New York City Improves Disease Surveillance To Avert Covid-19 Surge

Public health officials are triangulating different data sources to guide coronavirus response. New York City Improves Disease Surveillance To Avert Covid-19 Surge

Technology used by New York City public health officials to spot cases of Legionnaires’ disease or a serious food-borne illness has now been fine-tuned to pick up potentially connected cases of the novel coronavirus.

It is the latest advancement in an effort by the New York City Department of Health and Mental Hygiene to tease out potential links in clusters over time and, hopefully, trace back to the initial sources of infection.

“It’s not just about test, test, test everybody, although that’s important,” said Dr. Oxiris Barbot, New York City’s health commissioner. “It is about how you take that information and make smart decisions and really track down where transmission is actively happening.”

More than 200,000 people in New York City have tested positive for Covid-19 and more than 23,000 have died or are presumed to have died as of Tuesday from the disease, according to city data. The virus has disproportionately affected Black and Latino residents in densely packed, lower-income areas of the city.

Right now—while the percentage of people testing positive for the disease is around 1%—Dr. Barbot said her department is aiming to get to the lowest possible number of Covid-19 cases. The goal is to use the data to deploy resources to the communities where there is the most need.

This fine-tuning of testing and tracing will hopefully stem a resurgence as the city continues to reopen, and as the fall approaches, when many health experts worry about a collision of Covid-19 and seasonal flu cases.

Health officials, physicians and public health experts have repeatedly said that New York City was hindered in its initial response to the outbreak by a lack of testing.

Officials initially didn’t have good estimates for prediction models and scientists didn’t understand that people were spreading the disease while asymptomatic, said Lorna Thorpe, a professor of epidemiology at NYU Grossman School of Medicine.

In addition, this spring hospitals were overwhelmed in their ability to report daily on new cases and there wasn’t a good way to determine how many people had already been exposed to the disease, she said.

Public health officials are triangulating different data sources to guide outbreak response, said Dr. Thorpe. Part of that effort includes data gathering in communities where you know there is a higher possibility for infection spread, she said.

“There’s no one single measure to guide us through this, but you need the best possible measures, and they all have imperfections,” she said.

One tool, which officials have said they are now using, is testing of the city’s wastewater for evidence of the coronavirus. That effort could help health workers track a resurgence of the disease.

The analytical tool now being rolled out by the health department is a software called SaTScan. It works by looking at coronavirus cases reported by laboratories and comparing them against what is expected in an area over time.

If the system shows more cases than typically expected, it triggers a signal to health department epidemiologists to do deeper case investigations, said Demetre Daskalakis, deputy commissioner for the division of disease control at the city’s health department.

Without years and years of data on the new coronavirus, health workers have had to create models. Already, signals from SaTScan led to a cluster that was tracked to a private event where multiple people were sickened, said Dr. Daskalakis.

The way the city operates its Test & Trace Corps is also being refined for adaptation in the fall, said Ted Long, its executive director.

The contact-tracing initiative is currently designed to absorb as many as 250,000 initial cases and traced contacts, he said. In June, 16,000 cases and contacts were expected, and the city had around 10,000. In August, the system is designed to absorb a maximum of 165,000 people.

What Test and Trace will look like in the fall will be determined based on the summer months, said Dr. Long.

“There’s two buckets of tools that we need to have at the ready for fall,” said Dr. Long. “The first bucket is analytics. The second bucket is as much testing as possible.”

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