In E-mail to Fauci, Prime NYC Physician Questions COVID-19 Contact Tracing

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A leader in the city’s efforts to track the spread of COVID-19 recently questioned the effectiveness of Mayor Bill de Blasio’s $ 880 million test-and-trace program – and said spending more money on vaccinations THE CITY has learned.

Dr. Marcelle Layton, who heads the Communicable Disease Office for the city’s Department of Health and Mental Hygiene, offered Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases, expressed her candid assessment in an email dated January 6th.

She called for the grant requirements tying federal funding to Test-and-Trace to be lifted – and for the money to be pumped into declining vaccination efforts. Her memo was copied to public health officials from several major cities in the country.

“I wanted to address an issue that came up today on a call I’m coordinating because many of us have been questioning the effectiveness of contact tracing in mitigating COVID-19 for some time,” she wrote to Fauci.

Dr. Marcelle Layton talks about swine flu in 2009. Screengrab / C-SPAN

The email was received from the Brown Institute for Media Innovation’s COVID-19 documentation project and made available to THE CITY.

In early May, de Blasio announced the test-and-trace program, pledging to hire 1,000 contract workers to supplement the health department staff assigned to the agency charged with running the program, Health and Hospitals Corp. The goal: to track down close contacts of those infected.

The mayor said the army of contact tracers would “allow the city to immediately isolate and care for those who test positive for the virus, and then quickly track anyone they come in contact with and quarantine “.

“With every resource we have, we move mountains to test and track down every New Yorker,” he said.

However, the program ran into problems from the start, as many patients either refused to collaborate or claimed not to have had close contacts. By June, the Tracer Corps had contacted approximately 4,200 COVID-19 patients, of whom only 1,800 provided information about close contacts.

“Very limited resources”

In her email to Fauci, Layton describes her role as “the head of the [New York City] Surveillance Response “to the pandemic – argued that contact tracing is ineffective because so far” few of us [COVID] Cases occur in people who have been known to have had contacts under surveillance. ”

Efforts to track down potentially infected New Yorkers via contact tracing are also being undermined “given the level of asymptomatic and pre-symptomatic transmission,” she said.

She claimed that if the program worked the way it should, “We would expect it [an] Increasing percentage of new cases in known contacts. “That didn’t happen, Layton noted.

Continuing the focus on contact tracing may take away from what Layton identified as a higher priority: federal support for the hitherto bumpy vaccine distribution effort.

The city has relied heavily on federal funding to fund much of its Herculean efforts to control and ultimately end the pandemic, and as it noted, “much of our federal funding is related to testing and tracing.”

An excerpt from the email from Dr.  Marcelle Layton January 6th to Dr.  Anthony Fauci

An excerpt from the email from Dr. Marcelle Layton January 6th to Dr. Anthony FauciVia of the Brown Institute for Media Innovation’s COVID-19 Documentation Project

Records show that the financially troubled Health and Hospitals Corporation, which operates the city’s 11 public hospitals, is expecting massive change from the government to pay for the test-and-trace program.

In its budget for fiscal 2021, nearly $ 610 million of the $ 813 million HHC plans to spend on contact tracing comes from the government. The rest comes from city funds. Additional $ 67 million contracts come from other city authority budgets.

However, Layton urged the federal government to repeal a grant request that tied federal funds to test-and-trace programs and “shift resources to vaccination efforts when necessary, without the usual bureaucratic process and time it takes to divert funds.” required are”.

Layton said the need is not limited to New York, noting the “very limited resources in many health departments handling the spate of cases while we try to set up large-scale vaccination programs”.

“Focus on Vaccination”

The city and state have struggled with getting adequate supplies of vaccines from the federal government, but have also had difficulty getting legitimate New Yorkers shots in the arms since efforts began in December.

So far, just over 5% of city residents have been vaccinated. More than a quarter of those vaccinated in the five boroughs are from the suburbs – a dynamic that was shown at a large vaccination center in Washington Heights until THE CITY exposed the demographic imbalance.

Layton argued that federal funding would be better used for the vaccination effort in New York and beyond.

“I am sure that the most effective use of staff (especially more experienced public health staff) is to focus on vaccination,” she wrote, “while doing case investigations and contact tracing on higher risk environments (e.g. B. Nursing) are restricted to houses and correctional facilities) and not try to investigate all cases and monitor all contacts. “

“Test-and-trace is an important tool for stopping transmission chains.”

Layton didn’t respond to questions THE CITY emailed her.

In a statement emailed to THE CITY, Health Commissioner Dr. David Chokshi: “Test-and-Trace is an important tool for stopping transmission chains. It has been a linchpin of our fight against COVID-19 not only to identify exposed individuals, but also to connect them to resources to protect themselves and their communities. “

Chokshi noted that the program is providing hotel rooms for those who cannot safely quarantine at home and is helping those who test positive or have been exposed to COVID-19 to help resolve insurance and medical bills issues.

“The city has a unified strategy and we all agree on how to fight this virus,” he added. “New Yorkers have to be tested, every positive case has to be traced, and we have to make the vaccine available to as many people as possible immediately.”

A spokesman for the National Institute for Allergies and Infectious Diseases did not respond to THE CITY’s request for Layton’s request to lift the grant requirements associated with testing and tracking.

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