The duel over NYC’s contact tracing program

On Friday afternoon, the New York City Council held a hearing about Mayor Bill de Blasio’s decision to put New York City Health + Hospitals, the public hospital system, in charge of the city’s contact tracing program.

Just a week ago, de Blasio chose the hospital system over the city Department of Health and Mental Hygiene to lead the program, which struck many as odd. Several city and state lawmakers wrote a letter to de Blasio immediately after he announced the decision, questioning why he put the public hospital system in charge, instead of the health department, which has a 150-year history of contact tracing.

Deans from the public health schools at Columbia University and New York University also asked Gov. Andrew Cuomo this week to overrule de Blasio’s decision and put the health department in charge of the city’s contact tracing program. The mayor’s decision became even more scandalous on Thursday, when The New York Times reported that Dr. Mitchell Katz, the president and CEO of New York City Health + Hospitals, told de Blasio on March 10 that he didn’t believe banning large-scale events would prevent the spread of COVID-19.

A day before the Times’ report, the New York Post reported that Department of Health Commissioner Dr. Oxiris Barbot refused to provide New York City Police Department officers with face masks in late March. The story lacked important context, however, that gave a false impression of what Barbot was actually responding to, which was the NYPD’s demand for masks that were designated for city hospitals. The strange timing of this story’s emergence two months after it occurred alludes to the yearslong rift between City Hall and the health department. Some have even suggested that the story regarding Barbot is part of a Trumpian move on de Blasio’s part to oust the commissioner – whose resignation is already being requested by several politicians enraged by the Post’s article.

The stories about Katz and Barbot have put the two public health heads at odds, making the question of who will ultimately end up leading the city’s contact tracing program all the more confusing.

The March 10 Katz email

In an email from Katz to de Blasio on March 10, which was obtained by the Times, Katz said that he felt closures would mislead residents about the severity of the virus. “Canceling large gatherings gives people the wrong impression of this illness,” he wrote. “Many of the events are being canceled anyway, and fewer people are going out. However, it is very different when the government starts telling people to do this.”

Katz also said that Italy “is having a terrible problem that I do not believe we will have,” and suggested that canceling events would foster fear among the city residents.

He also argued that most people who become infected with COVID-19 would be likely to make a full recovery, suggesting that this will help build immunity to the virus. “We have to accept that unless a vaccine is rapidly developed, large numbers of people will get infected,” Katz wrote. “The good thing is greater than 99 percent will recover without harm. Once people recover they will have immunity. The immunity will protect the herd.”

Herd immunity happens when a large proportion of the population develops an immunity to an infectious disease. Immunity can occur if an individual becomes infected with a virus and recovers from it, or if they are given a vaccine for the virus. When enough people are immune, the virus spreads through a population much slower or is stopped completely, protecting the people who are unable to be vaccinated. It’s estimated that 50% to 70% of the population would need to become immune to the coronavirus to reach herd immunity.But neither the city or state are anywhere close to reaching that level of immunity.

“Right now, unless you’re New York City, chances are that 5% or less of the population is immune, so to get to herd immunity, you’d have to take the number of cases and deaths we’ve already experienced and multiply that by about 15,” Dr. Robert Atmar, an infectious disease specialist at the Baylor College of Medicine in Houston, told NBC News. “If we were to let that happen over a short period of time, it would obviously be catastrophic for the health system.”

In fairness to Katz, the health department had not begun advising City Hall to make more widespread closures until after March 9, and de Blasio failed to listen to its recommendations until March 16, when he forced city schools, gyms, bars, restaurants and nonessential stores to close.

During Friday’s council hearing, Katz defended his email, expressing that most of the city’s public health officials had limited information about the virus. “We were all wrong,” he said. “We should have done something way earlier. But that wasn’t anyone's fault. All of us were operating on the information we had.”

Katz also said that city officials were still under the belief at that point that the virus was only spread by symptomatic individuals. “Humility is a key feature we should take from this pandemic,” he said.

In late January, it was becoming apparent that the city would likely have a few cases of COVID-19 crop up since it is an international hub, and the health department was preparing for the inevitable. Unfortunately, the city and state’s confidence in its ability to combat the new virus, based on its past successes containing infectious diseases, such as measles, Legionnaires’ disease, SARS and Ebola, may have given them a false sense of security.

And in February, Barbot and de Blasio attempted to quash the growing anti-Asian sentiments, which stemmed from the disease’s Chinese origins, by encouraging people to partake in Lunar New Year celebrations and dine in the city’s Chinese neighborhoods.

Even after the state detected its first COVID-19 case on March 1, Cuomo and de Blasio remained positive that the state could take on the virus. “Excuse our arrogance as New Yorkers – I speak for the mayor also on this one – we think we have the best health care system on the planet right here in New York,” Cuomo said during a press conference on March 2. “So, when you’re saying, what happened in other countries versus what happened here, we don’t even think it’s going to be as bad as it was in other countries.”

However, epidemiologists have said that it was unlikely that anything could have prevented such a widespread outbreak in the city due to its high density. And numerous screwups on the part of the federal government, which did not provide accurate information about the virus and sent faulty COVID-19 tests to the state, contributed to the state’s high number of coronavirus cases. Though, it has been estimated that the city’s death toll might have been reduced by as much as 80% had it implemented widescale social distancing measures just four days earlier.

“I don’t give two rats’ asses about your cops”

In late March, NYPD Chief of Department Terence Monahan asked Barbot if she could supply his department with 500,000 face masks but she said she could only provide 50,000, the Post reported.

According to sources, the call became contentious. “I don’t give two rats’ asses about your cops,” Barbot told Monahan. “I need them for others.”

After the Post’s story was published on Wednesday, de Blasio expressed disappointment in Barbot and suggested she owed the NYPD an apology. “If what was reported was accurate, the commissioner needs to apologize to the men and women of the NYPD,” the mayor said during a press conference on Thursday.

The Sergeants Benevolent Association, one of the city’s largest police unions, also referred to Barbot as a “bitch” on Twitter, saying that she had “blood on her hands.”

However, what the Post’s story failed to mention is that the conversation occurred after the NYPD had shown up at a New Jersey warehouse and attempted to seize 500,000 N95 masks being reserved for hospitals. According to Monahan, the city Emergency Management Department said the NYPD could pick up 250,000 masks, but when officers arrived they were told only 50,000 were available, which spurred the heated conversation between Monahan and Barbot. And days after the altercation, the NYPD was provided with 500,000 masks.

Barbot has certainly had a significant number of missteps throughout the city’s COVID-19 crisis, just as Katz has, but she’s received more scorn from de Blasio than the public hospitals chief. The mayor’s differing treatment of the two health leaders points once again to his disdain for the health department. It does raise the question about whether this is the right time to allow old rivalries to affect how the city combats the coronavirus.

“It seems to be getting worse when we’re in the middle of a public health crisis,” Denis Nash, a professor at the CUNY Graduate School of Public Health and Health Policy who used to work in the health department, told the Times of the mayor’s disdain for the department. “I worry that a rift like that could cost many lives in New York.”