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Public Health

COVID-19 Case Investigation and Contact Tracing in New York City, June 1, 2020, to October 31, 2021

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
JAMA Network Open
Published Online: November 2, 2022
Original Investigation
Kathleen Blaney, MPH, RN1;
Steffen Foerster, PhD1;
Jennifer Baumgartner, MSPH1;
Megan Benckert, MSN2;
Janice Blake, MPH1;
Jackie Bray, MPH2,3;
Shadi Chamany, MD1;
Katelynn Devinney, MPH1;
Annie Fine, MD1,4;
Masha Gindler, BA2;
Laura Guerra, EdD2;
Amanda Johnson, MD2;
Chris Keeley, MUP2;
David Lee, MPH1;
Mia Lipsit, BA2;
Sarah McKenney, PhD1;
Kavita Misra, PhD1;
Sarah Perl, MPH1;
Dana Peters, MPH1;
Madhury Ray, MD1;
Eduardo Saad, MSc1;
Guajira Thomas, MD1;
Lisa Trieu, MPH1;
Chi-Chi Udeagu, MPH1;
Julian Watkins, MD1;
Marcia Wong, MD1;
Lindsay Zielinski, DO1;
Theodore Long, MD2;
Neil M. Vora, MD1
Author Affiliations
  • 1New York City Department of Health and Mental Hygiene, Queens, New York
  • 2New York City Health + Hospitals, New York, New York
  • 3Now with New York State Division of Homeland Security and Emergency Services, Albany, New York
  • 4Now with Council of State and Territorial Epidemiologists, Atlanta, Georgia
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Key Points

Question  What were the outcomes of the COVID-19 contact tracing program in New York City?

Findings  In this cross-sectional study, a workforce of 4147 contact tracers attempted case investigations on 941 035 persons and contact interviews on 1 218 650 persons from June 1, 2020, to October 31, 2021. Overall expense from May 6, 2020, to October 31, 2021, was approximately $600 million.

Meaning  These results suggest that a large program can be rapidly developed, operationalized, and subsequently maintained.

Abstract

Importance  Contact 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.

Objective  To 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 Participants  This 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 Measures  Number 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.

Results  Case 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 Relevance  Despite 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.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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Public Health Coronavirus (COVID-19)
Article Information

Accepted for Publication: September 8, 2022.

Published: November 2, 2022. doi:10.1001/jamanetworkopen.2022.39661

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. © 2022 Blaney K et al. JAMA Network Open.

Corresponding Author: Kathleen Blaney, MPH, RN, New York City Department of Health and Mental Hygiene, 42-09 28th St, CN 5-22, Queens, NY 11101 (kathleen.blaney@gmail.com).

Author Contributions: Ms Blaney and Dr Foerster had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Blaney, Blake, Bray, Gindler, Johnson, Keeley, McKenney, Perl, Peters, Ray, Udeagu, Watkins, Zielinski, Long, Vora.

Acquisition, analysis, or interpretation of data: Blaney, Foerster, Baumgartner, Benckert, Chamany, Devinney, Fine, Gindler, Guerra, Lee, Lipsit, Misra, Ray, Saad, Thomas, Trieu, Wong, Long, Vora.

Drafting of the manuscript: Blaney, Long, Vora.

Critical revision of the manuscript for important intellectual content: Blaney, Foerster, Baumgartner, Benckert, Blake, Bray, Chamany, Devinney, Fine, Gindler, Guerra, Johnson, Keeley, Lee, Lipsit, McKenney, Misra, Perl, Peters, Ray, Saad, Thomas, Trieu, Udeagu, Watkins, Wong, Zielinski, Long, Vora.

Statistical analysis: Blaney, Foerster, Fine.

Obtained funding: Johnson, Vora.

Administrative, technical, or material support: Blaney, Baumgartner, Benckert, Blake, Bray, Chamany, Devinney, Fine, Gindler, Johnson, Keeley, Lee, Lipsit, McKenney, Misra, Perl, Peters, Ray, Saad, Thomas, Trieu, Udeagu, Watkins, Wong, Vora.

