Best article I’ve seen on Bay Area/CA contact tracing - Printable Version
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Best article I’ve seen on Bay Area/CA contact tracing - Snorlax94 - 04-24-2020
https://www.paloaltoonline.com/news/2020/04/23/coronavirus-detectives-heres-how-counties-try-to-track-everyone-exposed
A mix of hope and frustration. The state announced plans to staff up an army of 10,000 contact tracers largely using current state employees. SF as we know is already starting to train 150 contact tracers.
“San Mateo County health officials are trying to understand the scope of demand before expanding contact tracing...Santa Clara County health administrators have not specified how many contract tracers they will need, but Chief Health Officer Sara Cody said Tuesday that the county must have the infrastructure and staffing needed for contact tracing before restrictions on the public can be eased.”
Yeah, so why are things still in such early planning stages?
Frustratingly slow but they are getting started on it in pieces. Does not bode well for opening many more businesses in the next few weeks.
I am frustrated. Sometimes it feels like the public health officers are taking on so much, they’re not doing enough of the strategic stuff. In a way, public health officers now have a role more impactful than mayors and to an extent even governors. I don’t doubt they are working incredibly long hours, but I worry they spend too much time being doctors and not enough time being executives — delegating, strategizing, leading, and hiring.
RE: Best article I’ve seen on Bay Area/CA contact tracing - BostonCard - 04-24-2020
I agree. I would have hoped that this planning and capability would have been developed over the past month. We've known that contact tracing would be needed to open up and that it would have required a lot of manpower for quite some time. Not sure why we are still in the "trying to understand the scope of demand" phase.
BC
RE: Best article I’ve seen on Bay Area/CA contact tracing - Goose - 04-24-2020
(04-24-2020, 01:34 AM)Snorlax94 Wrote: https://www.paloaltoonline.com/news/2020/04/23/coronavirus-detectives-heres-how-counties-try-to-track-everyone-exposed
A mix of hope and frustration. The state announced plans to staff up an army of 10,000 contact tracers largely using current state employees. SF as we know is already starting to train 150 contact tracers.
“San Mateo County health officials are trying to understand the scope of demand before expanding contact tracing...”
This is especially disconcerting considering the email I posted from San Mateo County Health explaining how they had this figured out and would be ready. What is actually going on here? Is this just a comment saying they aren't currently doing active contact tracing but are going to start when they believe the demand meets their capabilities? Is that all the Palo Alto Times could get, or is it just horrible reporting?
Quote:I am frustrated. Sometimes it feels like the public health officers are taking on so much, they’re not doing enough of the strategic stuff. In a way, public health officers now have a role more impactful than mayors and to an extent even governors. I don’t doubt they are working incredibly long hours, but I worry they spend too much time being doctors and not enough time being executives — delegating, strategizing, leading, and hiring.
I am not sure exactly what they are doing, which is disconcerting. I would expect they are spending 100% of their time gearing up to do the required contact tracing and figuring out what quarantine resources they need. I would have expected several special Board of Supervisors meetings in the county to figure out how to fund what is going to be needed, or to yell for help if they can't figure it out. These county health departments are supposed to be the "foot soldiers" of the effort and will be absolutely vital to doing it. The State is supposed to be the strategic reserve. The Feds (such as they are) are going to be the Special Forces. If it isn't going to work that way, what is the new plan? I am hearing dead silence. Not encouraging.
RE: Best article I’ve seen on Bay Area/CA contact tracing - akiddoc - 04-24-2020
I personally believe that this approach is doomed to failure. There are just too many people infected and too many are asymptomatic. We're going to have to let people under 65 go back to work with the knowledge that some will get sick and a few will die. We do the same with influenza. Start with the 20-40 age group if necessary. Once there is a high degree of previous infection in that age group the virus will spread more slowly.
