirus<\/span><\/a><span style=\"font-weight: 400;\">.&nbsp;<\/span><\/p>\n<p>Superspreader events are much more likely to occur in places where lots of people gather.<\/p>\n<\/div>\n<div class=\"columns large-6\">\n  One of the earliest superspreader events in the USA occurred at a choir practice in Washington State in which <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6919e6.htm\"><span style=\"font-weight: 400;\">one<br \/>\nperson infected between 32 and 52 other individuals<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">These concerns are why <\/span><a href=\"https:\/\/www.governor.ny.gov\/sites\/governor.ny.gov\/files\/atoms\/files\/NYC_Indoor_Food_Services_Summary_Guidelines.pdf\"><span style=\"font-weight: 400;\">New York State guidelines<\/span><\/a><span style=\"font-weight: 400;\"> require one member of each party eating at a restaurant indoors to leave their contact information for the purpose of helping with contact tracing efforts.<\/span><\/p>\n<p>In addition, this requirement is just one of many, such as keeping density at indoor restaurants at 25% capacity and requiring diners to wear face masks when not eating, that all attempt to prevent the spread of infection indoors<\/p>\n<\/div>\n<\/div>\n<hr>\n<div class=\"row\">\n<div class=\"columns large-6\">\n<h2>Local Law 61<\/h2>\n<p><span style=\"font-weight: 400;\">New York City <\/span><a href=\"https:\/\/legistar.council.nyc.gov\/LegislationDetail.aspx?ID=4536896&amp;GUID=EE9A133B-3DCC-4C83-BD7A-0A48E6649ED5&amp;Options=&amp;Search=\"><span style=\"font-weight: 400;\">Local Law 61<\/span><\/a><span style=\"font-weight: 400;\"> requires that Health+Hospitals report weekly and eventually daily on which communities are being served by NYC\u2019s Test &amp; Trace program.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">H+H is required to report on the number of contact tracers employed by languages spoken and zip code of residence.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In addition, H+H is required to report on the number of cases and contacts disaggregated by \u201czip code, race, ethnicity, gender, age range, whether they tested positive for currently having COVID-19 or experienced COVID-19 symptoms within the last 14 days, \u2026 and whether such individuals were referred to wraparound services\u201d.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Providing this data will allow community-based organizations (CBOs) and researchers to easily identify communities at risk of a spike in COVID-19 cases and ensure that the Test &amp; Trace program is appropriately meeting the needs of the city\u2019s vulnerable communities.<\/span><\/p>\n<\/div>\n<div class=\"columns large-6\">\n<h2>Exposure notification apps<\/h2>\n<p>Exposure notification apps, such as the recently launched \u201cCOVID Alert NY\u201d complement traditional contact tracing efforts.<\/p>\n<p>The app does not track your location but instead alerts you to potential exposure by exchanging random codes with devices that were less than 6 feet away from you for more than 10 minutes via bluetooth technology.<\/p>\n<p>Every day the app checks the random codes it has stored against a list of codes identified with the phones of individuals who have tested positive.<\/p>\n<p>If there is a match the app will notify you that you have potentially been exposed to COVID-19 and direct you to take appropriate precautions (quarantining, contacting a medical professional etc.).<\/p>\n<\/div>\n<\/div>\n<hr>\n<div class=\"row\">\n<div class=\"columns large-6\">\n<h2>Data privacy<\/h2>\n<p><span style=\"font-size: inherit;\"><span style=\"font-weight: 400;\">The New York City Department of Health &amp; Mental Hygiene has used contact tracing for past outbreaks with a proven record of confidentiality.<\/span><\/span><\/p>\n<\/div>\n<div class=\"columns large-6\">\n<h2>Takeaways<\/h2>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Contact tracing is an essential component of a suite of non-pharmaceutical interventions that will help curtail the spread of COVID-19 within NYC.<\/span><b>&nbsp;<\/b><\/li>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">All components are currently necessary to keep case counts low.<\/span><\/i><span style=\"font-weight: 400;\">&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Contact tracing can only succeed with effective community engagement&nbsp;<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<hr>\n<p><i class=\"fas fa-comments\" style=\"color: #2f56a6;\" aria-hidden=\"true\"><\/i>&nbsp;For feedback, comments, and questions please email <a href=\"mailto:datainfo@council.nyc.gov\"><strong>Data@council.nyc.gov<\/strong><\/a>.<\/p>\n<p>Created by the <a href=\"https:\/\/council.nyc.gov\/data\/\"><strong>NYC Council Data Team<\/strong><\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Contact Tracers work with people who have tested positive for COVID-19 to identify people they have had contact with and let them know they may have been exposed to the disease. <\/p>\n","protected":false},"author":134,"featured_media":1423,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-nomenu.php","meta":{"footnotes":""},"class_list":["post-1417","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/council.nyc.gov\/data\/wp-json\/wp\/v2\/pages\/1417","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/council.nyc.gov\/data\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/council.nyc.gov\/data\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/council.nyc.gov\/data\/wp-json\/wp\/v2\/users\/134"}],"replies":[{"embeddable":true,"href":"https:\/\/council.nyc.gov\/data\/wp-json\/wp\/v2\/comments?post=1417"}],"version-history":[{"count":0,"href":"https:\/\/council.nyc.gov\/data\/wp-json\/wp\/v2\/pages\/1417\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/council.nyc.gov\/data\/wp-json\/wp\/v2\/media\/1423"}],"wp:attachment":[{"href":"https:\/\/council.nyc.gov\/data\/wp-json\/wp\/v2\/media?parent=1417"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}