By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.
I didn’t intend to write about contact tracing again so soon, but this front-page NYT piece, Contact Tracing Is Failing in Many States. Here’s Why.- contained a screaming omission that just happened to be based on the same fallacy as an email claim I received today from a friend – proved too tempting a target. And incidentally, is a big, obvious part of the reason why the United States, despite its wealth and power, has the worst COVID-19 numbers in the world.
This short post will cover three points: first off, what the Grey Lady gets right, including how it seems to have successfully resisted Big Tech’s ongoing campaign to get people to conflate contact tracing and contact tracing by app.And then finally, the elephant in the room: how its crappy for-profit health care system hamstrings its contact tracing efforts.
What is Needed for Successful Contact Tracing
So, what the NYT gets right: That contact tracing is a successful part of public health policy, and one of the reasons other parts of the world have the pandemic under control:
Contact tracing, a cornerstone of the public health arsenal to tamp down the coronavirus across the world, has largely failed in the United States; the virus’s pervasiveness and major lags in testing have rendered the system almost pointless. In some regions, large swaths of the population have refused to participate or cannot even be located, further hampering health care workers.
“We are not doing it to the level or extent that it should be done,” said Steve Adler, the mayor of Austin, echoing the view of many state and city leaders. “There are three main reasons. One is the sheer number of people, the second is the delay in getting test results back, the third is the wide community spread of the disease.”
The US lacks infrastructure to do this properly, as well as well-trained tracers:
Crystal Watson, a risk-assessment specialist at the Center for Health Security at the Johns Hopkins 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 Massachusetts, New York, North Dakota and the District of Columbia. Massachusetts, where the nonprofit group Partners in Health leads the efforts, has done particularly well.
Slow testing rates impede success:
Perhaps most harmful to the effort have been the persistent delays in getting the results of diagnostic tests. Often by the time an individual tests positive, it’s too late for the health care workers tracking that person to do anything.
“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 turnarounds, contact tracing is instant and effective.
Public lack of trust in government doesn’t help matters either:
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 fueled 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.
NYT Doesn’t Conflate Contact Tracing and Contact Tracing By App
And, quelle surprise, maybe the tide is turning on elite acceptance of the claims of big Tech. Because the NYT here doesn’t fall for Big Tech’s propaganda and doesn’t conflate contact tracing and contact tracing by app, a claim I discussed most recently in COVID-19 Mistakes to Avoid: Don’t Conflate Contact Tracing with Contact Tracing By App and No, We Don’t Need to Place Our Faith in Downloading Some Untested, Privacy-Infringing App as the Only Possible COVID-19 Slayer; Why Don’t We Look to Places that Have Successfully Limited Disease Spread and Copy Their Policies?
The NYT merely brushed up against the topic and didn’t even mention it directly and certainly didn’t succumb to rah, rah; sis boom bah, a killer corner app will solve all! propaganda:
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 Americans are free to cross state lines, no national tracing program exists.
Support in Isolation or Self-Quarantine
And the NYT even recognized the importance of providing support and assistance to people in isolation or self-quarantine:
Every tracer must be paid, not a volunteer. And Massachusetts had to put in enough money to let the tracers “support” anyone expected to self-quarantine.
“We ask: Do you need food? Infant formula? Diapers? Cab fare? Unemployment insurance? And we help them get it,” Dr. Mukherjee said. “That way people feel it’s care, not surveillance.”
This is a big part of the successful strategy of Medellin, Columbia – a story that reader Nelson brought to my attention in the No, We Don’t Need to Place Our Faith in Downloading Some Untested, Privacy-Infringing App as the Only Possible COVID-19 Slayer; Why Don’t We Look to Places that Have Successfully Limited Disease Spread and Copy Their Policies? post cited above, and to which I added this comment:
I think it’s important to understand that the contact tracing aspect of the app is only one element of the city’s overall policy. From the source you cite [e.g., the WaPo]:
Quintero [the city’s mayor] said he knew that in order for many residents to quarantine, they’d need food and cash. Using his tech background, he led the city in launching Medellin Me Cuida (Medellin Takes Care of Me), an app offering aid to those who signed up and requested help.
The response has been enormous: 1.3 million families – some 3.25 million people in total – from Medellin and surrounding areas registered.
The aid was key for Maritza Alvarez, who lives with six elderly relatives, two of whom are street vendors. Since signing up, she said they’ve gotten packages of food three times and two cash transfers. That has allowed them to mostly stay indoors instead of going out to earn money and buy food.
As the WaPo article makes clear, the app told city officials which residents requested aid, and then cash and food deliveries let these people stay home. They weren’t necessarily tested and may never have contracted the disease. The aid is crucial, not that people request it via an app.
What About Health Care?
But while the NYT piece acknowledged the importance of providing food and other forms of economic assistance, it doesn’t really discuss extensively how our terrible health care system impeded contact tracing, just as it fails to prevent the spread of COVID-19. Some people worried about paying for their health care don’t get tested – because they fear paying for the consequences of a positive test. The point is instead buried here and cries out to be unpacked:
“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.”
