Contact tracing - Printable Version

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+--- Thread: Contact tracing (/thread-19870.html)

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RE: Contact tracing - BostonCard - 06-11-2020

(06-11-2020, 06:34 PM)Goose Wrote:  I understand your point. Right now, most places have a case load that would be manageable IF they were ready right today to use contact tracing to contain the spread. The problem is it appears that the places who had no capability or inadequate capability didn't move fast enough to prepare for re-opening. It was entirely clear that "the hammer" part of the treatment would be tolerated only until the curve was mostly flattened. We needed to be ready for "the dance". We aren't, and that is a reflection on our entire social mindset.

The thing is every bit helps.  Every chain that can be terminated reduces R0 fractionally and results in fewer chains that have to be terminated later.

Quote:It may help, especially in areas where the virus is still not very prevalent, but at this point we appear to have capitulated to the virus and it's every man for himself...



Pathetic.

Yup, it sounds like we as a society have determined that beating the virus is just too damned difficult.  I have my opinions about leadership at the top, and he has made things worse, but we have to look into the mirror to find the source of the failure.

BC

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RE: Contact tracing - 76lsjumb - 06-11-2020

(06-11-2020, 04:28 PM)Farm93 Wrote:  The injustice inspiring the protest has killed far more citizens than this virus will ever be able to kill.   So if a few thousand more die to raise awareness of our nation's original sin then that will be an acceptable sacrifice for many fighting that cause.

Some people may applaud that statement; some may find it horrific, but it is irrefutable that it is NOT a statement of scientific principle.  

Indeed, a statement like that would have been [and similar statements were] roundly and repeatedly condemned in harsh and uncivil language -- if not actually censored -- from the outset of this Board up until those protests happened.  Unless you are claiming the coronavirus suddenly developed a political leaning -- something people with other deeply held convictions exercising their First Amendment rights were routinely informed was not the case -- you should at least be willing to admit that appropriate public health decisions need only be based on science up to the point where YOU believe there is a more important non-scientific principle at stake. At that point, YOUR principle is more important, even if it causes deaths that would otherwise not have occurred.  

Moreover, since you mention sin, it is at least a little ironic that churches were -- and in some places still are -- precluded from operating in the manner that you believe protestors were and should be rightfully allowed to operate.  

Welcome to the much maligned [at least on this Board] group that doesn't believe SCIENCE is the ultimate answer to this situation.

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RE: Contact tracing - fullmetal - 06-11-2020

(06-11-2020, 08:10 PM)76lsjumb Wrote:  

(06-11-2020, 04:28 PM)Farm93 Wrote:  The injustice inspiring the protest has killed far more citizens than this virus will ever be able to kill.   So if a few thousand more die to raise awareness of our nation's original sin then that will be an acceptable sacrifice for many fighting that cause.

Some people may applaud that statement; some may find it horrific, but it is irrefutable that it is NOT a statement of scientific principle.

I dunno, it seems to be a self-evident conclusion that hundreds of thousands of protesters are taking their chances with covid in order to make their case known to politicians, and that their lives would be an acceptable sacrifice for the cause.

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RE: Contact tracing - Goose - 06-11-2020

(06-11-2020, 08:10 PM)76lsjumb Wrote:  Moreover, since you mention sin, it is at least a little ironic that churches were -- and in some places still are -- precluded from operating in the manner that you believe protestors were and should be rightfully allowed to operate.  

Interesting point. No matter where one sits on any of the issues, it is difficult to reconcile concerns about large gatherings with not enjoining large demonstrations. I suspect the concern was that attempts to enjoin demonstrations on the grounds of COVID-19 would have been considered disingenuous, which would have provoked violent resistance. This raises a lot of issues I think.

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RE: Contact tracing - dabigv13 - 06-11-2020

Personally, I think the protests are certainly bad in the middle of a pandemic, and I wish political and public health officials were more emphatic about the risks.

Yes, it was outdoors and many were wearing masks, and most were young people, but if you went out, you really ought to isolate afterwards.

All that being said, conservatives griping about the viral risks of the protests ring really hollow considering the dudes with long guns (and no masks) rioting to get haircuts and go to Lowes only a couple weeks before.

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RE: Contact tracing - Goose - 06-11-2020

(06-11-2020, 07:06 PM)BostonCard Wrote:  The thing is every bit helps.  Every chain that can be terminated reduces R0 fractionally and results in fewer chains that have to be terminated later.

