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Jersey City Times Staff

‘Patchwork’ Public Health System Complicates COVID-19 Contact Tracing, Community Notification

November 16, 2020/in header, Latest News, News /by Jersey City Times Staff

It’s a challenge to coordinate the gathering and dissemination of vital information

This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com.

Full story link – HERE.

By Lilo H. Stainton

The coronavirus is once again circulating rapidly in communities across New Jersey. State officials have reported thousands of new cases daily and shared data that shows how some situations — like youth sports and private parties — appear to have an outsize role in the spread.

But it is not clear if New Jerseyans are getting the information they need to keep themselves — and others — safe.

Much of the data is posted on the state’s COVID-19 website and Gov. Phil Murphy now intends to hold three media briefings weekly, instead of the twice-weekly events he convened during the summer and fall. The state also works with county and local health departments to alert the public when potential coronavirus clusters are identified. And schools have a protocol for contacting parents when outbreaks are discovered in a district.

But the public notification system is complex and coordination can be a challenge, according to those involved. The work generally depends on a network of government and public health officials who have been on the front lines of the state’s coronavirus battle since March, and the growing surge of new cases adds to the weight of their responsibilities.

“The state is a microcosm of the nation. We have this patchwork public health system. We don’t have a coordinated public health system,” said epidemiologist Stephanie Silvera, a professor of public health at Montclair State University.

Most of the time, it works well enough, Silvera said. “The problem is, when you have a global pandemic that really requires a coordinated response, the systems we have really do get put under pressure quickly,” she added.

For weeks, New Jersey officials have pointed to the rapid rise in new cases and hospitalizations as evidence that the state has entered a “second wave” of the pandemic, first diagnosed here in March. Since then, more than 270,000 cases of COVID-19 have been reported, including at least 16,500 fatalities confirmed or likely to have been caused by the disease.

Cases began to spike up again in October

After the initial onslaught of the virus, which peaked in April here, the rate of community spread — and new cases, hospitalizations and deaths — declined significantly over the summer. But the pattern changed in October, when transmission began to spike up again as people moved indoors (where spread is more likely) and appeared to ease up on pandemic precautions. At times last week, the number of new cases in New Jersey was nearly 10 times the daily diagnoses reported in late August.

According to information provided to the state Department of Health’s Communicable Disease Service by local health departments — which are responsible for calling individuals who test positive to inform them about the risks and tracing their potential contacts to contain the spread — much of the transmission appears to involve youth sports and associated events as well as gatherings in private homes.

DOH Commissioner Judy Persichilli shared charts Thursday that showed, of the 164 outbreaks that occurred between late March and Nov. 1 and could be definitively traced: 17% were connected to sports teams; 14% involved public safety, food and agriculture businesses, including restaurants; 13% were linked to private gatherings; 12% involved day care facilities, and 10% came from other work-related situations. It is not clear exactly how many cases are linked to these clusters.

“Often, the Department does not get additional reports on cases from the local health department after the initial report of an outbreak. The outbreaks drive the public health action taken, not necessarily the number of cases associated with it,” DOH communications officer Dawn Thomas said.

When examining a subset of that data — the 51 outbreaks reported in October alone — Persichilli said the DOH found that 33% involved sports teams; 11% were connected to government offices; and public safety jobs, day care and other workplace scenarios contributed another 10% each. The data would be more complete if New Jerseyans were more willing to participate when called by contact tracers, she noted, something that remains a challenge in nearly two-thirds of the cases investigated.

 “This information is vital to protecting the health of others and containing the spread of the virus,” Persichilli said Thursday.

Viral transmission is difficult to track

DOH officials have repeatedly stressed that, even with public participation, it is often difficult to track down the source or location of viral transmission. “We know if someone tests positive. But even to that person, it may not be clear when or how they were exposed,” Thomas said.

New Jersey’s public health system predates the coronavirus, with contact tracing and public notification processes designed to keep citizens safe from outbreaks like hepatitis, measles and the flu. The Communicable Disease Service depends on reports from health care providers and public health officials. When outbreaks involve multiple locations, the state makes a public announcement. When the threat is more isolated, it is up to the county or local health department to inform the public.

