This Town Put the Brakes on Covid-19—Here’s What Worked
Covid-19 cases in Paterson, New Jersey, were high during the peak, but two months later, they were down. Here's how contact tracing helped.
Covid-19 contact tracing
In a pandemic with no vaccine yet, no cure, and a few promising Covid-19 drugs, trying to contain the spread of the responsible virus is key. And contact tracing—getting in touch with patients and the people they may have been in close contact with—is an integral part of the strategy.
So far, the U.S. has only done a “fair to average” job of contact tracing during Covid-19, says Perry N. Halkitis, dean of the Rutgers School of Public Health in Piscataway, New Jersey. That’s one of the reasons the pandemic rages on with no end in sight.
But the City of Paterson, New Jersey, is an exception to this trend. By mid-July, public health officials had investigated more than 90 percent of 6,537 Covid-19 patients and reached out to their contacts. No doubt, a successful contact tracing effort was partly responsible for a dramatic decline in numbers from a peak of 263 one day in mid-April to only seven daily cases two months later.
Here’s how they did it and, importantly, what the rest of the nation can learn from their example.
Moussa Alshemeri/Getty Images
Covid-19 comes to Paterson
New Jersey’s third largest city saw its first presumptive case of infection with SARS-CoV-2, the virus that causes Covid-19, on March 4. That was two-and-a-half months after officials learned about the first case in the U.S., patient zero, (January 20). On March 9, Paterson had its first case: a man from a family of four. Two other family members soon followed, according to research presented on October 21 at ID (Infectious Diseases) Week.
Public health officials in Paterson began worrying: How many others were already infected but didn’t know it? How far had the virus spread among the more than 150,000 inhabitants of a city packed into 8.4 square miles?
As it turned out, Paterson was well positioned to launch an aggressive contact tracing program for Covid-19. At the end of 2019, the State of New Jersey gave Paterson a $95,000 grant to develop a “Communicable Disease Strike Team.” The team of 25 went through several trainings in January, including one on contact tracing presented by Johns Hopkins University. At the time, they were focused on large outbreaks of foodborne and other illnesses.
Contact tracing is incredibly resource-intensive, says Emily Sickbert-Bennett, director of infection prevention at the University of North Carolina at Chapel Hill. Even before the first Covid-19 case appeared, the city had a team of 25 ready and waiting.
“That’s how our team started,” says Thakur “Paul” Persaud, MD, health officer and program manager, disease prevention and control in the City of Paterson’s Division of Health. “Then we started getting the first cases of Covid-19.”
Paterson’s Covid-response strategy
While other public health departments were scrounging funds to hire temporary workers, Paterson had the beginnings of what would become a Covid-response strategy in place. But it needed more to handle a pandemic that was growing beyond what anyone had expected. The city didn’t have the funds to hire and train new contact tracers so they reassigned personnel already on staff.
“We cross trained front-line employees at the local health department level, including nurses and registered environmental health specialists,” says Dr. Persaud, who was the author of the recent research.
“We also brought in some of our HIV and STD [sexually transmitted disease] counselors. We made use of existing staff.” By mid-April, the Covid-19 Strike Team was 50 strong, making up 80 percent of a 60-person staff in the public health department. (Here’s a Wuhan nurse’s report on getting sick with Covid-19.)
Restructuring the health division
Persaud then restructured the division of health. “We came up with a model where we divided the team into two sections,” he says. Case investigators got the names of people who had tested positive for Covid-19 from the city’s Communicable Disease Reporting and Surveillance System.
They then called them, told them the results of the test, asked if they had symptoms, explained the concepts of isolation and quarantine, and tried to elicit the names of any others they’d been in close contact with. Contact tracers followed up with the people on the secondary list of names, those who might also have the virus but not yet know it. The contact tracers also called people in isolation or quarantine every single day.
In addition to all this initial training, members of the strike team also participated in weekly training and individualized daily trainings. Those addressed “issues that might arise, the best way of handling difficult cases and barriers,” Persaud noted in his ID Society presentation. They also added a layer of community policing for hard-to-find cases and contacts.
Managing quarantine and isolation
Even the best contact tracing system will come to nothing if people don’t comply with voluntary quarantine and isolation orders. “If you quarantine people, obviously they are not going to be able to transmit that disease to someone else,” says Dr. Persaud.
That’s part of the process of breaking the chain of infection, he adds. Contact tracers took on this task as well, calling patients and at-risk contacts daily. That’s thousands upon thousands of phone calls and contact points over the course of a few months. (You may want to know if you can catch Covid-19 twice.)
“Beyond just having the resources and people who are trained to do it, contact tracing is still a challenge to do well,” says Sickbert-Bennett. “The barriers include being able to reach people by phone, people not always leaving contact numbers, people screening calls, and having some mistrust.”
Then there’s the fear of retribution if you are positive. Contact tracers pushed hard in North Carolina but, in one county, almost half of patients said they had had no contacts, and one quarter weren’t reached at all.
The Paterson effort succeeded partly because the health department had already done a good job building trust in the community. Also, the Strike Team was very persistent. If someone said they had to get a contact’s permission before giving out information, the team would call back. If one tracer or investigator had trouble getting information, another team member would take over.
Lessons learned from Covid-19
There are a number of lessons for other public-health officials still trying to come to terms with the Covid-19 pandemic. While much of the rest of the country was reactive, says Halkitis, Paterson was proactive. “It was all hands on deck. We’re just going to stop and rethink how we’re going about business,” he notes. “A lot of departments went about business as usual.”
Then there was trust, which Paterson did a good job building. “Contact tracing,” says Halkitis, “is about human relations.” According to Dr. Persaud, the approach could be replicated in other locations including those with limited or no resources.
“Those who know Paterson know the issues we have with finances,” he said during his presentation, noting also that the city’s median household income is only $39,000. “It’s almost impossible to hire anyone in Paterson. I don’t think it gets any worse than what we have here. Yes, it can be done.”
Next, learn about the signs you had Covid-19.
- Perry N. Halkitis, PhD, Dean, Rutgers School of Public Health
- Infectious Diseases Society of America: "Contact Tracing Program In New Jersey City Offers Cost-Effective Model For COVID-19"
- Emily Sickbert-Bennett, PhD, director of infection prevention, University of North Carolina at Chapel Hill
- Thakur "Paul" Persaud, MD, PhD, health officer and program manager, disease prevention and control, City of Paterson Division of Health
- Morbidity and Mortality Weekly Report: "COVID-19 Contact Tracing in Two Counties — North Carolina, June–July 2020"