RE: Best article I’ve seen on Bay Area/CA contact tracing - 2006alum - 04-24-2020
(04-24-2020, 02:27 PM)akiddoc Wrote: I personally believe that this approach is doomed to failure. There are just too many people infected and too many are asymptomatic. We're going to have to let people under 65 go back to work with the knowledge that some will get sick and a few will die. We do the same with influenza. Start with the 20-40 age group if necessary. Once there is a high degree of previous infection in that age group the virus will spread more slowly.
By all accounts, that's largely the method South Korea used to flatten the curve and get things down to where today they reported no new deaths from COVID-19 for the first time in 38 days:
[tweet]https://twitter.com/guardian/status/1253179142750814209?s=20[/tweet]
Do you just think that their approach is not feasible in the United States?
Speaking as one of the "20-40 age group," what do you mean by "let go back to work?" I already am working -- from home. And if my employer told me, "you have to get back in the office, we have immunity from liability for your death or serious illness, and some of you will just have to take it on the chin if you get sick and/or die," needless to say, I wouldn't be very happy. There has to be a better way than that.
RE: Best article I’ve seen on Bay Area/CA contact tracing - dabigv13 - 04-24-2020
Its hard to imagine we can effectively run a tracing program as well as South Korea, or even have the patience to wait for our community transmission to drop to a low enough point where its feasible. I imagine we'll probably end up adopting some sort of Sweden model where we try and let it burn through at a controlled pace.
I think this would be an unnecessary loss of life and will cripple the economy more than a longer period of shelter in place and controlled tracing and quarantine would, but we don't have the leadership to make the hard early choices this would require.
RE: Best article I’ve seen on Bay Area/CA contact tracing - stupac2 - 04-24-2020
Related to 2006's point above, one thing I've yet to see addressed anywhere is what happens to all the kids. Schools and daycares are mostly closed, and even the places reopening soon don't seem to be including them. It's just not tenable to work full time while also watching over a kid (no matter what my timesheet says >.>), so what's the plan there?
I'm sort of coming around to akkiddoc's point that we might just not be able to replicate SK's success, which is damning but might be true. In that case the best option would be to get to herd immunity as quickly as possible without overwhelming the health system. Which would be terrible, but it might be our best option. (Hah, looks like since hitting "reply" dabigv posted basically the same thing.)
RE: Best article I’ve seen on Bay Area/CA contact tracing - Snorlax94 - 04-24-2020
(04-24-2020, 03:12 PM)dabigv13 Wrote: Its hard to imagine we can effectively run a tracing program as well as South Korea, or even have the patience to wait for our community transmission to drop to a low enough point where its feasible. I imagine we'll probably end up adopting some sort of Sweden model where we try and let it burn through at a controlled pace.I keep fluctuating day by day, one day I’m hopeful we can trace and contain, other days I feel like we’ll have to go with the slow burn.
But here’s a thought I found hopeful: in Santa Clara County, the new confirmed cases has dropped from a high of 80-100
cases a day to 20-30. And we can assume that was where we were 7 days ago, maybe now it’s 10-15. Now, we all know the true rate is higher because in the past we didn’t even test the medium-symptomatic people let alone the asymptomatic exposed, and there is a multiplier — maybe it’s 10x, maybe it’s 50x.
But as our testing is increasing, the state and counties are moving to the point where all symptomatic and asymptomatic essential workers are welcome to test (in sf, at least). I agree it’s not clear we can achieve containment, but I do think it’s worth trying.
And it can’t hurt — even if they can’t trace every case, if they have the capacity to test a lot of people, contacting all contacts of anyone who tests positive and signing them up for a same-day test could protect many people.
It’s just still behind where we wish they were.
RE: Best article I’ve seen on Bay Area/CA contact tracing - BostonCard - 04-24-2020
(04-24-2020, 03:19 PM)stupac2 Wrote: Related to 2006's point above, one thing I've yet to see addressed anywhere is what happens to all the kids. Schools and daycares are mostly closed, and even the places reopening soon don't seem to be including them. It's just not tenable to work full time while also watching over a kid (no matter what my timesheet says >.>), so what's the plan there?
