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De Blasio Strips Control of Virus Tracing From Health Department De Blasio Strips Control of Virus Tracing From Health Department
(25 days later)
New York City will soon assemble an army of more than 1,000 disease detectives to trace the contacts of every person who tests positive for the coronavirus, an approach seen as crucial to quelling the outbreak and paving the way to reopen the hobbled city.New York City will soon assemble an army of more than 1,000 disease detectives to trace the contacts of every person who tests positive for the coronavirus, an approach seen as crucial to quelling the outbreak and paving the way to reopen the hobbled city.
But that effort will not be led by the city’s renowned Health Department, which for decades has conducted contact tracing for diseases such as tuberculosis, H.I.V. and Ebola.But that effort will not be led by the city’s renowned Health Department, which for decades has conducted contact tracing for diseases such as tuberculosis, H.I.V. and Ebola.
Instead, in a sharp departure from current and past practice, the city is going to put the vast new public health apparatus in the hands of its public hospital system, Health and Hospitals, city officials acknowledged on Thursday night after being approached by The New York Times about the changes.Instead, in a sharp departure from current and past practice, the city is going to put the vast new public health apparatus in the hands of its public hospital system, Health and Hospitals, city officials acknowledged on Thursday night after being approached by The New York Times about the changes.
The decision, which Mayor Bill de Blasio announced at his daily briefing on Friday, puzzled current and former health officials, who questioned the wisdom of changing what has worked before, especially during a pandemic.The decision, which Mayor Bill de Blasio announced at his daily briefing on Friday, puzzled current and former health officials, who questioned the wisdom of changing what has worked before, especially during a pandemic.
The department conducted tracing of coronavirus cases at the start of the outbreak, and had been doing so again recently, in preparation for the city’s expansion.The department conducted tracing of coronavirus cases at the start of the outbreak, and had been doing so again recently, in preparation for the city’s expansion.
Dr. Mary T. Bassett, a former city health commissioner under Mr. de Blasio and now the director of the FXB Center for Health and Human Rights at Harvard University, said that the three key elements of handling the coronavirus — testing, tracing and quarantine — have long been performed by the Health Department.Dr. Mary T. Bassett, a former city health commissioner under Mr. de Blasio and now the director of the FXB Center for Health and Human Rights at Harvard University, said that the three key elements of handling the coronavirus — testing, tracing and quarantine — have long been performed by the Health Department.
“These are core functions of public health agencies around the world, including New York City, which has decades of experience,” Dr. Bassett said in an email. “To confront Covid-19, it makes sense to build on this expertise.”“These are core functions of public health agencies around the world, including New York City, which has decades of experience,” Dr. Bassett said in an email. “To confront Covid-19, it makes sense to build on this expertise.”
The move also angered some within the ranks of the Health Department, which has been at odds with Mr. de Blasio since the early days of the outbreak, when top officials in the department clashed with City Hall over the timing of school closures and public health messaging.The move also angered some within the ranks of the Health Department, which has been at odds with Mr. de Blasio since the early days of the outbreak, when top officials in the department clashed with City Hall over the timing of school closures and public health messaging.
In announcing the move Friday morning, the mayor said, “Everything at Health and Hospitals has been based on speed and intensity and precision, and they’ve done an amazing job.”In announcing the move Friday morning, the mayor said, “Everything at Health and Hospitals has been based on speed and intensity and precision, and they’ve done an amazing job.”
Dr. Mitchell Katz, the head of Health and Hospitals, said that the move was made because his agency, a public benefit corporation rather than a city department, could more quickly hire contact tracers and enter into contracts for testing and other needed services.Dr. Mitchell Katz, the head of Health and Hospitals, said that the move was made because his agency, a public benefit corporation rather than a city department, could more quickly hire contact tracers and enter into contracts for testing and other needed services.
His agency, he said, would also oversee the hotels for housing people who could not quarantine at home, as well as some coronavirus testing.His agency, he said, would also oversee the hotels for housing people who could not quarantine at home, as well as some coronavirus testing.
But he said the tracing itself would be supervised by a team of roughly 50 Health Department experts who will be detailed to Health and Hospitals to run the operation.But he said the tracing itself would be supervised by a team of roughly 50 Health Department experts who will be detailed to Health and Hospitals to run the operation.
“So we’ll be able to have the best of both worlds,” he said. “We’ll be able to have the people who are used to supervising this kind of work still doing the supervision of it. But we’ll be able to hire as quickly as possible and get as many tests done” as possible.“So we’ll be able to have the best of both worlds,” he said. “We’ll be able to have the people who are used to supervising this kind of work still doing the supervision of it. But we’ll be able to hire as quickly as possible and get as many tests done” as possible.
The city’s public hospital system struggled with budgetary shortfalls even before the coronavirus outbreak sent thousands of sick and dying patients into its 11 hospitals. Their emergency rooms have been the front lines of the crisis, as doctors and nurses faced a wave of patients at facilities including Elmhurst Hospital in Queens and Woodhull Hospital in Brooklyn. Staff members died, even some who did not work directly with patients.The city’s public hospital system struggled with budgetary shortfalls even before the coronavirus outbreak sent thousands of sick and dying patients into its 11 hospitals. Their emergency rooms have been the front lines of the crisis, as doctors and nurses faced a wave of patients at facilities including Elmhurst Hospital in Queens and Woodhull Hospital in Brooklyn. Staff members died, even some who did not work directly with patients.