For sure. It makes one question why SCC wasn't at least trying to track and trace during the entire interval. Getting as many chains broken early as possible certainly wouldn't have hurt. For some reason San Mateo county isn't publishing any data on how many people they have "suggested" quarantine themselves. That would give us some idea how effective they actually are. I have asked for this, but so far, no joy. I will continue to push.

Quote:Yup, it sounds like we as a society have determined that beating the virus is just too damned difficult.  I have my opinions about leadership at the top, and he has made things worse, but we have to look into the mirror to find the source of the failure.



BC

I don't think we a a society made that decision. I think everybody on the Cardboard fully expected the counties to do a pretty good job of getting things in place. Initially, I sure did. Lots of praise was being passed out regarding their quick actions to do SIP (never mind that admits that they weren't able to contain things. We were giving them a pass on the "black swan"). What I fear is that we as a society have created a social and governmental structure that is all about appearances and therapy dogs, not actual competence. The SCC people were tooting their own horn during the May 26 meeting while saying "Oh, by the way, we won't be at full strength until July 15". Yea, I am bitter =).

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RE: Contact tracing - 2006alum - 06-11-2020

(06-11-2020, 09:27 PM)Goose Wrote:  What I fear is that we as a society have created a social and governmental structure that is all about appearances and therapy dogs, not actual competence. 

This, times 1,000. It's why Cuomo got so much credit when very, very few of the discretionary decisions he made as governor could actually be associated with a reduction in harm. He mostly just looked good standing strong and stern on TV. And it's why Trump is flailing so wildly in the midst of two national crises (COVID-19 and the Black Lives Matter uprisings): appearances and therapy dogs (and their Trumpian Bible-bearing equivalents) don't put food on anyone's table, don't prevent anyone's grandmother from contracting COVID-19, and don't ensure that every individual suspected and stopped by the police is treated in a similar manner. The work of governance is hard, and I increasingly think Americans aren't willing to do hard work, even the hard work of carefully assessing whether their elected politicians are doing it. And this inattention virus, too, seems to be spreading: Newsom is saying movie theaters in SoCal can open this weekend even as LA County has the second largest number of active cases of any county in the nation (and higher than all five counties that constitute the five boroughs of NYC). I can't at the moment find case counts by county over time, but it's almost surely the case that SoCal has more active cases now than it did two, four, or six weeks ago. Unless and until Newsom can demonstrate that there's an army of contact tracers in place and law enforcement personnel to enforce strong quarantine requirements, there is zero reason to think these decisions are being made on the basis of public health. 

Indeed, for the life of me, there seems to be almost zero correlation between the public health data and the decisions being made by those in charge nearly everywhere. 90% of America is in worse shape w/r/t COVID-19 than it was a month ago, and yet 90% of America seems to be ready to act like the virus has magically disappeared.

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RE: Contact tracing - BostonCard - 06-11-2020

The New York Times has county by county data and make their data available for download:



https://raw.githubusercontent.com/nytimes/covid-19-data/master/us-counties.csv



You can use it to make plots like this of southern California:




And here is the corresponding plot of deaths (note there is weekly variation and the data is noisier):







Don't ask me why San Diego reported a negative number of deaths in late April.



BC

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RE: Contact tracing - 2006alum - 06-11-2020

[tweet] https://twitter.com/bethlinas/status/1271252059174682631?s=20[/tweet]

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RE: Contact tracing - Farm93 - 06-12-2020

I think many of you missed the intent of my original post.  This is an historic opportunity because of COVID19 and therefore this is the time.
Why?

Black men die at the hands of the police all of the time, usually a few every week in the USA.   So George Floyd's death is not unique really.   The idea that it was captured on video was also not unique.   The length of time was rather unique and the capturing of the police officers face during the 8+ minutes was powerful.

The real key that made his death so unique compared to the thousands of black men that die every decade from police interactions was that so many people watched it, and COVID19 is the reason.  People are at home.   There are no sports, no new TV shows, no youth sports, or recitals, no music concerts or summer festivals.   Mr. Floyd's death was displayed to a largely captive audience with no way to escape the brutal death even if they wanted to ignore it.   That's all thanks to COVID19.

If COVID19 enabled a heightened awareness of the plight then it is reasonable to conclude that those that have fought for equality in the judicial system for centuries would need to use this same period of time to demand change.   Waiting until a vaccine in 2021 or 2022 to hold a protest would mean to lose the opportunity.   Hold those rallies and marches in the summer of 2021 after some other death while black situation and the protest events likely would have a different set of participants and far less coverage.   With fewer participants and less coverage there would be less impact and little, if any, change.

