HIV Aids

Why Is NYC Mayor de Blasio Taking COVID-19 Contact Tracing Away From Health Department Experts?

“He has a huge ego, and he can’t stand being shown up by anyone. He also doesn’t give a shit about public health. And he’s lazy. There’s no reason for this other than pettiness.”

That’s the Rev. Charles King, the cofounder and CEO of New York City HIV and homelessness nonprofit Housing Works, blasting a powerful leader for acting against the best interest of public health in the middle of the COVID-19 crisis.

But if you think he’s talking about Trump, think again: He’s actually talking about New York City Mayor Bill de Blasio. Specifically, about de Blasio’s decision to give the vast and complex job of COVID contact tracing—which involves identifying, contacting, and urging quarantine for anyone who was in proximity with someone with COVID, as a means of containing the spread—to the New York City Health and Hospitals Corporation (H+H), which runs the city’s nonprofit hospitals, instead of leaving it to the city’s department of health (DOH), which has run contact tracing for more than a century on communicable diseases from tuberculosis (TB) to HIV/AIDS to measles.

And King, like many New York public health advocates and even some city lawmakers, is outraged about that, calling it not only a petty move on the mayor’s part to get back at a health department he has long been at odds with—but dangerous, because it wastes valuable time transferring something that DOH is already equipped to do to an entity that has never done it before.

“Every time there’s been a public health issue or crisis in NYC, de Blasio has ended up at war with his own health department,” said King on May 14, a day before City Council held (via Zoom) a nearly five-hour hearing grilling officials from the mayor’s office, the DOH, and H+H on exactly how and why the job transfer came about, and how exactly H+H intended to stand up and execute a massive task (involving the hiring of thousands of new workers) the likes of which it had never taken on before.

“H+H scaling up COVID testing is great,” continued King. “If they want to run isolation shelters, that’d be smart. But they’re not the best people to do contact tracing. They’ve barely set up the system to do it.” (At the May 15 hearing, H+H officials said they’d hired 500 people and were in the process of hiring 1,500 more.) “They’ve decided not to work through community groups, which was probably dumb. DOH would’ve contracted with community groups, but H+H never does that.”

Another source of outrage is that H+H has pulled about 40 staffers from DOH’s own contact tracing corps to do the job for them. “H+H has zero experience with this, so they gutted DOH to do it at a time when DOH still needs to be tracking HIV, measles, TB,” says King. “What if we have other outbreaks in the middle of COVID? Why does de Blasio think that H+H is better for this than DOH?”

King was one of 11 leading public health experts who on May 13 signed a petition urging New York State Health Commissioner Howard Zucker, M.D., to “exercise his legal authority and supervisory responsibility” to return COVID contact tracing responsibility to the DOH. Most of the 11 experts have deep background in HIV/AIDS, especially the longtime use of contact tracing to track and contain HIV outbreaks.

Also among the 11 was C. Virginia Fields, former Manhattan borough president and current head of the National Black Leadership Commission on Health, who said that de Blasio’s decision struck her as “political, especially given that DOH is the institution that provides these services and has the infrastructure to do so. I find it very disturbing and unacceptable to be bringing a new organization up to par on this in the middle of a crisis. It might all work out eventually, but we’re wasting time.”

At the City Council hearing, many councilmembers, including Council Speaker Corey Johnson, who is openly gay and HIV positive, said they were worried that H+H did not have the ties or training with different communities or the privacy protections in place to do contact tracing in the way that DOH has been honing it for decades, particularly when it comes to working with nonprofits on the ground—and especially in communities of immigrants, people of color, and other vulnerable populations who’ve been hit hard by the epidemic.

Councilmembers also pointed out that DOH had been doing COVID contact tracing as far back as February, with a team of about 100, according to DOH’s Demetre Daskalakis, M.D., M.P.H., who has become the face of the city’s effort to end the HIV epidemic—and who was in the hearing.

In response, Mitchell Katz, M.D., who heads H+H, said that no data from the program would be shared with federal authorities. He also said repeatedly that contact tracing was put under H+H to be part of the entity’s “three pillars” of fighting COVID: tracing, testing, and treating/isolating people with COVID-19 in hotels. And he said that H+H could more easily hire the tracers.

On May 14, Politico reported sources saying that DOH was going to go forward with contact tracing until powerful union interests pressured de Blasio into giving it to H+H, where tracers would be union-protected.

But King and others, including Treatment Action Group’s executive director Mark Harrington, among the 11 on the petition, said that de Blasio and Katz used both the “three pillars” and the easier-hiring argument after the fact, to justify a de Blasio power grab enacted to get back at DOH for disagreeing with him in early March about the severity of the COVID threat and the need for a shutdown. The mayor has been widely perceived as having, like Trump, downplayed the threat until COVID was already running rampant throughout the city.

Harrington allowed that the real reason for de Blasio’s decision could be pressure from the union. But he also said it was just as likely that “it’s a venomous power play against DOH because he’s angry at Oxiris [Barbot, M.D., head of the DOH] and Demetre, because they embarrassed the mayor because he was wrong” about the COVID threat. “He’s undermined DOH every step of the way”—he bitterly clashed with DOH in 2015 over the handling of an outbreak of Legionnaires’ Disease in the Bronx—“and this is just another opportunity to get revenge.”

Neither City Hall nor DOH nor H+H returned emails asking for comment on this story. Meantime, via a private recruitment firm, H+H is currently accepting applications for both contact tracers and contact-tracing supervisors—work-from-home, phone-based jobs that reportedly are in high demand among countless New Yorkers whom COVID has put out of work.

At the City Council hearing, Katz, who touted his own experience with contact tracing while heading up public health in San Francisco, assured that the H+H-run program would be both successful at tracking and containing COVID and at preserving people’s privacy. “This is an integrated team between H+H, DOH, and the mayor’s office working together with a common goal,” he said. “Contact tracing done in isolation from H+H’s ability to test and then isolate people would not be nearly as effective.”

But after the hearing, advocates who signed the petition were not entirely convinced that the power transfer from DOH to H+H would be for the better. Harrington pointed out that H+H officials in the hearing gave different numbers at different times for how many COVID tests per day in were needed in New York City. “They don’t have a clue,” he said. “It’s not clear when they can launch it. Their answers on everything were vague and contradictory. Mitch [Katz] referred so many questions back to Demetre, but Demetre isn’t in the line of command for this effort anymore.

“It’s all completely unnecessary,” he added. “All City Hall had to do was let DOH continue to do its job and bring on extra staffing to do the testing.”

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