Is NY ready to launch a test-and-trace program for COVID-19?

On Wednesday, Gov. Andrew Cuomo announced that billionaire and former New York City Mayor Michael Bloomberg will help the state create a test-and-trace program for identifying, tracking and isolating cases of COVID-19.

The program would involve mass testing for the new coronavirus, tracking down anyone who has recently come in contact with an infected person and asking them to self-isolate. “Michael Bloomberg will design the program, design the training, he’s going to make a financial contribution,” Cuomo said during his coronavirus briefing. “He has tremendous insight both governmentally and from a private sector business perspective in this.”

Hours before Cuomo made this announcement New York City Mayor Bill de Blasio said that the city has plans for a test-and-trace program. However, the city isn’t close to being able to administer and process the number of tests required to properly implement such a program. The mayor has estimated that it would need to administer hundreds of thousands of tests per day in order for a test-and-trace program to be effective. “We're not there yet, but we're going to show you how we get there pending being able, of course, to get the help we still need from the federal government, to get that vast amount of testing or somehow to find it in the international market, which to date has been extremely difficult,” de Blasio said at a press conference.

Dustin Duncan, an associate professor of epidemiology at Columbia University, similarly told City & State that the state would need a “steady supply (of testing materials) or a sufficient number of testing kits” to get such a program up and running. 

The city and state have been struggling to increase their testing capabilities as the country experiences medical supply shortages and health care workers needed to administer the tests continue to get sick and lack sufficient personal protective equipment such as masks. 

On Tuesday, President Donald Trump agreed to help the state increase its testing capabilities by helping it attain the supplies it needs but it’s unclear how much that would ramp up the city and state’s testing capabilities.

Another roadblock preventing a statewide test and trace program from launching anytime soon is the U.S’s overall lack of contact tracers. Contact tracers are extremely important as they can prevent a string of outbreaks from happening by getting in contact with individuals who might be infected. There are currently fewer than 2,000 professionally trained contact tracers in the country but it’s estimated that the country will need anywhere from 100,000 to 300,000 tracers to effectively combat the virus. The cost to hire 100,000 tracers could be as high as $3.6 billion.

Contact tracing is also a difficult skill that requires about a year’s worth of training and mentorships to develop. “Learning contact tracing is not easy,” Tom Frieden, the former Center for Disease Control director and New York City health commissioner told Politico. “Training is very important. Listening to someone, understanding their concerns, helping them remember.”

Efforts to expedite training have already begun across the country and online tutorials are being offered to teach non-medical professionals about the basics of contact tracing. States such as Vermont, Utah, California and Arkansas have already begun developing contact tracing programs and recruiting volunteer contact tracers. 

There are also slightly less hands-on approaches to contact tracing, including surveilling cell phone data, looking into credit card histories, mobile applications and facial recognition technology. While these methods may have proved useful in other countries, such as South Korea, concerns have already been raised regarding the use of surveillance technology leading to potential human rights violations. Duncan suspects that any negative perception of such contact tracing tactics would have a lot to do with how much the country values individualism. “I think, in other societies, the focus is more on the collective versus the individual,” he said. “My sense is that is part of the reason why President Donald Trump has allowed governors to make decisions on when they open up their states or not – besides some political reasons – is because we have adopted this idea that as an individual you have rights: you have your right to shelter in place or not, to bear a gun or whatever is more important than the collective good.”

Of course, Duncan concedes, people might not want just anyone knowing where they’re going all of the time. However, the epidemiologist’s biggest concern is ensuring that people asked to stay in isolation adhere to proper isolation protocols, though he’s not sure how that could be monitored. “I'm not sure what policies or procedures beyond an individual’s desire to adhere to a shelter-in-place protocol for two weeks or more (could make an individual follow such protocols),” he said.

Countries including Singapore, Taiwan, South Korea and New Zealand, which have all seen fewer deaths per capita than the U.S., have all used contact tracing. Hong Kong, the special administrative region of China that operates as quasi-independently, has been implementing a test and trace programrecommended by the World Health Organization since February. As a result, only four people have died from the virus in Hong Kong. The city began aggressively testing anyone with symptoms immediately, quarantining anyone who tested positive in a hospital, then tracing their contacts from the past few days. Anyone who came in contact with an infected individual was instructed to self-isolate. 

Unlike European countries that similarly tested and traced early on, Hong Kong never implemented strict lockdown measures, though its residents did begin changing their behavior. People began avoiding crowded spaces and wearing masks when in public. “By quickly implementing public health measures, Hong Kong has demonstrated that Covid-19 transmission can be effectively contained without resorting to the highly disruptive complete lockdown adopted by China, the U.S., and Western European countries,” Benjamin Cowling, a professor from the University of Hong Kong who studied Hong Kong’s response to its coronavirus outbreak, told the Guardian.

However, Cowling also told the Guardian that it was a combination of factors that were responsible for Hong Kong’s success, not just testing and tracing people. One of the most important differences is the city’s ability to quarantine its residents much more easily. “In Hong Kong, we have designated facilities for quarantine outside of the home and also procedures for strict enforcement of home quarantine,” he said. “Individuals with higher risk of infection (perhaps greater exposure to infection) would be quarantined outside the home, and those with lower risk would be placed in home quarantine for 14 days.” 

The state can’t set up a test-and-trace program without abundant testing and an army of contact tracers. But right-wing activists protesting lockdown restrictions will just have to wait for that before they can safely get their precious haircuts and spray tans.