Additionally, President Trump is critical here.   In the 50s and 60s it was well understood that peaceful protest worked best if those politicians and police officials in charge insisted on using force and violence to suppress those seeking civil rights.  The next president (2021 or 2025) is unlikely to make statements and actions in response to the protests quite as...helpful...as the actions and statements of President Trump.

For many protesting this is probably the single best opportunity for change (COVID related slowdown & POTUS45) in generations.   The idea that those protesting, in the USA and around the world, are risking their lives and the lives of their loved ones is a tribute to their commitment to the noble cause of a more perfect union.

I wish it would not result in more deaths or that it would not be used as an excuse by POTUS45's administration for all of the COVID deaths that are going to happen throughout the rest of 2020.  I also wish the COVID risk accepted by the protesters would not be transferred to others, but that's not how contagious diseases work.   I do suspect history will look favorably upon those that marched in 2020.

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(06-11-2020, 10:22 PM)BostonCard Wrote:  The New York Times has county by county data and make their data available for download:

The USA moved forward on opening because we were impatient.   We have a health care system built upon people getting coverage from their employer, so we waiting had economic AND health care coverage consequences in the mix.   

Officials from around the world noted the USA was not ready to open.   The cases were not down to a rate that could be traced and public awareness on the importance of masks and social distancing is limited.   There were many countries that were much closer to ready that still had issues, but I guess as a nation we decided our belief in American exceptionalism would beat back COVID spread.  

At this point President Trump is making an all-in gamble on warmer weather or the WARP speed vaccine development solving the problem before November.   Seems like a weekly CDC briefing on sensible prevention steps and national tracing would be reasonable additions to the plan, but I guess that is not needed if we really are all-in on the gamble.

It is at this time that I wish POTUS45 didn't have quite so many all-in losses (bankruptcies) in his life as a business executive.

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RE: Contact tracing - Mick - 06-12-2020

(06-11-2020, 10:22 PM)BostonCard Wrote:  The New York Times has county by county data and make their data available for download:
https://raw.githubusercontent.com/nytimes/covid-19-data/master/us-counties.csv
You can use it to make plots like this of southern California:


And here is the corresponding plot of deaths (note there is weekly variation and the data is noisier):


Don't ask me why San Diego reported a negative number of deaths in late April.
BC

Because they weren't dead yet...

https://www.youtube.com/watch?v=jYcPBE5PXhs

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RE: Contact tracing - oldalum - 06-12-2020

(06-11-2020, 10:22 PM)BostonCard Wrote:  Don't ask me why San Diego reported a negative number of deaths in late April.

successful resuscitations??    :)

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RE: Contact tracing - burger - 06-12-2020

(06-11-2020, 10:22 PM)BostonCard Wrote:  Don't ask me why San Diego reported a negative number of deaths in late April.

Probably a data correction. I've seen these in a few other datasets.

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RE: Contact tracing - M T - 06-12-2020

(06-11-2020, 10:22 PM)BostonCard Wrote:  Don't ask me why San Diego reported a negative number of deaths in late April.

I think you mean "Don't ask me why the NYTimes is reporting a negative number of deaths in late April in San Diego."

San Diego's current data is here.  (The earliest archive.org copy is May 8 which has a few but not many differences) The LA Times keeps their own copy.

The LA Times copy shows (for instance) 15 deaths around April 20 and again a week or so in May.  The San Diego data does not show that (single daily maximum is 10).   The San Diego data is by date of death.  My guess is the LA Times is by date of announcement.  I can think of a few reasons the NYT would have to correct their data and might choose to do so by having a negative count.

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RE: Contact tracing - Snorlax94 - 06-21-2020

N.Y.C. Hired 3,000 Workers for Contact Tracing. It’s Not Going Well.

https://www.nytimes.com/2020/06/21/nyregion/nyc-contact-tracing.html?action=click&module=Top%20Stories&pgtype=Homepage

The glass half full thinking is that the contact tracers are new and are learning, and will get better. And the hope (for locals) is that people in California will be more cooperative and more community-minded and will work with the contact tracers to make it a success.

The glass half empty thinking is that something is just wrong with America. I saw an interview with an infectious disease doctor from Vanderbilt saying that Americans are just so "independent" minded, but so are Germans and New Zealanders and South Koreans and people in so many other countries where the cases are dropping. For now, Americans are responding to contact tracing the same way they've responded to masks: at times, selfishly, self-destructively, immaturely, and hostile to science.