Supervision: Blaney, Bray, Gindler, Johnson, Udeagu, Long, Vora.

Conflict of Interest Disclosures: Dr Fine reported receiving grants from the US Centers for Disease Control in a cooperative agreement during the conduct of the study. Dr Watkins reported grants from Robert Wood Johnson Foundation outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the New York City Department of Health and Mental Hygiene, Health + Hospitals, and the Department of Information Technology staff who worked tirelessly to support Trace, as well as the T2 Community Advisory Board and the thousands of contact tracers who made this operation possible.

References
1.
New York City Department of Health and Mental Hygiene. COVID Data. Accessed November 23, 2021. https://www1.nyc.gov/site/doh/covid/COVID-data-totals.page#summary
2.
New York City Health and Hospitals. Test and Trace Corps. Accessed February 15, 2021. https://www.nychealthandhospitals.org/test-and-trace/
3.
Rainisch  G , Jeon  S , Pappas  D ,  et al.  Estimated COVID-19 cases and hospitalizations averted by case investigation and contact tracing in the US.   JAMA Netw Open. 2022;5(3):e224042. doi:10.1001/jamanetworkopen.2022.4042PubMedGoogle ScholarCrossref
4.
Rubin  R .  Building an “army of disease detectives” to trace COVID contacts.   JAMA. 2020;323(23):2357-2360. doi:10.1001/jama.2020.8880PubMedGoogle ScholarCrossref
5.
US Centers for Disease Control and Prevention. Contact Tracing Resources. Accessed February 15, 2021. https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/contact-tracing-resources.html
6.
New York City Department of Health and Mental Hygiene. Health Alert #37: All Point-of-Care COVID-19 Test Results Must be Reported Electronically. Accessed February 18, 2022. https://www1.nyc.gov/assets/doh/downloads/pdf/han/advisory/2020/covid-19-point-of-care-test-results.pdf
7.
Salesforce. Accessed March 29, 2021. https://www.salesforce.com
8.
Twilio. Accessed April 15, 2022. https://www.twilio.org
9.
Coronavirus Disease. 2019 (COVID-19) Case Definition. Accessed February 22, 2022. https://ndc.services.cdc.gov/case-definitions/coronavirus-disease-2019-2021/
10.
New York State Health Advisory. Accessed February 15, 2021. https://coronavirus.health.ny.gov/system/files/documents/2020/12/covid19-health-advisory-updated-quarantine-guidance-12.26.20.pdf
11.
US Centers for Disease Prevention and Control. Isolate If You Are Sick. Accessed May 14, 2021. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/isolation.html
12.
New York Forward. Industry Guidance. Accessed May 14, 2021.https://forward.ny.gov/
13.
US Centers for Disease Prevention and Control. When to Quarantine. Accessed May14, 2021. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html
14.
New York City Department of Health. Citywide Immunization Registry. Accessed January 14, 2022. https://www1.nyc.gov/site/doh/providers/reporting-and-services/citywide-immunization-registry-cir.page
15.
US Centers for Disease Prevention and Control. Scientific Brief: Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing. Updated December 2, 2020. Accessed February 24. 2022. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/scientific-brief-options-to-reduce-quarantine.html
16.
Healthix website. Accessed March 29, 2021. https://healthix.org/
17.
Thomson Reuters CLEAR website. Accessed March 29, 2021.https://legal.thomsonreuters.com/en/products/clear-investigation-software
18.
Udeagu  C-CN , Huang  J , Misra  K ,  et al.  Community-based workforce for COVID-19 contact tracing and prevention activities in New York City, July–December 2020.   Public Health Reports. Published online July 21, 2022. doi:10.1177/00333549221110833Google Scholar
