Syracuse, NY – Tom Buckel got nervous after spending a few hours on the Onondaga County Board of Elections last week. Dozens of people, many seniors, have sat side by side at tables to count absentee ballots during a raging pandemic.
Buckel, a campaign lawyer, decided to leave.
It turns out that Buckel, 64, was right to be suspicious. On November 13, the day after his arrival, the counting of the ballots was interrupted because an election staff member had tested positive for coronavirus. Seven other electoral council staff, all of whom worked in the counting rooms, then tested positive for Covid-19.
County health department investigators were then faced with a challenge: determining which of the 150 campaign volunteers who observed the ballot count had been exposed and should be quarantined.
Despite their best efforts, it 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.
Poll observer Tom Boll, who was exposed on November 10, received the quarantine call eight days later.
“A little late,” Boll noted.
Neither man had been confined to the house 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 had the virus. (As it happens, both tested negative this week.)
The high-level group at the Election Council offers insight into the enormous challenges contact tracers face as they lose ground to a virus suddenly plaguing the community.
In the past seven days alone, Onondaga County has recorded 17% of the total cases since March. Therefore:
- The number of patients hospitalized for Covid-19 has risen steadily, from 23 on November 1 to 84 on Thursday, one less than the record set in May. And hospitals are preparing for more.
- Demand for coronavirus testing has exploded, creating days of waiting days for appointments and long queues at sites that don’t require pre-registration.
- County health officials have stopped issuing warnings about potential exhibits in public places such as stores and restaurants because they were unnecessary. The virus “is everywhere,” County Director Ryan McMahon said.
As of Tuesday evening, county officials identified 75 people in quarantine among those at the Election Council.
County health investigators are overwhelmed by a huge wave of coronavirus cases, complicating their efforts to reach contacts quickly. A month ago, the health service was treating 25 to 30 new cases a day. Last week, an average day resulted in 196 new cases.
In view of this, Buckel said he was impressed the county identified him for quarantine within three days. A county employee also called to recommend that he get tested, which he did.
“They seem to be everywhere,” he says.
But the virus quickly spread over the past month, accelerated by ill-conceived parties and other gatherings, leaving the county health department to play catch-up.
The more the virus spreads in the community, the longer it takes to find all the people who may have been infected. This gives the virus a better chance to spread.
It’s not that state and county governments haven’t prepared 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. In the past two months, the state has recruited some 400 contact tracers to work in Onondaga County and four other counties in central New York City.
Yet the system is overloaded. Since November 10, the day the postal vote count began, Onondaga County has confirmed more new cases of coronavirus than in July, August and September combined.
Similar outbreaks are occurring across the country.
A tough battle
Health investigators can only start tracking contacts of coronavirus patients after learning of a positive test result. It could be a week or more after a patient becomes ill.
Amid the growing pandemic, patients in central New York City have waited two or more days for an appointment to get tested. Then it takes up to three working days to get the result.
At the electoral commission, the first worker to test positive had been out of work since November 5. County officials did not say when the worker was tested, but their result did not return until November 13. Seven other staff members were tested that day. By the time officials learned they were positive, two more days had passed.
Contact tracing for the coronavirus is an uphill battle at the best of times. The virus is highly contagious, and up to 40% of those infected have no 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 that it slows down transmission so that contact tracing can work. What masks do is they slow down the transmission so that contact tracing can work. Masks and social distancing without contact tracing (aren’t) that useful, unless you’re forever socially distanced. ”
Ideally, health officials should quarantine close contacts of a Covid-19 patient within 24 hours of the patient testing positive, Larsen said. Under these 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 says. “I get nervous when it’s not at this (speed).”
Each additional day gives the virus more opportunities to spread. After three days, the contact tracing “isn’t working,” Larsen said.
In settings such as 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 the number of cases was smaller, county officials said.
But the sheer number of new cases is overwhelming, and many investigations that do not take place in organized settings are taking longer than a few months ago.
“It’s not that fast,” McMahon said.
Fighting ‘Covid Fatigue’
The county now has help from the state, which hired a private contractor Public Consulting Group to handle the contact tracing. The company has around 400 CNY tracers, health officials said.
After the county health department investigates a case of Covid-19 and identifies people who need to remain in quarantine, those names are given to state contact tracers.
The state has resumed the work of notifying people of quarantine and managing their final release. The county continues to monitor patients who test positive, whose house arrest is called segregation.
McMahon said his workers were exhausted by eight consecutive months. 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 people who are reluctant to get tested and quarantined simply cannot afford it, Larsen said. Many are service workers who live paycheck after paycheck and cannot afford to miss work.
If Congress comes up with another stimulus bill, he said, it would be wise to target a large sum of money to provide incentives for people who need to quarantine.
“Unattended contact tracing is the recipe for failure,” he said.
Despite all the challenges, county health officials say contact tracing remains an effective tool against the coronavirus. The key will be to make testing more available to reduce delays in finding positive cases, McMahon said. The county executive said he was 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 volume of work. They stopped compiling detailed daily statistics on the sources of infection. They stopped posting routine notices about possible exhibits in restaurants, shops 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 the ballots last week at the Election Council ended up in quarantine, county officials said.
Helen “Pinkie” Kiggins Walsh, 62, who has spent the entire week at counting tables with her husband, said she had not been contacted by the county or state health department. She said she assumed that meant they hadn’t been in close enough contact with an infected worker to merit quarantine.
Diane Dwire, 74, said she spent three days observing the count. At 9 p.m. Wednesday, 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 avoids people anyway.
“I know what I’m supposed to do,” Dwire said.
The count will resume on November 30 at the Elections Office, once all employees have left quarantine. Officials will reduce the number of people at each table this time around, said Dustin Czarny, the Democratic Elections Commissioner. He plans to have around 60 people spread across the four rooms instead of 100.
Participants will also be asked to wear face shields in addition to masks. They may need to get pre-tested for the coronavirus. And Czarny said he was trying to borrow plastic partitions from Erie County to put them on the tables.
“We can’t have another delay,” Czarny said. “We have to do that count.”
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