Objectives: High rates of hospitalization and death disproportionately affected Black, Latino, and Asian residents of New York City at the beginning of the COVID-19 pandemic. To suppress COVID-19 transmission, New York City implemented a workforce of community engagement specialists (CESs) to conduct home-based contact tracing when telephone numbers were lacking or telephone-based efforts were unsuccessful and to disseminate COVID-19 information and sanitary supplies. Materials and Methods: We describe the recruitment, training, and deployment of a multilingual CES workforce with diverse sociodemographic backgrounds during July–December 2020 in New York City. We developed standard operating procedures for infection control and safety measures, procured supplies and means of transportation, and developed protocols and algorithms to efficiently distribute workload. Results: From July through December 2020, 519 CESs were trained to conduct in-person contact tracing and activities in community settings, including homes, schools, and businesses, where they disseminated educational materials, face masks, hand sanitizer, and home-based specimen collection kits. During the study period, 94 704 records of people with COVID-19 and 61 246 contacts not reached by telephone-based contact tracers were referred to CESs. CESs attempted home visits or telephone calls with 84 230 people with COVID-19 and 49 303 contacts, reaching approximately 55 592 (66%) and 35 005 (71%), respectively. Other CES activities included monitoring recently arrived travelers under quarantine, eliciting contacts at point-of-care testing sites, and advising schools on school-based COVID-19 mitigation strategies. Practice Implications: This diverse CES workforce allowed for safe, in-person implementation of contact tracing and other prevention services for individuals and communities impacted by COVID-19. This approach prioritized equitable delivery of community-based support services and resources.
Understanding SARS-CoV-2 transmission within and among communities is critical for tailoring public health policies to local context. However, analysis of community transmission is challenging due to a lack of high-resolution surveillance and testing data. Here, using contact tracing records for 644,029 cases and their contacts in New York City during the second pandemic wave, we provide a detailed characterization of the operational performance of contact tracing and reconstruct exposure and transmission networks at individual and ZIP code scales. We find considerable heterogeneity in reported close contacts and secondary infections and evidence of extensive transmission across ZIP code areas. Our analysis reveals the spatial pattern of SARS-CoV-2 spread and communities that are tightly interconnected by exposure and transmission. We find that locations with higher vaccination coverage and lower numbers of visitors to points-of-interest had reduced within- and cross-ZIP code transmission events, highlighting potential measures for curtailing SARS-CoV-2 spread in urban settings.
ImportanceContact tracing is a core strategy for preventing the spread of many infectious diseases of public health concern. Better understanding of the outcomes of contact tracing for COVID-19 as well as the operational opportunities and challenges in establishing a program for a jurisdiction as large as New York City (NYC) is important for the evaluation of this strategy.ObjectiveTo describe the establishment, scaling, and maintenance of Trace, NYC’s contact tracing program, and share data on outcomes during its first 17 months.Design, Setting, and ParticipantsThis cross-sectional study included people with laboratory test–confirmed and probable COVID-19 and their contacts in NYC between June 1, 2020, and October 31, 2021. Trace launched on June 1, 2020, and had a workforce of 4147 contact tracers, with the majority of the workforce performing their jobs completely remotely. Data were analyzed in March 2022.Main Outcomes and MeasuresNumber and proportion of persons with COVID-19 and contacts on whom investigations were attempted and completed; timeliness of interviews relative to symptom onset or exposure for symptomatic cases and contacts, respectively.ResultsCase investigations were attempted for 941 035 persons. Of those, 840 922 (89.4%) were reached and 711 353 (75.6%) completed an intake interview (women and girls, 358 775 [50.4%]; 60 178 [8.5%] Asian, 110 636 [15.6%] Black, 210 489 [28.3%] Hispanic or Latino, 157 349 [22.1%] White). Interviews were attempted for 1 218 650 contacts. Of those, 904 927 (74.3%) were reached, and 590 333 (48.4%) completed intake (women and girls, 219 261 [37.2%]; 47 403 [8.0%] Asian, 98 916 [16.8%] Black, 177 600 [30.1%] Hispanic or Latino, 116 559 [19.7%] White). Completion rates were consistent over time and resistant to changes related to vaccination as well as isolation and quarantine guidance. Among symptomatic cases, median time from symptom onset to intake completion was 4.7 days; a median 1.4 contacts were identified per case. Median time from contacts’ last date of exposure to intake completion was 2.3 days. Among contacts, 30.1% were tested within 14 days of notification. Among cases, 27.8% were known to Trace as contacts. The overall expense for Trace from May 6, 2020, through October 31, 2021, was approximately $600 million.Conclusions and RelevanceDespite the complexity of developing a contact tracing program in a diverse city with a population of over 8 million people, in this case study we were able to identify 1.4 contacts per case and offer resources to safely isolate and quarantine to over 1 million cases and contacts in this study period.
T he World Health Organization (WHO) characterized the spread of SARS-CoV-2, the virus that causes COVID-19, as a pandemic in March 2020 (1). At the onset of the pandemic, WHO recognized transmission risks during gatherings and subsequently issued guidance and policy documents for gatherings during the COVID-19 pandemic (2). Mass gatherings are defined by WHO as events involving large numbers of attendees at a specific location, for a specific purpose, over a specific duration of time (3). Given the high density and mobility of participants, mass gatherings can be associated with increased transmission of SARS-CoV-2. These gatherings can create conditions conducive for SARS-CoV-2 transmission, given crowding, challenges with physical distancing, and prolonged and frequent contact among mass gathering participants. Therefore, the WHO recommended that, during the pandemic, gatherings "should not take place unless the basic precautionary measures to prevent and control infection are strictly applied and adhered to by all attendees" (2). These basic precautionary measures include physical distancing, regular handwashing, adherence to mask guidance issued by local health authorities, staying outdoors and avoiding crowding, and ensuring proper ventilation when indoors.Orthodox Jewish communities in New York City (NYC), New York, USA, have been disproportionally affected by COVID-19. In the early fall of 2020, the incidence of COVID-19 in Orthodox Jewish neighborhoods was 4 times higher than the citywide average (4). As of April 2020, the Hasidic neighborhood of Borough Park in Brooklyn had the second-highest number of COVID-19 cases in NYC, and the predominantly Orthodox County of Rockland County, New York, experienced the second-highest number of COVID-19 cases per capita in the United States (5).Each year, ≈30,000 Hasidic and other Orthodox Jews travel to Uman, a city that has 86,900 persons
COVID-19 patients diagnosed ≥3 days after symptom onset had increased odds of hospitalization. The 75th percentile for diagnosis delay was 5 days for residents of low-privilege areas and Black and Hispanic people diagnosed before SARS-CoV-2 Delta predominance, compared with 4 days for other patients, indicating inequities in prompt diagnosis.
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