Quote:The city has hired 3,000 disease detectives and case monitors, who are supposed to identify anyone who has come into contact with the hundreds of people who are still testing positive for the virus in the city every day. But the first statistics from the program, which began on June 1, indicate that tracers are often unable to locate infected people or gather information from them.

Only 35 percent of the 5,347 city residents who tested positive or were presumed positive for Covid-19 in the program’s first two weeks gave information about close contacts to tracers, the city said in releasing the first statistics.

Quote:Dr. Ted Long, head of New York City’s new Test and Trace Corps, insisted that the program was going well, but acknowledged that many people who tested positive had failed to provide information over the phone to the contact tracers, or left interviews before being asked. Others told the tracers they had been only at home and had not put others at risk, and then did not name family members.

Quote:China, South Korea and Germany and other countries have set up extensive tracking programs that have helped officials make major strides in reducing the outbreak. In South Korea, for example, people at weddings, funerals, karaoke bars, nightclubs and internet-game parlors write down their names and telephone numbers, and the authorities have been able to draw on cellphone location data, credit card transactions and even closed-circuit video footage

Quote:In Massachusetts, which has one of the most established tracing programs in the country, health officials said in May that only about 60 percent of infected patients were picking up the phone. In Louisiana, less than half were answering.

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RE: Contact tracing - M T - 06-21-2020

Snorlax got his post up as I was writing mine... So I've removed the overlap

Quote:...
The city gave no metrics for whether it was successfully persuading those contacted to get tested or to quarantine.
...
[[The head of the tracing program]  added that he believed that the tracers would be more successful when they start going to people’s homes in the next week or two, rather than just relying on communication over the phone.  [Yes, they're going to ask contact tracers to go into homes of people that just got a positive test.  With all the concern about privacy, they're going to send someone cloaked in PPE to your front door!   What an opportunity for strong-arm robbers.  I will be surprised if they exceed 35% access rate that way.]
,,,

A question I would like to ask in Santa Clara County (or anywhere):  Of the positive cases, what percent were taking the test because they had been notified through contact tracing that they were exposed and should quarantine and get tested.  In other words, is contact tracing catching 1% or 99% of the new cases? 

When person A gets the disease, and they contact A's close contact B, do they either get B's close contacts or alert B that he should prepare a list of close contacts?   [3 scenarios:  A and B got it at the same time; B gets it from A; or A got it from B (who doesn't know or doesn't want to admit he has it)]

Btw, Britain isn't having much success at contact tracing so far either.

I think contact tracing might work better if the patient is offered the opportunity (& guidance) to be the first to call his close contacts.  I might not answer a strange phone number, but if a co-worker contacted me by email, or a friend by phone or text, I'd be more likely to see what is in the message.  But everything I've seen appears to be treating COVID-19 like some shameful thing you don't want anyone to know you got.  
(I've had two people, a  co-worker and a person I only interacted with over the phone, be unavailable for two weeks.  Duh, I wonder what that could be.)

That's the wrong message, IMO.  If I were to get COVID-19, I'd probably be extremely diligent in contacting anyone I had been in contact with, at least for the people I knew.  I'd care for their well-being, and more importantly, for the well-being of those around them.  If I infected a co-worker, I can't prevent him from getting sick, but maybe I can alert him so he doesn't infect a parent.   I'd think enlisting those patients that are willing would be a very effective method of contacting the contacts.  Sure, the professional contact tracers can follow up with details about when to get (re)tested, programs to help with those infected, etc.

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Too Slow?

If contact tracing is to be most effective, it must catch the secondary infections before they become infectious.  For it to be of much use at all, it should catch the secondary infections before they would already have symptoms and would already have taken the tests.

Suppose A was exposed on June 1, became infectious on June 4, gets symptoms on June 6, takes the test on June 7, and the results come back on June 8 (or June 9).   Suppose B was infected by A on June 4, he well could be infectious on June 7, and gets symptoms on June 9.

The contact tracer may get to this case on June 8 (or, maybe not until June 9).  Then they have to contact A (in NYC, 15% didn't give phone numbers), tell him the news, and get a list of names.  (Quick, can you tell me everyone you spent 15 minutes within 6' (that's their definition of who is a close contact) over the last 14 days?  What about that guy at the next table in the LA bar?)   Then he's got to track down B (and any others), and then contact B.

It doesn't seem likely he'd get to B before he already infected people (and they infect others before they're contacted too), and quite possibly until after B already has shown symptoms and taken the test himself.

