Comprehensive contact tracing efforts in one New Jersey city worked to drive COVID-19 cases down, even with limited resources, a researcher said.
From a mid-April peak of 263 cases, contact tracers in the city of Paterson brought that number down to seven cases, with over 90% of confirmed cases investigated as of June 15, reported Paul Persaud, MD, of Paterson Department of Health in New Jersey, in a presentation from the virtual IDWeek.
Moreover, the 4.65% mortality rate in Paterson, the third largest city in New Jersey, was lower than two other towns in the same county, other large cities in New Jersey such as Newark and Jersey City, and in the entire state overall.
Through a base of 25 members of a “strike team” first designed to investigate outbreaks of foodborne illnesses, the team expanded to 50 members deployed for contact tracing, including a case coordinator, case investigators, a case/contact monitor, and contact tracers, the authors said.
“When we first started this, we had no funding from the CARES Act. We relied on existing staff,” said Persaud during a press conference.
He detailed the challenge that investigators faced with contact tracing, given that Paterson is a densely populated area with a population of over 150,000 people (60% Hispanic/Latino, 25% Black, 9% white, and 4% Asian), with a median household income of around $39,000.
The authors outlined how the team worked: case coordinators extracted cases from the Communicable Disease Reporting and Surveillance System and assigned them to case investigators, who conducted the epidemiological investigation and determined the isolation/quarantine period. A contact tracer monitored cases and contacts throughout isolation and followed up with daily phone calls, they added.
“Once we called and said we were calling from the health department, that helped,” Persaud said, though he added, “We had our fair share of people hanging up the phone on us.” If that happened, another member of the team would try to make contact.
“We never gave up,” he said.
As the outbreak evolved, the authors described how some contact tracers were trained to become case investigators, while additional health department employees were then trained as contact tracers to replace them. The department even enlisted community policing for hard-to-find cases and contacts.
The experiment was a success, with the authors showing cases declining from a moving average of 216.3 on April 24 to a current moving average of 7.5 cases as of Oct. 3.
Researchers emphasized the importance of buy in from the mayor and city administration, as well as the importance of training, internal reinforcement, and the commitment of the staff to the process.
“It’s not always easy to cross-train employees, especially in institutions where there are limited financial resources,” he said.
Persaud thought the model outlined could potentially be replicated in a rural setting. However, the authors noted it was unclear how this intervention impacted COVID-19 case-fatality rates, and called for more research to investigate.
IDWeek is jointly sponsored by the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.
The authors disclosed no conflicts of interest.