19.
Coursera. COVID Contact Tracing Offered by Johns Hopkins University. Accessed March 29. 2021. https://www.coursera.org/learn/COVID-contact-tracing
20.
Kilmarx  PH , Long  T , Reid  MJA .  A national public health workforce to control COVID-19 and address health disparities in the United States.   Open Forum Infect Dis. 2021;8(7):ofab304. doi:10.1093/ofid/ofab304PubMedGoogle ScholarCrossref
21.
Fetzer  T , Graeber  T .  Measuring the scientific effectiveness of contact tracing: Evidence from a natural experiment.   Proc Natl Acad Sci U S A. 2021;118(33):e2100814118. doi:10.1073/pnas.2100814118PubMedGoogle ScholarCrossref
22.
Spencer  KD , Chung  CL , Stargel  A ,  et al.  COVID-19 case investigation and contact tracing efforts from health departments—United States, June 25-July 24, 2020.   MMWR Morb Mortal Wkly Rep. 2021;70(3):83-87. doi:10.15585/mmwr.mm7003a3PubMedGoogle ScholarCrossref
23.
Lash  RR , Moonan  PK , Byers  BL ,  et al; COVID-19 Contact Tracing Assessment Team.  COVID-19 case investigation and contact tracing in the US, 2020.   JAMA Netw Open. 2021;4(6):e2115850. doi:10.1001/jamanetworkopen.2021.15850PubMedGoogle ScholarCrossref
24.
United States Census. QuickFacts—New York City, New York. Accessed September 25, 2021. https://www.census.gov/quickfacts/newyorkcitynewyork
25.
National Association of County & City Health Officials. Building COVID-19 Contact Tracing Capacity in Health Departments to Support Reopening American Society Safely. Accessed September 15, 2021. https://www.naccho.org/uploads/full-width-images/Contact-Tracing-Statement-4-16-2020.pdf
26.
New York City Department of Health and Mental Hygiene Community Engagement Framework. April 16, 2020. Accessed January 14, 2022.https://www1.nyc.gov/assets/doh/downloads/pdf/che/community-engagement-framework.pdf
27.
New York City Department of Health and Mental Hygiene COVID-19 Equity Action Plan. June 5, 2020. Accessed August 25, 2022. https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-equity-action-plan.pdf
28.
New York City Health and Hospitals. Community Advisory Board. Accessed August 25, 2022. https://www.nychealthandhospitals.org/test-and-trace/community-advisory-board/
29.
New York State. COVID Alert NY. Accessed August 25, 2022. https://coronavirus.health.ny.gov/covid-alert-ny
30.
New York City Health and Hospitals. NYC Test & Trace Corps Launches “Validate My Tracer” Tool to Enable New Yorkers to Verify the Identity of Their Contact Tracer. November 20, 2020. Accessed August 25, 2022. https://www.nychealthandhospitals.org/pressrelease/nyc-test-trace-corps-launches-validate-my-tracer-tool-to-enable-new-yorkers-to-verify-the-identity-of-their-contact-tracer
31.
NYC Well. Accessed August 25, 2022. https://nycwell.cityofnewyork.us/en/
32.
Gao  W , Lv  J , Pang  Y , Li  LM .  Role of asymptomatic and pre-symptomatic infections in covid-19 pandemic.   BMJ. 2021;375(2342):n2342. doi:10.1136/bmj.n2342PubMedGoogle ScholarCrossref
33.
Rocklöv  J , Sjödin  H .  High population densities catalyse the spread of COVID-19.   J Travel Med. 2020;27(3):taaa038. doi:10.1093/jtm/taaa038PubMedGoogle ScholarCrossref
34.
Christie  A , Brooks  JT , Hicks  LA ,  et al.  Guidance for implementing COVID-19 prevention strategies in the context of varying community transmission levels and vaccination coverage.   MMWR Morb Mortal Wkly Rep. 2021;70(30):1044-1047. doi:10.15585/mmwr.mm7030e2Google ScholarCrossref
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