This seems WAY too slow for this disease.  I'd argue that there should be 7x24 testing widely advertised (not every site, but perhaps at every 24hr ER) to eliminate the half day or more waiting overnight for half the cases to wait for testing to be open (when the patient doesn't have to be at work).  There should not be 39 hours to get the test results as SCC is reporting.  I would guess a bunch of that is waiting for samples to be sent from collection to the lab.

I'd still like to know why California is not adopting the Apple/Google app. Not that it is a panacea, but it can speed things up, and find contacts not given to the tracer.

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RE: Contact tracing - Goose - 06-21-2020

I am going to be real unpopular with this post, but I believe the only way contact tracing will work is if a health department representative goes to your door and tells you what you are going to do. Not asks, tells. You can't "end the interview". If you refuse, they take you away to quarantine in a county run facility. They do have the power to do this BTW. This is how it works in Korea, Taiwan, etc. The population cooperates partly because they know that if they don't, they will lose their freedom of choice. The people in the USA need to see that this is what happens if you don't cooperate with county health. Compliance will go way up. Yes, it is a bit draconian. However, citizens have responsibilities to their community. Traditionally, this has been one of them. It has been a while since it has mattered, but it matters now. If everybody "does the right thing", there will be no drama. If they chose not to, it must have appropriate consequences.

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RE: Contact tracing - M T - 06-21-2020

Goose, you may have been talking about either the patient who had a positive test, or a close contact.  I will presume you meant only the person with the positive test.

I think you could ease what you described a bit:  The "county run facility" could be a hotel/motel/dorm, not a jail.  The patient would be confined, but would have meals brought in, have bed, bathroom, TV, access to Internet & phone, etc.  No visitors (but families/cohabitants in quarantine would be kept together, and probably could remain until the last ends his/her quarantine).     It certainly is less onerous than being in a hospital the entire time (what China did).

However, note that NYC has found that very few of such hotel rooms have been utilized.

I was quite surprised when SCC case #4 (or so), was let to return home with no monitoring (as far as reported) after her positive test, since she didn't need hospitalization.

A less optimal approach is to allow the individual to wear a location monitoring device to confirm that they stay home, as their choice rather than being moved to a county-run facility.   This has the risk of their infecting others that may come to the house (household members, food delivery, etc.) and they spread it further.

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But, we don't really know that the disease is being spread significantly by individuals who know they have tested positive.  So, I'm not sure I would yet support this approach.  I think the voluntary isolation in a county facility is a good option, but unless you know someone is leaving their quarantine, I'm not quite ready for involuntary movement to a facility.  I would support involuntary location tracking during quarantine.

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lex24 - lex24 - 06-21-2020

The only reason I can conceive of people not cooperating with contact tracing is fear that they face liability if others get ill as a result of the contact.

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RE: Contact tracing - CardinalSagehen - 06-21-2020

I think we need to execute competently on basic, voluntary forms of tracing, including most notably a nationwide, opt-in contact tracing app with a robust PR campaign behind it. We should do this before moving to involuntary tracing, which I’d also support if the situation were grave enough and we had executed competently on everything else first. Right now, it’s hard to say what’s necessary because we have sucked so badly at the basics.  

Go to Setings / Privacy / Health / Covid-19 Exposure Notifications on your iPhone or the equivalent on your Android phone. You will see that Apple and Google have done some of their part by making contact tracing APIs available already.  The feature is totally opt-in, and data storage is decentralized and anonymized. Both companies have vowed never to use the data for commercial purposes and to kill the APIs after Covid-19 has passed. Only public health officials are supposed to be able to see the data, and I’m not quite clear on this, but I believe it might be anonymous data for them, too. 

Importantly, the tracing feature uses local Bluetooth signals, not GPS, to record proximity to others that turn out to be infected.   

An app doesn’t have to be used correctly and honestly by everyone to make a difference.  I think even 10-15% penetration of the American populace (with a natural uptick in the hardest-hit areas) would start to matter.  

Contact notification is immediate. Notified contacts would presumably get tested quickly and prevent further spreading.    

Our software industry is unparalleled and second to none, but apparently we can’t release a simple Bluetooth app because we have 50 states running in different directions and no federal Internet privacy laws to govern this sort of thing.

As a result, for now, the contact tracing features on all of our smartphones remain dormant and useless. I’d love to see what we can do with a real effort around these apps and a federal privacy framework to govern them.

There’s a bipartisan bill in Congress right now called the Exposure Notification Privacy Act.  I haven’t read it, but at a high level, I believe something like this is necessary to help us navigate the obvious privacy issues and move toward better, faster, safer use of technology for contact tracing.

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