As it happens, this was also the fallacy inherent in the email of an old friend – perhaps my oldest, from university – who is so far to the right, if the earth were flat, I think he might fall off. He’s a wee bit older, but not that much – and one of the only people who I still allow to condescend.I suppose because of and the differences in age and relative maturity when we first met. And because as I think Christopher Hitchens once said, you can’t make old friends. So I cut him some slack. And suppress my giggles when he tells me just how far Left Trump’s predecessor was.
We have fierce discussions about public policy – and agree on very little. I know when I can successfully rebut his claims – and he’s silent as to mine – that my position is as close to bulletproof as I can make it. Reexamining one’s assumptions is always a useful exercise.
Today found him lecturing me via an email message about Hong Kong – which readers will know, is a bit rich, as I’ve now written extensively and often on its comparative performance on managing COVID-19 (at lthe very east a half dozen times). After airily telling me Hong Kong’s COVID-19 numbers have recently spiked in a Yes Virginia there is a Santa Claus tone- well, yes, to 3273, against 27 deaths, for a densely-populated city of 7.5 million, just under the size of New York City, my friend dismissed my claim that a good health care system had anything to do with Hong Kong’s still exemplary COVID-19 management. The quality of health care speaks to treatment, not detection of and control of incidences of infection, my friend informed me. So, the claim as I understand it is that anybody’s infection numbers can’t be based on healthcare, which happens after you get the virus.
Well, not exactly. A population not concerned about paying for its health care, or falling sick, does not hide under the mattress, but is willing to get tested, and have its contacts traced, and follow public health recommendations, such as wearing a mask.
‘Tis a pity that in an article on contact tracing, the NYT still doesn’t grasp this. Nor does my super-intelligent rightwing friend, along with so many other Americans.
The hard truth may well be that officials were not too stressed about developing reliable contact tracing or any of the rest of it as ‘herd immunity’ would render this pointless. So why spend the time, money and effort doing any of this stuff for real when money & resources are in short supply because of the pandemic? A bit of contact tracing theater plus the promise of a technological fix in the way of an app for those so inclined and its all sweet – until its not.
@The Rev Kev
July 31, 2020 at 10:20 am
Since you posted your comment this (yesterday?) morning more news has come out.
Original at Vanity Fair.
Thanks John. I had just finished reading that Vanity Fair article and it is an ugly story indeed. Jared is going to need a body guard for the rest of his miserable life because of all the deaths that he is responsible for. That VF article starts off by talking about 1 million diagnostics test kits being delivered to the United Arab Emirates but what is the bet that millions more were shipped to countries like Saudi Arabia and Israel – while Americans were dying by the thousands because of a lack of those very same kits. The lesson here is that billionaires can’t do jack-s*** anymore and no better than governments can do. Who knew?
Absolutely devastating. Here’s the Vanity Fair original: How Jared Kushner’s Secret Testing Plan “Went Poof Into Thin Air”.
Thanks for posting your comments John and The Rev Kev.
@The Rev Kev
August 1, 2020 at 2:15 am
It seems like everyone in the Trump administration is a miserable s#!t and psychopaths as well. Obviously, the billionaires are the same.
The highest risk sub-populations are high density… lower rent housing, prisons and other incarcerations such as state run nursing/mental homes, refugee and immigrant prisons (sorry, ‘camps’). The determined lack of effort to protect these specific populations feels like policy to me.
Feels like ? ? ?
The USA’s population doesn’t have a reputation for overwhelming empathy. The inculcation of Us vs Them has siloed most people into only caring about their narrow band of ‘Us’. It’s not just the racial divide, but the generally held opinion that assaults in prison are acceptable leaves me aghast.
A reminder that hatred within society is not necessarily racist in the black/white sense: Tutsi vs Hutu killings in Rwanda in the mid 1990s, and the horrors of Partition in 1947 India.
“It’s not just the racial divide, but the generally held opinion that assaults in prison are acceptable leaves me aghast.“
Thank you, YES. I have been appalled and horrified by this for a long time.
“A population not concerned about paying for its health care, or falling sick, does not hide under the mattress, but is willing to get tested, and have its contacts traced, and follow public health recommendations, such as wearing a mask.
‘Tis a pity that in an article on contact tracing, the NYT still doesn’t grasp this. Nor does my super-intelligent rightwing friend, along with so many other Americans.”
Thanks for putting into words like that. Have sensed our lack of access to healthcare is big factor but did not connect the dots very well like that.
And this thinking that low or no cost access to healthcare has nothing to do with our worst in the world Covid numbers is very pervasive. Any suggestion of this on others sites can provoke a tidal wave of:
1). Total denial the US has bad Covid numbers (especially vs the so called socialist nations healthcare systems which are of course always the worst so they claim) and/or…
2). Total denial that our healthcare system is anything but the greatest ever.
Agreed! But the dismal performance of Britain’s NHS is an exemplary counterargument that has been thrown in my face by my Neanderthal bro-in-law. I found myself lacking a quick, evidence-based counterargument. Blaming Tory sabotage was not sufficient against the argument that “all socialist policies are unsalvageable”.