I'm sort of coming around to akkiddoc's point that we might just not be able to replicate SK's success, which is damning but might be true. In that case the best option would be to get to herd immunity as quickly as possible without overwhelming the health system. Which would be terrible, but it might be our best option. (Hah, looks like since hitting "reply" dabigv posted basically the same thing.)
I think the most likely outcome is capitulation, which is why this whole blown response is so sad.
BC
RE: Best article I’ve seen on Bay Area/CA contact tracing - Goose - 04-24-2020
I got the impression that in San Mateo county they were tracking and tracing all along, based on what I received two weeks ago. I have reproduced it below for reference.
Thank you for your interest in SM County Health’s actions to investigate contacts as part of our public health protection responsibilities that we are engaged in with the challenge of COVID-19.
We are continuing to perform contact investigations for all residents who have tested positive for COVID-19 as well as follow-up on identified exposures in San Mateo County, including ill individuals visiting the area. As the availability of testing increases, we expect to see the number of cases continue to rise. Contact investigation and follow-up is resource-intensive. We are continuing to increase staffing capacity, redirecting Health staff from other areas of responsibility that have been curtailed as we prioritize our essential functions and/or for which demand has lessened, so that new positive results can be investigated quickly even as the number of reports rise.
Regards,
srija
Srija Srinivasan
Deputy Chief
San Mateo County Health
(650) 573-2095 T
ssrinivasan@smcgov.org
smchealth.org
facebook.com/smchealth
twitter.com/smchealth
From this, one could conclude they were never overwhelmed. That said, I would like to suggest that one of the main problems in contact tracing and testing has been that we don't know a lot about this virus. AFAIK, we really don't know how common asymptomatic infection is. We really don't know what the incubation period is (defined as the time from exposure until one is contagious to others) We also don't know for sure how long one is typically contagious, although two to three weeks seems to be the number.
Just to be clear, this is how I understand contact tracing and testing works.
1)A patient is diagnosed with COVID-19 (either by PCR test or otherwise). That patient will be quarantined for two to three weeks, but due to the fact we are not yet sure about reinfection the person will need to be quarantined by themselves.
2)The county determines all the people that have been in "significant" contact with this patient (by interviews, by cell phone location, however else).
Determining which "contacts" require follow up is probably a bit of an art. Somehow those contacts will be determined.
Those contacts will be informed that they are presumably exposed. If any of these people have symptoms, they for sure will be either diagnosed with COVID-19 on that basis and/or tested for the virus using a PCR test. For each contact so diagnosed go to step 1 above.
Now comes another tricky part.
3) I believe that ideally you quarantine all the remaining contacts, even though they are not (yet) sick. They also will have to be quarantined by themselves since if they are going to get sick we don't want them spreading the disease to those that are not sick and conversely.
At this point, you also have to decide whether it is worth testing them with a PCR test. They are going to be quarantined anyway. If they test positive the county can immediately go to step 1 with this patient. This is a "win" because it starts contact tracing sooner and should result in less spread. It also allows detection of asymptomatic patients that would not otherwise be detected. If they test negative, you still have to quarantine them because they possibly just haven't developed the disease adequately to test positive. If the testing capacity is adequate, you test. If it isn't, you have to make choices.
As I see it, one big issue is where do you put all those quarantined people. In the US, if you send them home many of them, particularly if they aren't sick, simply won't comply with the quarantine. Ft. Hunter Liggett is nice this time of year. Failing that, how about the Ft. Ord firing ranges. Plenty of sand :-).
So, do I have this right? Comments welcome.
RE: Best article I’ve seen on Bay Area/CA contact tracing - Snorlax94 - 04-24-2020
(04-24-2020, 04:33 PM)BostonCard Wrote: I think the most likely outcome is capitulation, which is why this whole blown response is so sad.Awww, sure we’re down 42-3 and our head coach is — well, it’s Trump — but it’s only the first quarter and there is still a lot of football left to play.