Thomas said the public notification process also varies by disease and is determined by the experts involved; measles, being highly contagious and easy to transmit, requires robust public outreach, as does a situation involving a food handler with hepatitis A, who may have infected others, for example. There is no state regulation dictating how this process works, she said, but the DOH often consults with local officials regarding public outreach, she said.

“It’s a little bit of a black box if you’re not inside of it,” Montclair State’s Silvera said of the multifaceted system.

But when it comes to the coronavirus, the scope of the pandemic has created challenges for the multiple state, county and local public health entities involved in protecting communities from viral spread, according to those involved; these agencies must also balance privacy issues and other concerns. New Jersey has essentially doubled its existing contact tracing capacity since March but as case loads rise, the workload expands, which could result in delays alerting community members of a potential danger.

‘What’s new is the level of contact tracing’

“This isn’t new in the field of public health to do contact tracing. What’s new is the level of contact tracing that’s required,” Silvera explained. “The capacity has to match the number of cases.”

The DOH has contracted with a staffing firm to recruit new contact tracers and tapped Rutgers University’s School of Public Health to train them in an effort to ensure each county has at least 30 tracers for each 100,000 residents. Four counties have reached this threshold — Cumberland, Passaic, Salem and Warren — but several, including Bergen and Morris, remain at nearly half this rate, according to state figures.

But with community spread so rampant, and daily infections and hospitalization numbers rising so quickly, contact tracing itself offers limited protection, experts acknowledged. In recent days, Murphy and Persichilli have underscored the critical importance of basic infection-control measures, like wearing masks, washing hands and maintaining social distance.

“We’re unfortunately pretty well beyond containment and we’re going to be moving back to mitigation and trying to reduce the impact” of COVID-19, Silvera said.

 

Header:  Photo by CDC on Unsplash

CDC Contract Tracing
Jersey City Times Staff

Contact Tracing Plan for NJ: What We Know Now

June 3, 2020/in header, Latest News, News /by Jersey City Times Staff

Contact Tracing Plan for NJ: What We Know Now

This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com.

Full story link – HERE.

Lilo H. Stainton

It’s seen as a critical pillar in plans to reopen New Jersey and could involve hiring at least 5,000 people at costs that could top $5 million a week, but significant details about the status of a contact-tracing program are still at least a week away.

Gov. Phil Murphy on Monday urged patience about plans to establish a contact-tracing corps and said his administration expected to provide additional details on the initiative in seven to 10 days.

Contact tracing is critical as the state moves into Stage Two of its reopening strategy in the weeks to come, with restaurants offering outdoor dining, hair salons welcoming customers, and a quarantine-weary public flocking to parks and beaches, amid worries among experts that the virus could flare up once again.

The contact-tracing process involves identifying and tracking down all those who have come in contact with someone diagnosed with COVID-19, informing them of the risks and connecting them with a safe place to be isolated, if needed, to help cut down on the spread of the virus.

Murphy stressed its importance when he first outlined a broad strategy for reopening New Jersey’s businesses and public spaces in late April. The work requires individuals who can connect culturally with the people they call, and the governor has underscored the need to hire tracers from local communities.

Contact-tracing workforce

Two weeks later, in mid-May, the state released limited details about its plans for expanded COVID-19 testing, contact tracing and follow-up services, which Murphy said would cost “hundreds of millions of dollars.” They included a proposal to hire a company to create and oversee the contact-tracing workforce, which would be deployed to supplement the 800 to 900 contact tracers now at work on behalf of local or county health departments. The draft included a pay scale for these workers ranging from $25 an hour for tracers to $30 an hour for 21 county coordinators.

In the May announcement, Murphy stressed testing was just part of the solution. “We also have to have the infrastructure in place to fully follow up on those tests, and to reach out to those who may have been exposed to COVID-19 by someone who tests positive in the future,” he said.

As of Tuesday, COVID-19 had been detected in nearly 162,000 New Jerseyans, including nearly 11,800 who have died.

“In fact, contact tracing has not only been going on throughout this emergency, it is a practice that has been employed in other efforts to fight communicable diseases. The only thing that differs from those instances and today is the scope and the scale,” Murphy said. “In other words, we’re going to have to use contact tracing unlike it’s ever been deployed before.”

