Syracuse, N.Y. – Tom Buckel got nervous after a couple hours at the Onondaga County Board of Elections last week. Dozens of people, many senior citizens, sat close together at tables counting absentee ballots during a raging pandemic.
Buckel, an attorney for a campaign, decided to leave.
Turns out Buckel, 64, was right to be wary. On Nov. 13, the day after he was there, ballot counting was halted because an election worker had tested positive for coronavirus. Seven other election board staffers, all of whom worked the counting rooms, later tested positive for Covid-19.
County health department investigators then faced a challenge: Figure out which of the 150 campaign volunteers who observed ballot counting had been exposed and needed to be put in quarantine.
Despite their best efforts, that took about three days. Ideally, to stop the virus in its tracks, contact tracing would only take a day, experts say. By the time Buckel learned he was in quarantine for two weeks, he only had eight days left to stay home.
Ballot observer Tom Boll, who was exposed Nov. 10, got the quarantine call eight days later.
“Kinda late,” Boll noted.
Neither man had confined himself to home until the call came. Since the virus incubates in as little as two days, they could have become infectious and spread the disease if they had the virus. (As it happens, both tested negative this week.)
The high-profile cluster at the Board of Elections provides a glimpse of the massive challenges contact tracers face as they lose ground to a virus that is suddenly running rampant through the community.
In just the past seven days, Onondaga County has logged 17% of the total cases since March. As a result:
The number of patients hospitalized with Covid-19 rose steadily from 23 on Nov. 1 to 84 on Thursday, one short of the record set in May. And hospitals are bracing for more.Demand for coronavirus tests has exploded, creating days-long waits for appointments and long lines at sites that don’t require pre-registration.County health officials stopped publishing warnings about potential exposures at public locations such as stores and restaurants because they were pointless. The virus “is everywhere,’’ County Executive Ryan McMahon said.
As of Tuesday night, county officials had identified 75 people for quarantines out of those who were at the Board of Elections.
County health investigators are swamped by a huge surge of coronavirus cases, which complicates their efforts to reach contacts quickly. A month ago, the health department handled 25 to 30 new cases a day. Last week, an average day brought 196 new cases.
Given that, Buckel said he was impressed that the county identified him for quarantine within three days. A county worker also called to recommend he get tested, which he did.
“They seem to be all over this,’’ he said.
But the virus has spread quickly during the past month, accelerated by ill-conceived parties and other gatherings, leaving the county health department to play catchup.
The more the virus spreads in the community, the longer it takes to track down everyone who may have been infected. Which gives the virus more opportunity to spread.
It’s not that state and county governments failed to gear up for battle. The county has deployed 110 workers to investigate Covid-19 cases, more than four times the 25 who were working in April during the first big wave of illnesses. Over the past couple months, the state has recruited some 400 contact tracers to work in Onondaga County and four other counties of Central New York.
Still, the system is overloaded. Since Nov. 10, the day absentee ballot counting started, Onondaga County has confirmed more new cases of coronavirus than it had in July, August and September combined.
Similar outbreaks are happening throughout the country.
An uphill battle
Health investigators can only start hunting down the contacts of coronavirus patients after learning of a positive test result. That could be a week or more after a patient gets sick.
Amid the surging pandemic, Central New York patients have waited two days or more for an appointment to get tested. Then it takes as much as three business days to get the result.
At the Board of Elections, the first worker to test positive had been out of work since Nov. 5. County officials have not said when the worker got tested, but their result did not come back until Nov. 13. Seven more staff were tested that day. By the time officials learned they were positive, two more days had passed.
Contact tracing for coronavirus is an uphill battle under the best of circumstances. The virus is highly contagious, and up to 40% of infectious people never show any symptoms.
But it’s the government’s only tool to stop the pandemic, said David Larsen, an epidemiologist at Syracuse University.
“It has to work,’’ Larsen said. “What social distancing does is, it slows transmission so that contact tracing can work. What masks do is, they slow transmission so that contact tracing can work. Masks and social distancing without contact tracing (are) not all that helpful, unless you’re going to be social-distanced forever.’’
Ideally, health officials should quarantine the close contacts of a Covid-19 patient within 24 hours of the patient’s positive test, Larsen said. Under those conditions, contact tracing has the potential to reduce the spread to less than one new case per patient, forcing the virus to recede.
“The most effective would be within 24 hours,’’ he said. “I get nervous when it’s not at that (speed).”
Every extra day gives the virus more opportunities to spread. After three days, contact tracing “is not working,’’ Larsen said.
At settings like schools or the Board of Elections, where the names and phone numbers of potential contacts are readily available, contact tracers can still quarantine people as quickly as they did when caseloads were smaller, county officials said.
But the sheer number of new cases is overwhelming, and many investigations that don’t happen in organized settings are taking longer than they did a couple months ago.
“It’s not as fast,’’ McMahon said.
Fighting ‘Covid fatigue’
The county now has help from the state, which hired private contractor Public Consulting Group to handle contact tracing. The company has about 400 tracers in CNY, health officials said.
After the county health department investigates a case of Covid-19 and identifies people who must stay in quarantine, those names are given to the state’s contact tracers.
The state has taken over the job of notifying people to quarantine and managing their ultimate release. The county continues to oversee the patients who test positive, whose home confinement is called isolation.
McMahon said his workers are worn out by eight nonstop months of this. He often acknowledges that community residents also suffer from “Covid fatigue.’’
Larsen, the epidemiologist, said policymakers often overlook a critical factor that undermines the effectiveness of contact tracing and quarantines: financial stress. Many of the people who are reluctant to get tested and quarantine simply can’t afford to, Larsen said. Many are service workers who live paycheck to paycheck and can’t afford to miss work.
If Congress comes up with another stimulus bill, he said, they would be wise to target a big chunk of money to provide incentives for people who must quarantine.
“Contact tracing without support is a recipe for failure,” he said.
Despite all the challenges, county health officials say contact tracing remains an effective tool against coronavirus. The key will be to make testing more available to cut down the delays in finding positive cases, McMahon said. The county executive said he is optimistic, in part because SUNY Upstate Medical University will have more capacity when it finishes testing students at other SUNY campuses.
For now, county officials are streamlining their work as much as possible to keep up with the caseload. They’ve stopped compiling detailed daily statistics on sources of infection. They’ve stopped issuing routine notices of possible exposures at restaurants, stores and buses.
Dr. Indu Gupta, the county health commissioner, was too busy this week to be interviewed, county spokesman Justin Sayles said.
About half of the people who counted ballots last week at the Board of Elections ended up in quarantine, county officials said.
Helen “Pinkie” Kiggins Walsh, 62, who spent all week at the ballot counting tables along with her husband, said they had not been contacted by the county or state health department. She said she assumed that meant they had not been in close enough contact with an infected worker to merit being placed in quarantine.
Diane Dwire, 74, said she spent three days observing the count. Wednesday at 9 p.m., she missed a call from a number identified as “NYS Contact Tracing,’’ so she assumes she will be quarantined. Dwire, a retired public health nurse, said she has been avoiding people anyway.
“I know what I’m supposed to do,’’ Dwire said.
Ballot counting will resume Nov. 30 at the Board of Elections, after all the employees exit quarantine. Officials will reduce the number of people at each table this time, said Dustin Czarny, the Democratic elections commissioner. He plans to have about 60 people arranged throughout the four rooms rather than 100.
Participants also will be asked to wear face shields in addition to masks. They may have to get pre-tested for coronavirus. And Czarny said he is trying to borrow some plastic partitions from Erie County to arrange on the tables.
“We cannot have another delay,’’ Czarny said. “We have to get this count done.”
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