BC
(04-24-2020, 04:52 PM)Goose Wrote: We are continuing to perform contact investigations for all residents who have tested positive for COVID-19 as well as follow-up on identified exposures in San Mateo County, including ill individuals visiting the area. As the availability of testing increases, we expect to see the number of cases continue to rise.Hey Goose, yeah I thought about your correspondence with the SMDPH when I saw this article. That was April 9ish, right? And they are still “determining the scope.”
The counties might CLAIM to be doing this but I can tell you I think that is BS. As I mentioned on a different thread, someone I know felt sick in mid-March. They were concerned about an elderly family member in the same household. They requested to get tested, but because it was mild, they were denied. Finally, because of the concern about the elderly family member, someone suggested they try to get tested at Stanford. The person was able to get tested at Stanford and was confirmed positive. Then, there was concern about a co-worker who works with the positive case person, every weekday, collaborating in the same room. That co-worker tried to get tested. And was denied. Finally, the co-worker tried the Stanford route, got tested, and was negative. In mid-late March, I can assure you, in Santa Clara County, they were not letting mildly symptomatic people get tested. They were not contacting close co-workers of confirmed POSITIVE cases, they were not even letting them get tested if they begged to get tested. The testing limitations have been such a crippling problem.
If one worker at a Costco is positive, do you shut down the Costco, quarantine everyone who works and shopped at that Costco, and quarantine all the workers’ families? Probably not all of them, but I wish we could call all of them and get them tested.
RE: Best article I’ve seen on Bay Area/CA contact tracing - chrisk - 04-24-2020
(04-24-2020, 04:52 PM)Goose Wrote: I got the impression that in San Mateo county they were tracking and tracing all along, based on what I received two weeks ago. I have reproduced it below for reference.
Thank you for your interest in SM County Health’s actions to investigate contacts as part of our public health protection responsibilities that we are engaged in with the challenge of COVID-19.
We are continuing to perform contact investigations for all residents who have tested positive for COVID-19 as well as follow-up on identified exposures in San Mateo County, including ill individuals visiting the area. As the availability of testing increases, we expect to see the number of cases continue to rise. Contact investigation and follow-up is resource-intensive. We are continuing to increase staffing capacity, redirecting Health staff from other areas of responsibility that have been curtailed as we prioritize our essential functions and/or for which demand has lessened, so that new positive results can be investigated quickly even as the number of reports rise.
Regards,
srija
Srija Srinivasan
Deputy Chief
San Mateo County Health
(650) 573-2095 T
ssrinivasan@smcgov.org
smchealth.org
facebook.com/smchealth
twitter.com/smchealth
From this, one could conclude they were never overwhelmed. That said, I would like to suggest that one of the main problems in contact tracing and testing has been that we don't know a lot about this virus. AFAIK, we really don't know how common asymptomatic infection is. We really don't know what the incubation period is (defined as the time from exposure until one is contagious to others) We also don't know for sure how long one is typically contagious, although two to three weeks seems to be the number.
Just to be clear, this is how I understand contact tracing and testing works.
1)A patient is diagnosed with COVID-19 (either by PCR test or otherwise). That patient will be quarantined for two to three weeks, but due to the fact we are not yet sure about reinfection the person will need to be quarantined by themselves.
2)The county determines all the people that have been in "significant" contact with this patient (by interviews, by cell phone location, however else).
Determining which "contacts" require follow up is probably a bit of an art. Somehow those contacts will be determined.
Those contacts will be informed that they are presumably exposed. If any of these people have symptoms, they for sure will be either diagnosed with COVID-19 on that basis and/or tested for the virus using a PCR test. For each contact so diagnosed go to step 1 above.
Now comes another tricky part.
3) I believe that ideally you quarantine all the remaining contacts, even though they are not (yet) sick. They also will have to be quarantined by themselves since if they are going to get sick we don't want them spreading the disease to those that are not sick and conversely.