A spokeswoman for Mr. de Blasio declined to comment about any dissatisfaction expressed by Health Department officials and declined to make the city health commissioner, Dr. Oxiris Barbot, available to discuss the matter.A spokeswoman for Mr. de Blasio declined to comment about any dissatisfaction expressed by Health Department officials and declined to make the city health commissioner, Dr. Oxiris Barbot, available to discuss the matter.
Contact tracing is one part of an accepted strategy for responding to disease outbreaks, and it is now at the center of a national discussion of how and when to begin allowing economic activity to restart. State officials included the number of contact tracers working in a region as one key metric for determining when businesses in that region would able to reopen.Contact tracing is one part of an accepted strategy for responding to disease outbreaks, and it is now at the center of a national discussion of how and when to begin allowing economic activity to restart. State officials included the number of contact tracers working in a region as one key metric for determining when businesses in that region would able to reopen.
Mr. de Blasio, in recent days, has talked repeatedly about the large new public health system that will be needed to contain the virus as the number of new cases recedes. Officials have said the efforts are essential to reviving the city’s economic life.Mr. de Blasio, in recent days, has talked repeatedly about the large new public health system that will be needed to contain the virus as the number of new cases recedes. Officials have said the efforts are essential to reviving the city’s economic life.
“You’re talking about tens of thousands of people who will be tested daily,” the mayor said in an interview on MSNBC on Sunday. “You’re talking about a tracing apparatus that, anyone who is tested positive, we ask them, we interview them: who they’ve been close with in recent days, who they’ve come in contact with.”“You’re talking about tens of thousands of people who will be tested daily,” the mayor said in an interview on MSNBC on Sunday. “You’re talking about a tracing apparatus that, anyone who is tested positive, we ask them, we interview them: who they’ve been close with in recent days, who they’ve come in contact with.”
Updated June 1, 2020
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
Before the shift, hiring was being conducted by the nonprofit Fund for Public Health in New York City in partnership with the Health Department; salaries for contact tracers started at $57,000 a year. Thousands had already applied.Before the shift, hiring was being conducted by the nonprofit Fund for Public Health in New York City in partnership with the Health Department; salaries for contact tracers started at $57,000 a year. Thousands had already applied.
Dr. Thomas R. Frieden, the former director of the Centers for Disease Control and Prevention and former New York City health commissioner, said that the city’s Health Department is the “greatest in the world” and that “if any health department can excel at contact tracing, New York City can.”Dr. Thomas R. Frieden, the former director of the Centers for Disease Control and Prevention and former New York City health commissioner, said that the city’s Health Department is the “greatest in the world” and that “if any health department can excel at contact tracing, New York City can.”
David Harvey, executive director of the National Coalition of STD Directors, a membership organization of health officials who deal with contact tracing to limit the spread of sexually transmitted diseases, said that while there was a “role for the health care delivery system to coordinate with the health department,” the group was concerned that the mayor’s decision might slow the implementation of contract tracing in the city.David Harvey, executive director of the National Coalition of STD Directors, a membership organization of health officials who deal with contact tracing to limit the spread of sexually transmitted diseases, said that while there was a “role for the health care delivery system to coordinate with the health department,” the group was concerned that the mayor’s decision might slow the implementation of contract tracing in the city.
“New York is leading the nation as the epicenter of this epidemic and it is a leader of the nation,” Mr. Harvey added. “We are worried about anything that delays the rollout of an expanded contact tracing program.”“New York is leading the nation as the epicenter of this epidemic and it is a leader of the nation,” Mr. Harvey added. “We are worried about anything that delays the rollout of an expanded contact tracing program.”
The Health Department has the authority to issue quarantine orders in New York City. Such orders are likely to be an important part of the program, which would not only involve getting in touch with people who have had close contact with an infected person, but also getting those contacts to quarantine themselves, either at home or, possibly, in a city-funded hotel.The Health Department has the authority to issue quarantine orders in New York City. Such orders are likely to be an important part of the program, which would not only involve getting in touch with people who have had close contact with an infected person, but also getting those contacts to quarantine themselves, either at home or, possibly, in a city-funded hotel.
During the Ebola outbreak early in Mr. de Blasio’s first term, the Health Department created a telephone center to track potential contacts.During the Ebola outbreak early in Mr. de Blasio’s first term, the Health Department created a telephone center to track potential contacts.
As the rapid spread of infections overwhelmed the system in late March and April, the city largely stopped doing contact tracing on confirmed Covid-19 cases. In recent weeks, health workers have been doing a few case investigations to prepare to ramp up the system, and they plan to restart tracing on a broad scale once hundreds of new people have been hired.As the rapid spread of infections overwhelmed the system in late March and April, the city largely stopped doing contact tracing on confirmed Covid-19 cases. In recent weeks, health workers have been doing a few case investigations to prepare to ramp up the system, and they plan to restart tracing on a broad scale once hundreds of new people have been hired.
Yet the city has never tried to trace a disease as commonplace in the population as Covid-19, Dr. Shama Ahuja, who oversees tuberculosis contact tracing for the Health Department, said in an interview last week.Yet the city has never tried to trace a disease as commonplace in the population as Covid-19, Dr. Shama Ahuja, who oversees tuberculosis contact tracing for the Health Department, said in an interview last week.
“It is like tracing the flu,” she said. “The level of this effort is unprecedented.”“It is like tracing the flu,” she said. “The level of this effort is unprecedented.”
Sharon Otterman contributed reporting.Sharon Otterman contributed reporting.