New details

Here’s a look, then, at what’s now known about the contact-tracing effort:

It will build on existing work: Contact tracing is a longstanding practice that epidemiologists use to control the spread of contagious conditions like HIV/AIDS and sexually transmitted diseases and has traditionally been handled exclusively at the local or county level, according to the draft guidelines for potential contractors. But some local health offices — which typically handle issues ranging from restaurant inspections to local flu outbreaks and have limited staff and financial resources — have been overwhelmed by added workload created by the pandemic.

State officials signed an agreement with the Rutgers School of Public Health to use recent graduates as part of this tracing corps. They have also consulted leaders at the four regional health hubs, coalitions that have evolved out of data-sharing projects designed to improve care for individuals in Camden, Trenton, Newark and Paterson.

It will tap tracers who reflect the community: While it is not clear if and how these hubs will be used, those involved said they feature deeply rooted community partnerships that could enable the state to find contact tracers who share the culture and background of those they need to reach.

“You have to be able to find (contact tracers) who can gain the trust of the community,” said Gregory Paulson, president and CEO of the Trenton Health Team, the hub based in Mercer County. “We look forward to working with the state as they roll out this process.”

It could require thousands of people and tens of millions of dollars: Estimates range greatly and depend on the number of individuals who test positive, but Murphy first suggested the state might need to hire as many as 7,000 additional contact tracers. When the draft guidelines came out in May, the anticipated need had been reduced to between 1,000 and 5,000 tracers.

The draft proposal also envisions hiring from 50 to 250 supervisors, depending on staff levels, as well as at least one data manager, social support coordinators and program coordinator in each of the state’s 21 counties.

Wages could run between $1.13 million and $5.37 million each week, if paid on the scale envisioned.

It will require outside help: The plan also calls for the state to hire a firm, or joint venture, that would recruit tracers and other staff, working with local nonprofits and other groups to ensure they represent local communities. The entity would then train these workers, provide technology if needed, dispatch them to support local departments as needed, oversee and administer benefits for the workers, and ensure that all data is properly entered into a shared system.

Murphy also signed an executive order requiring all tracers to be using the same web-based platform and the state has contracted with two firms to create a centralized database and uniform reporting system.

It’s going to matter more as New Jersey reopens: The rate of new cases in New Jersey has generally trended downward since April 22, but hundreds of additional COVID-19 cases are still being discovered every day. Plus, testing capacity continues to expand, meaning more people will be diagnosed with the virus.

“Implementing a robust contact tracing program is a key mechanism to break the chain of transmission and slow community spread for individuals who have come into contact with those infected by COVID-19,” the state said in the May 12 press release that outlined its intentions.

 

Header: Photo by CDC on Unsplash

News Briefs

Mayor Fulop and Via,  announced the expansion to weekend service of Via’s on-demand publicly subsidized transit system.

A GoFundMe page has been created here for Christian Parra, age 34, of Jersey City, who was shot on Sunday night in BJ’s parking lot on Marin Boulevard and Second Street. He left a wife and three children. Anyone with information is asked to contact the Office of the Hudson County Prosecutor at 201-915-1345 or to leave an anonymous tip here. 

Jesus Gonzalez, 30, died in a car crash on Saturday night when the car in which he was a passenger hit the attenuator-protected guard rail on Christopher Columbus Drive near Merseles Street. The driver, also 30, was listed in critical condition at Jersey City Medical Center.

The Jersey City Education Association has started a GoFundMe campaign to support the family of 11-year-old Desire Reid and eight-month old Kenyon Robinson who died in a house fire on Martin Luther King Drive on Wednesday night. Here is the link.

Vaccine-eligible individuals can make an appointment online by visiting hudsoncovidvax.org.

The 2021 tree planting applications are available. If you have an empty tree pit on your block or a street you can fill out the form and the city’s arborists will handle it.  bit.ly/adoptatreespri…

Keep abreast of Jersey City Covid-19 statistics here.

Governor Murphy has launched a “Covid Transparency Website” where New Jerseyans can track state expenditures related to Covid.  Go here.

For info on vaccinations, call Vaccination Call Center and our operators will assist you with scheduling one: 855-568-0545

 

 

 

 

 

 

 

 

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