At this point, you also have to decide whether it is worth testing them with a PCR test. They are going to be quarantined anyway. If they test positive the county can immediately go to step 1 with this patient. This is a "win" because it starts contact tracing sooner and should result in less spread. It also allows detection of asymptomatic patients that would not otherwise be detected. If they test negative, you still have to quarantine them because they possibly just haven't developed the disease adequately to test positive. If the testing capacity is adequate, you test. If it isn't, you have to make choices.
As I see it, one big issue is where do you put all those quarantined people. In the US, if you send them home many of them, particularly if they aren't sick, simply won't comply with the quarantine. Ft. Hunter Liggett is nice this time of year. Failing that, how about the Ft. Ord firing ranges. Plenty of sand :-).
So, do I have this right? Comments welcome.
There are plenty of empty hotel rooms. I read about an infected person in SM County who was sent to a hotel to keep him away from his family as well as others.
(Also, the Fairfield Inn in San Carlos was taken over to house sick Grand Princess passengers and is now available for other quarantine purposes).
RE: Best article I’ve seen on Bay Area/CA contact tracing - Mick - 04-25-2020
(04-24-2020, 03:00 PM)2006alum Wrote:(04-24-2020, 02:27 PM)akiddoc Wrote: I personally believe that this approach is doomed to failure. There are just too many people infected and too many are asymptomatic. We're going to have to let people under 65 go back to work with the knowledge that some will get sick and a few will die. We do the same with influenza. Start with the 20-40 age group if necessary. Once there is a high degree of previous infection in that age group the virus will spread more slowly.
By all accounts, that's largely the method South Korea used to flatten the curve and get things down to where today they reported no new deaths from COVID-19 for the first time in 38 days:
[tweet]https://twitter.com/guardian/status/1253179142750814209?s=20[/tweet]
Do you just think that their approach is not feasible in the United States?
Speaking as one of the "20-40 age group," what do you mean by "let go back to work?" I already am working -- from home. And if my employer told me, "you have to get back in the office, we have immunity from liability for your death or serious illness, and some of you will just have to take it on the chin if you get sick and/or die," needless to say, I wouldn't be very happy. There has to be a better way than that.
I think there already is a better way, particularly if you're working from home.
I'd be very much surprised if employers forced employees to go back to work if they don't need to be in a specific facility. I just ran a COVID-19 "Return to Work" survey, and few employers intend to force employees back to work. And for many firms, ours included, management is finding out that employees who work from home are very productive, particularly if they no longer have lengthy commutes and have project-based workflow. And to be candid, I suspect many, if not most companies are eyeing their real estate-related costs (leasing, utilities, etc.) and visualizing a nice add to the bottom line without them. I know we're doing that.
As for employees with jobs that necessitate being inside a facility who don't want to return to a facility...there's 26 million+ workers who desperately want jobs in a market where there are none. it's going to be an employer's market for quite a while, particularly as we stall returning to work.
RE: Best article I’ve seen on Bay Area/CA contact tracing - 2006alum - 04-25-2020
(04-25-2020, 05:43 AM)Mick Wrote:(04-24-2020, 03:00 PM)2006alum Wrote: Speaking as one of the "20-40 age group," what do you mean by "let go back to work?" I already am working -- from home. And if my employer told me, "you have to get back in the office, we have immunity from liability for your death or serious illness, and some of you will just have to take it on the chin if you get sick and/or die," needless to say, I wouldn't be very happy. There has to be a better way than that.
I think there already is a better way, particularly if you're working from home.
I'd be very much surprised if employers forced employees to go back to work if they don't need to be in a specific facility. I just ran a COVID-19 "Return to Work" survey, and few employers intend to force employees back to work. And for many firms, ours included, management is finding out that employees who work from home are very productive, particularly if they no longer have lengthy commutes and have project-based workflow. And to be candid, I suspect many, if not most companies are eyeing their real estate-related costs (leasing, utilities, etc.) and visualizing a nice add to the bottom line without them. I know we're doing that.
