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In Note to Fauci, Top City Doctor Takes Shot at de Blasio’s COVID-19 Contact Tracing Program

Dr. Anthony Fauci gives a coronavirus update from the White House, April 4, 2020.
Dr. Anthony Fauci gives a coronavirus update from the White House, April 4, 2020.
Andrea Hanks/Official White House Photo

A leader of the city’s effort to track COVID-19 spread recently questioned the effectiveness of Mayor Bill de Blasio’s $880 million test-and-trace program — and said more money needs to instead go to vaccinations, THE CITY has learned.

Dr. Marcelle Layton, who runs the bureau of communicable diseases for the city Department of Health and Mental Hygiene, offered her candid assessment in a Jan. 6 email to Dr. Anthony Fauci, head of the National Institute of Allergies and Infectious Diseases.

She requested that grant requirements tying federal funds to test-and-trace be lifted — and that the money be pumped into the flagging vaccination effort. Her memo was copied to public health officials from several large cities around the country.

“I wanted to raise an issue that came up on a call today that I coordinate as many of us for a while now have questioned the effectiveness of contact tracing in mitigating COVID-19,” she wrote Fauci.

Dr. Marcelle Layton speaks about the Swine Flu in 2009.
Dr. Marcelle Layton speaks about the Swine Flu in 2009.
Screengrab/C-SPAN

The email was obtained by the Brown Institute for Media Innovation’s Documenting COVID-19 project and provided to THE CITY.

In early May, de Blasio announced the test-and-trace program, promising to hire 1,000 temporary workers to supplement health department staff assigned to the agency that would run the program, the Health and Hospitals Corp. The goal: to track down close contacts of those infected.

The mayor declared the army of contact tracers would “allow the city to to immediately isolate and care for those who test positive for the virus and then rapidly track, assess and quarantine anyone they came into contact with who they may have infected.”

“With every resource at our disposal, we are moving mountains to test and trace every New Yorker,” he said.

The program, however, ran into problems from the start, with many patients either refusing to cooperate or claiming they’d had no close contacts. By June, the tracer corps had contacted about 4,200 COVID-19 patients, of whom only 1,800 provided any information on close contacts.

‘Very Limited Resources’

In her email to Fauci, Layton — describing her role as “leading the [New York City] surveillance response” to the pandemic — argued that contact tracing isn’t effective because to date “few of our [COVID] cases occur among persons who were already known contacts under monitoring.”

The quest to track down potentially infected New Yorkers via contact tracing is also undermined “given the degree of asymptomatic and pre-symptomatic transmission,” she explained.

She contended that if the program were working as it should, “We would expect [an] increasing percentage of new cases to occur among known contacts.” That has not happened, Layton noted.

Continuing the focus on contact tracing potentially takes away from what Layton called a higher priority: federal support for the so far bumpy effort to distribute vaccines.

The city has relied heavily on federal funding to pay for much of its Herculean effort to control and ultimately end the pandemic, and, as she noted, “Much of our federal funding is tied to testing and tracing.”

An excerpt from Dr. Marcelle Layton’s Jan.6 email to Dr. Anthony Fauci
An excerpt from Dr. Marcelle Layton’s Jan.6 email to Dr. Anthony Fauci
Via the Brown Institute for Media Innovation’s Documenting COVID-19 project

Records show the financially ailing Health and Hospitals Corporation, which operates the city’s 11 public hospitals, is counting on a mighty chunk of change from the feds to pay for the test-and-trace program.

In its 2021 fiscal year budget, nearly $610 million of the $813 million HHC plans to spend on contact tracing comes from the feds. The rest is from city funds, with another $67 million in contracts coming out of other city agency budgets.

But Layton asked that the federal government lift a grant requirement tying federal funds to test-and-trace programs and shift “resources if needed to vaccination efforts without the usual bureaucratic process and time required to redirect funds.”

Layton said the need isn’t confined to New York, noting the “very limited resources at many health departments who are dealing with the surge of cases at the same time we’re trying to set up large scale vaccination programs.”

‘Focus on Vaccination’

The city and state have been struggling to obtain an adequate supply of vaccines from the federal government, but have also had difficulty getting shots into the arms of eligible New Yorkers since the effort kicked off in December.

So far, just over 5% of city residents have been vaccinated. More than a quarter of those vaccinated across the five boroughs have hailed from the suburbs — a dynamic that was on display at a major inoculation center in Washington Heights until THE CITY exposed the demographic imbalance.

Layton argued federal funds would be better deployed to the vaccination effort in New York and beyond.

“There is no question in my mind that the most effective use of staffing (especially more experienced public health staff) is to focus on vaccination,” she wrote, “while limiting case investigations and contact tracing to more high risk settings (such as nursing homes and correctional facilities) and not trying to investigate all cases and monitor all contacts.”

Layton did not respond to questions emailed to her by THE CITY.

In statement emailed to THE CITY, Health Commissioner Dr. David Chokshi said: “Test-and-trace is a critical tool in stopping chains of transmission. It has been a linchpin of our fight against COVID-19, not just identifying people who have been exposed, but also connecting them to resources to keep themselves and their communities safe.”

Chokshi noted that the program provides hotel rooms for those who can’t quarantine safely at home and helps those who’ve tested positive or have been exposed to COVID-19 navigate issues with insurance and medical bills.

“The city has a unified strategy and we’re all on the same page about how we beat this virus,” he added. “New Yorkers must be tested, each positive case must be traced and we must get the vaccine to as many people as we can immediately.”

A spokesperson for the National Institute for Allergies and Infectious Diseases did not respond to THE CITY’s query about Layton’s request to lift grant requirements tied to test and trace.

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