Tracking the spread: Contact tracing picks back up because of delta variant

Tens of thousands of Long Islanders who had close contact with people newly infected with COVID-19 have been getting phone calls in recent weeks as part of an effort to piece together how the coronavirus is spreading in the region — and how to help control it.

Contact tracing isn't a new concept, but it has been of more importance lately with the state's COVID-19 caseload surging because of the highly contagious delta variant. Yet tracing is more difficult today than it had been early in the pandemic, because high-risk venues such as bars are open without restrictions, one medical expert said.

In a crowded bar, someone who later tests positive might be in close contact with multiple total strangers, making it impossible to track them, said Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital and Long Island Jewish Medical Center.

And "we don’t really know who is vaccinated and unvaccinated in many of these venues," Farber said.

While some other states are so swamped with new cases that they have not been able to keep up, New York State and county officials said hundreds of people work each day to reach everyone on Long Island who tests positive and those who were in close contact with them.

The labor-intensive tracing system saves lives, Farber said.

"The whole point of contact tracing is to try to break the chain of infection," he said. By notifying people they were exposed to COVID-19, and then quarantining them, "You significantly decrease the risk of secondary infection," Farber added.

The state hired temporary workers to help track down the rising number of close contacts who, if they’re unvaccinated, are given quarantine orders. Long Island schools do their own contact tracing and, although not required by law, some businesses do so as well.

In a school or work setting, some of the close contacts are easy to identify. The state follows U.S. Centers for Disease Control and Prevention guidelines in defining a close contact as someone who was within 6 feet of an infected person for at least 15 minutes over a 24-hour period, had direct physical contact with that person or is a member of the same household.

Fully vaccinated close contacts — and those who tested positive for the coronavirus in the previous three months — are not required to quarantine as long as they don’t show COVID-19 symptoms, state rules say. They are required to self-isolate if they develop symptoms. Vaccinated people are asked to obtain a COVID-19 test three to five days after exposure, and they must wear masks while in public indoor settings for two weeks or until they test negative.

No 'superspreader' events, Suffolk says

Despite the absence of most COVID-related restrictions, Suffolk County has not had a "mega-superspreader event" in the last several months, although there have been "small clusters here and there of three or four cases," said Dr. Gregson Pigott, Suffolk’s health commissioner.

That’s largely thanks to widespread vaccination, he said. "The vaccination rate does make a huge difference," said Pigott, who just over a year ago, before vaccinations began, faced a coronavirus outbreak at a Miller Place party that led to 38 people testing positive.

In Nassau County, there have been multiple events tied to four or more infections in the past several months, Nassau health commissioner Dr. Larry Eisenstein said in an email. But he declined to give details "due to confidentiality" or explain why the county has the confidentiality rule.

Contact tracing predates COVID-19. Health departments for years have been isolating people with infectious diseases such as measles and meningitis, and quarantining their close contacts.

Yet county health departments were overwhelmed by contact tracing in the early weeks of the coronavirus pandemic, so in May 2020 the state began focusing on reaching the close contacts of those newly infected, and the counties focused on interviewing those who tested positive and eliciting the names of contacts.

"We talk with them about what they did and who they were with during their infection period," said Jennifer Culp, assistant to the Suffolk health commissioner.

There are more than 800 state contact-tracing staff who focus on Long Island, with the number shifting based upon caseload, state Health Department spokeswoman Erin Silk said in an email. There are nearly 3,800 contact-tracing staff — all of them temporary hires — statewide. That's more than early summer, before the delta variant began dominating. But it's less than half the roughly 8,000 contact tracers during the bigger COVID-19 surge in January, Silk said.

Statewide, the number of coronavirus cases has skyrocketed from fewer than 300 on some days in June to as many as 6,000-plus daily cases in September. Also, by last month, more than 99% of positive test result samples that the state analyzed were of the delta variant.

On Long Island, there were an average of 808 new daily COVID-19 cases in August and September.

Suffolk has had to shift county employees — some from outside the health department — from different positions to COVID-19 duties as numbers have risen, Culp said. "We add people as needed," she said.

Currently, there are more than 100 full- and part-time employees focusing on investigating COVID-19 cases, and related work, Culp said.

Eisenstein declined to give details about staffing, including the number of investigators Nassau has, other than to say "it varies based on caseload."

Those who violate isolation or quarantine orders, or refuse to supply contacts, face fines of up to $10,000, but officials in both counties said after subpoenas or warnings of a potential fine, initially recalcitrant people comply.

Quarantine differs for schoolchildren

Long Island's K-12 schools handle contact tracing and then supply names of people eligible for quarantine to counties, county officials said.

"They can do it much quicker, and we want to obviously get the kids isolated and quarantined, and we follow up with the official interview," including details on quarantining, Culp said.

In schools, the state has an exception to its quarantine requirement: If an infected child was 3 to 6 feet from another child, the second child does not need to quarantine "if both children correctly and consistently wore well-fitting masks."

Some schools have more stringent requirements. East Suffolk BOCES submits names to the health department for quarantine of children 3 to 6 feet away from an infected child, whether it appears masks were worn or not, because it is difficult to determine whether masks were correctly worn the entire time, chief operating officer Julie Lutz said.

Local health departments usually work with employers to identify close work contacts, Silk said.

But some employers do internal contact tracing first.

At Melville-based H2M architects + engineers, chief human resources officer Liz Uzzo said employees are told to immediately call or email her if they test positive. They are asked for names of close contacts, who a company employee then calls, to ensure they don’t come to work the next morning, Uzzo said.

"It’s a time-consuming process, but it’s one that has to be done" because state contact tracers may not reach the close contacts quickly enough, she said.

"We’re catching it before the Department of Health is even getting involved," Uzzo said.

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By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.