Ready or not, here it comes. The District is officially moving into Phase Two of its reopening plan on Monday, which will allow restaurants to open for limited indoor dining and increase the mass gathering limit from 10 to 50 people, among other things.
Mayor Muriel Bowser announced the decision on Friday, citing 15 days of decline in community spread of COVID-19 (one more day than the 14 officials said they wanted to see before moving to Phase Two). The city is also meeting various other indicators that officials are using to assess readiness for the next reopening phase: a coronavirus test positivity rate below 15% for seven days, a transmission rate below one for more than five days, and hospital bed occupancy below 80% capacity for two weeks (see the full list of metrics at the D.C. reopening tracker).
But there’s one — rather significant — snag. The city is not meeting a major reopening metric, even as it barrels ahead at full steam toward Phase Two: goals around contract tracing. The practice of contacting newly diagnosed individuals to ensure they’re isolating and find out who they may have exposed to the illness allows public health officials to more effectively contain the spread of the virus.
D.C. set a goal of attempting to reach out to more than 90% of newly diagnosed people within one day of being notified of their positive test result, and 90% of a newly diagnosed person’s close contacts within two days of being notified of the result. Both of these numbers are being calculated over a seven-day average, and both fall woefully short of the stated goal: As of Friday, the city is at 23.4% for contact tracing new cases and 43.6% for contact tracing close contacts. (As of Thursday, the city wasn’t yet reporting the latter figure in the reopening tracker.)
So, what exactly is behind these numbers? And why is the city pushing forward with the next phase anyway?
The answer—as has been the case with other missed metrics–is complicated, according to city officials.
In a press conference this week, D.C. Department of Health Director LaQuandra Nesbitt mentioned that the department has been migrating its contact tracing data to a new system, and that there is a two-day data lag on the website, meaning that the public does not have access to all the information the city has. The reopening tracker notes that the current metric is “an undercount,” and that “the ability to measure this metric will improve with a planned transition to a new contact tracing platform.”
But the city admits that it’s not currently meeting its goals. Alison Reeves, a spokesperson for the Department of Health, confirmed to DCist over email that its seven-day average for this metric is not yet at the 90-percent threshold. But over the last two days, DOH has attempted to contact more than 90% of new positive cases within one day of notification, according to Reeves.
“We are in a much better position moving forward to contact people within one day of notification as evidenced by our ability to have done that in the past two days, so we expect this metric to improve over the next several days, reaching the threshold of 90% in the next week or so,” Reeves says. “We will continue to monitor it as we move through the various phases of reopening.”
Bowser’s office did not respond to a request for comment about the decision to reopen despite not having met this metric. DOH did not respond to a follow-up question about what the city will do if it does not meet the 90-percent threshold over the next week.
In a press conference earlier in the week, Bowser said that the reason the contact-tracing metric was falling below the threshold was because the city “[hasn’t] been able to watch it for long enough.”
She continued: “And our expectation, if the last two days is an indicator, then we will be able to meet it … we have the number of people who we need, and the number of cases we’ve seen over the last couple of weeks, we know that we can hit those numbers. That’s where we’re going to be.”
Dr. Candice Chen, an associate professor of health policy and management at the GW Milken Institute School of Public Health, says that she believes the city’s two consecutive days of meeting the threshold are a promising sign (Chen has not directly worked with DOH on contact tracing efforts, though she has helped create a Contact Tracing Estimator Tool that calculates how many tracers governments around the country currently need).
“Having a metric like that, of 90%, is really advanced,” she says. “If in the last two days they were able to reach their goal, assuming they’re not misrepresenting anything, I think that’s really positive. If they can do it over the course of the two days and it’s not a surge in the data and they’re building [their capacity], that’s promising.”
In a recent NPR analysis using Chen’s estimator tool, D.C. was one of just 10 states or territories currently estimated to have enough contact tracers to handle their COVID caseload.
Chen says it’s important to keep in mind that these numbers could always change, and it’s important for DOH to make sure it has a plan to quickly recruit more tracers (and have the infrastructure in place to train them) if we see a spike in cases.
“I would hope that DOH is already planning for this,” she says. “We’ve had demonstrations, we know that we are looking at increasing our reopening. What’s that going to do to our expected cases and our contact tracer needs?”
The city says it has laid the groundwork and built the infrastructure to improve contact tracing efforts in the near term. It has so far hired and onboarded more than 200 contact tracers, and an additional 100 were hired and started training this week, per DOH.
Additionally, the new contact tracing platform “will increase in intelligence capabilities over time to identify connections between unrelated cases,” Reeves says.
Natalie Delgadillo
Elliot C. Williams