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.
Background This study was to investigate the burden and trend of viral and bacterial pneumonia hospitalization in New York City (NYC) from 2001 to 2016. Methods We analyzed hospital discharge data for NYC residents during 2001–2016 using Statewide Planning and Research Cooperative System. Annual crude hospitalization rate and percentage of in-hospital all causes death were calculated, using NYC population as denominator. Poisson regression was performed to assess temporal trends of pneumonia hospitalization rate and percentage of in-hospital death from 2001 to 2016. Results During 2001–2016, there were 122,324 pneumonia hospitalizations with identified viral or bacterial pathogen in NYC, of which 7,826 (6.4%) were influenza, 13,059 (10.7%) were other viruses, 11,847 (9.7%) were pneumococcus, and 89,592 (73.2%) were other bacteria. From 2001 to 2016, there was significantly increased viral and bacterial pneumonia hospitalization rate, except for pneumococcal pneumonia, and pneumococcal pneumonia had significantly decreased hospitalization rate (p< 0.0001). From 2001 to 2016, the percentage of in-hospital death for viral pneumonia except influenza significantly increased (p=0.0002), whereas decreased for bacterial pneumonia (p< 0.0001). Patients aged ≥65 years old had the highest percentage of in-hospital death among all ages for both viral and bacterial pneumonia, especially there was 19.5% of in-hospital death for pneumococcal pneumonia and 23.4% for other bacterial pneumonia. Conclusion While hospital discharge data are subject to limitations particularly for large amount of un-identified pathogens for pneumonia, our analysis showed increased viral activities considering the changes in hospitalization rate and percentage of in-hospital death in NYC during 2001–2016. There was a reduced pneumococcal pneumonia hospitalization rate and percentage of in-hospital death, likely related to the increased vaccine uptake, and a reduced percentage of in-hospital death for overall bacterial pneumonia, likely related to improved antibiotic treatment management. Further studies are warranted to evaluate the necessity of increasing the pneumococcal vaccine coverage in elderly, as well as reducing antimicrobial resistance to improve the management of bacterial infection. Disclosures All Authors: No reported disclosures
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 higher vaccination coverage and reduced numbers of visitors to points-of-interest are associated with fewer within- and cross-ZIP code transmission events, highlighting potential measures for curtailing SARS-CoV-2 spread in urban settings.
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