Excellent article, thank you! The NY Times reporting on Japan also leaves out the issue of health care payment. Japan has private care but regulated costs and universal insurance with transparent co-pays and no surprise billings. One can go to any doctor knowing that co-pays that exceed a reasonable amount in any one month are covered. I may have missed something, but all I’ve seen the NY Times discuss is masks, culture, testing or lack thereof, problems with nightlife or less remote working, and early on, speculation that Japan was hiding infections.
I’ve also seen occasional references, perhaps in NY Times, to Japan’s public health departments which are important. But I have seen nothing about the fact that people can follow the public health department’s recommendations without fear of high costs that are unknown (and really unknowable in our insane system).
My Medicare plan charges a $40 co-pay for me to see a doctor. But the (non-profit, world-famous, world-class) hospital system that employs the doctors ALSO charges me a $40 FACILITIES fee to see that doctor.
Such utter crap is tolerated only in the land of the free, home of the brave.
Yeah but there is still no rational explanation (which is ironic because economists consider themselves to be oh-so-rational) for co-pays. Ever. Anywhere.
Nobody wants to go to the doctor except for a very small sliver of the population that probably does not exceed the number of people that are clinically insane. Discouragement is not necessary. Meanwhile you discourage that young single two-job mother from getting that spot on her arm looked at because $80 is a couple of days eats.
Ahem. There is a big difference than an MD’s office in a small practice versus a big outpatient clinic or a hospital. Doctors are all masked up, minimize getting close save when they really have to, like listening to your heart or lungs. I’ve seen doctors 8x since Covid-19 got bad, two wo them with my mother, and also got a blood draw (at a lab when no one else was in the waiting room or from what I could tell, the treatment rooms too).
this is excellent!
I literally got in an argument with a public health leader yesterday who wanted me to know that running the hospitals at capacity was mandatory since without that they could not possibly be profitable.
Thanks! When I wrote it, I thought this was a post people might be able to pass along. Might be useful for convincing those who are persuadable and not locked into their mindset.
In addition to the support, no mention of some kind of guaranteed sick-leave system?
A large part of it is cultural – I know too many people who would go in with sniffles or worse. It’s not always the manager’s fault either. I’ve worked in workplaces where management tells people to go home if they’re visibly sick (related, losing their lose-it-or-use-it vacation days), but…
I distinctly recall a University of Pittsburgh coworker telling me that I must never, EVER call in sick. That was an absolute no-no. She said, “We die at our DESKS!”
Guess who left that job after a mere 15 months? Me, that’s who. It wasn’t because of the illness policy. It was the bullying boss who berated one too many times. Buh-bye, sweetie. I’m outta this university and outta this city.
She sure didn’t see that one coming. But, as the job grew more and more intolerable, I saved more and more money. It gave me the freedom to Q-U-I-T and take three months off to explore the American West on my bicycle. Then I settled in Tucson, and I’ve been here ever since.
Pittsburgh’s loss is Tucson’s gain!
The cause of the spreading pandemic is the failure of the U.S. Federal Government. WaPo; “Uncertainty, anxiety and sleepless nights for the unemployed as Congress lets $600 benefit lapse.” Either this is criminal incompetence, or it is intentional. The wealthy have benefited. No one else. The horror is that they do not care how many Americans die or starve.
American deaths are past WWI levels, and will pass WWII and reach American Civil War casualty levels if the for-profit vaccine/treatment does not work next year. Societal collapse is certain unless democracy and the national public health system are restored.
July 31, 2020 at 10:10 pm
First, VV, I want to thank you for your comments on posts here at NC. They are succinct and to the point, and I’ve always appreciated your point of view.
“Either this is criminal incompetence, or it is intentional.”
Are they mutually exclusive? The cruelty is certainly intentional:
Vanity Fair has the original article.
I’m reminded of that old proverb: Success has many fathers, failure is an orphan. Certainly the federal government has failed. But none of the states has covered themselves with glory.
At the risk of sounding like a broken record, compare Hong Kong’s performance to that of NY. NYC has roughly 8.5 million people, HK 7.5 million. To date, even with its recent spike, HK has recorded 3273 cases, against 27 deaths, while in NYC, the figures are 230,000 cases, and 23,002 deaths.
I know that WHO has copped some criticism at NC. Here’s the NZ experience.
The public announcements from NZ Police with assistance from Wellington Paranormal are quite entertaining.
Important COVID-19 messages from Wellington Paranormal
The San Jose Mercury News just published: https://www.mercurynews.com/2020/08/15/californias-coronavirus-contact-tracing-efforts-hampered-by-lack-of-bilingual-staff/
Tracing becomes extremely difficult when you don’t speak the contacts’ language. And the apps are generally only in the predominant language. Add in the US (beyond the healthcare=bankruptcy for many) that the greatest plurality of cases are now in populations that are actively being attacked by this administration and your recipe for failure will asymptotically approach 100%. Who would knowingly talk to tracers who are government paid, don’t speak their language, offer no monetary relief and may very well be la migre?