As for employees with jobs that necessitate being inside a facility who don't want to return to a facility...there's 26 million+ workers who desperately want jobs in a market where there are none. it's going to be an employer's market for quite a while, particularly as we stall returning to work.
Did your RTW survey ask about if/how employers were rethinking physical distancing in workplaces that are more densely packed but require employees to be in the office (I'm thinking places like call centers)? I'd be curious to hear what modifications private employers may be anticipating, such as fever checks, larger enforced distances between desks, etc.
It still doesn't sound like we have a great plan for work that requires being in a facility - saying it's an employer's market essentially concedes the plan is to invoke duress to force employees to return. And I suppose once August 1 hits and the topped up unemployment insurance ends, that could work. But I still don't see how customer-facing businesses like restaurants, movie theaters, etc. will work. Even if you can get employees to return, most restaurants rely on an older demographic to survive, and if I know my local bistro is relying on young people to risk getting COVID-19 in order to operate, do I really want to be served by a asymptomatic carrier if I'm 60+, immuno-compromised, etc.? Why do I risk a crowded bar when I can meet my friends in the park, for a small house party, etc. I can pass on the latest movie releases and stream something from home. And so on.
If those declining to eat out, go to the movies, go to bars, etc., constitute even more than 5-10% of the population, I still don't understand how these low-margin businesses will have the gross margins to be profitable while open. Maybe they can live off the SBA loans for the next 12-18 months until a vaccine?
RE: Best article I’ve seen on Bay Area/CA contact tracing - Mick - 04-25-2020
(04-25-2020, 06:45 AM)2006alum Wrote: Did your RTW survey ask about if/how employers were rethinking physical distancing in workplaces that are more densely packed but require employees to be in the office (I'm thinking places like call centers)? I'd be curious to hear what modifications private employers may be anticipating, such as fever checks, larger enforced distances between desks, etc.
Our survey doesn't go quite that deep and tends to focus on labor & employment issues. We do ask about modifications, but only 13% have a fully fleshed out plan that includes major modifications. Another 1/3 have a fully fleshed out plan that involve minor modifications. About 1/3 are "working on it" The rest plan to work remotely, while a very small percentage plan no changes. Typical size of the company, about 300 employees; 150+ respondents.
(04-25-2020, 06:45 AM)2006alum Wrote:
It still doesn't sound like we have a great plan for work that requires being in a facility - saying it's an employer's market essentially concedes the plan is to invoke duress to force employees to return. And I suppose once August 1 hits and the topped up unemployment insurance ends, that could work. But I still don't see how customer-facing businesses like restaurants, movie theaters, etc. will work. Even if you can get employees to return, most restaurants rely on an older demographic to survive, and if I know my local bistro is relying on young people to risk getting COVID-19 in order to operate, do I really want to be served by a asymptomatic carrier if I'm 60+, immuno-compromised, etc.? Why do I risk a crowded bar when I can meet my friends in the park, for a small house party, etc. I can pass on the latest movie releases and stream something from home. And so on.
I'd agree. There's too many ramifications, too many variables. We have about 20 people working on a three-page long list of considerations, and we have very few public or client visitors.
People will be desperate for income. Four months is going to go by in a hurry. Businesses will have their requisite employees, and as you point out, there won't be as many customers. We've done a pretty good job of destroying the economy (save the hate posts, I'm just citing a fact), so no one has any money to spend. While you'd be surprised at how many people are desperate to leave their homes for almost any reason, revenue is a long way off.
(04-25-2020, 06:45 AM)2006alum Wrote:
If those declining to eat out, go to the movies, go to bars, etc., constitute even more than 5-10% of the population, I still don't understand how these low-margin businesses will have the gross margins to be profitable while open. Maybe they can live off the SBA loans for the next 12-18 months until a vaccine?
I don't either. I don't understand how the majority of people are going to live with no income. How will they buy food, pay the rent? No idea.