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Where did Victoria go so wrong with contact tracing and have they fixed it?

Victoria’s contact tracing system has faced criticism in the past for being inefficient, with officials flying to New South Wales in September to learn from that state.



a person in a car: Photograph: Lisa Maree Williams/Getty Images


© Provided by The Guardian
Photograph: Lisa Maree Williams/Getty Images

Comparisons are difficult in a pandemic because each outbreak has its own unique characteristics. That said, there are some key features that underpin the differing responses of NSW and Victoria when it comes to contact tracing.

Fundamentally, NSW’s system of decentralised local area health districts meant when the second wave hit, that state was able to draw on teams embedded in their local communities to manage contact tracing. These teams worked independently but also in concert under the mothership of NSW Health.



a person in a car: ‘NSW’s system of decentralised local area health districts meant when the second wave hit, that state was able to draw on teams embedded in their local communities to manage contact tracing.’


© Photograph: Lisa Maree Williams/Getty Images
‘NSW’s system of decentralised local area health districts meant when the second wave hit, that state was able to draw on teams embedded in their local communities to manage contact tracing.’

Related: Sun, sand and coronavirus: Australia aims to enforce a Covid-safe summer

In Victoria, a legacy of cuts left the Department of Health and Human Services under-resourced and highly centralised, meaning there was a smaller base upon which to build the surge contact tracing capacity (with some contact tracers coming from interstate).

This was further challenged with the rapid rise in daily new cases, from 65 to 288 in one week alone in July. Systems had to be developed quickly to manage large quantities of data and feed it back to a central hub. The state had to “build the aeroplane while flying”.

Much has changed since then, and for the better. Some hard lessons have been learned along the way but the contact tracing system in Victoria is now very comprehensive and increasingly robust.

Community engagement, local knowledge

Community engagement and local knowledge might seem like buzzwords but in a pandemic, they’re vital to ring-fencing a cluster.

NSW’s system of devolved public health units and teams meant when local outbreaks occurred, locally embedded health workers were at an advantage. They’re already linked with local area health providers for testing, they already have relationships with community members and community leaders, and they know the physical layout of the area.

If you’re doing a contact tracing interview with someone and they’re talking about a key landmark at a certain time of day, you can visualise it and understand what it means in terms of risk.

What’s crucial is a nuanced understanding of local, social, and cultural factors that may facilitate spread or affect how people understand self-isolation and what’s being asked of them. It can also make a critical difference in encouraging people to come forward for testing.

It’s not just about making sure you have materials

White House now has two CDC epidemiologists helping with contact tracing

President Trump and at least 34 White House staff members and other contacts have tested positive for the virus, according to Wednesday’s senior leadership brief on the covid-19 response prepared by the Federal Emergency Management Agency. Some of those people are suspected of having become infected at White House and Republican National Committee events.

The White House by Tuesday completed contact tracing related to the president’s infection and cases involving several other people, a senior White House official said, raising concerns among infectious-disease experts about whether a thorough investigation could be completed so quickly. The official, who spoke on the condition of anonymity to discuss internal matters, said anyone meeting the CDC’s definition of “close contact” with someone who tested positive had been notified and given health recommendations.

It remains unclear when the White House began contact tracing. If the effort did not begin right away, or go far back enough, infections may have been missed, experts said.

If the White House had started immediately, “then early control could have held back numbers of infections and further need for ongoing tracking,” said Jeanne Marrazzo, an infectious-diseases expert at the University of Alabama at Birmingham.

Several White House staffers and administration officials expressed anger and bewilderment that the White House had not undertaken a more robust contact-tracing effort sooner. They said many people — including White House residence staff who do not have the stature of a lawmaker or a top political aide — had not been contacted despite possible exposures, putting them and others at risk in a still-growing outbreak. The officials spoke on the condition of anonymity to discuss sensitive matters.

The CDC began offering help last Friday, after President Trump announced he had tested positive, only to be repeatedly spurned, according to a CDC official who spoke on the condition of anonymity to discuss internal matters. On Wednesday, an arrangement was made for “some limited CDC involvement,” the official said.

White House officials rejected the assertion they have turned down help, pointing to the CDC epidemiologist already detailed to the White House Medical Unit. That epidemiologist is leading the White House investigation and has been in communication with agency officials, according to a senior White House official who spoke on the condition of anonymity to discuss internal deliberations.

White House officials said they have completed their investigation of the Rose Garden event celebrating the Supreme Court nomination of Amy Coney Barrett that was attended by nearly 200 people, based on photos.

The White House Medical Unit, with a staff of more than 50, has been in touch with the D.C. Department of Health and mayor’s office to report confirmed cases, the official added.

“Any positive case is taken very seriously, which is why the White House Medical Unit leads a robust contact-tracing program with CDC personnel and guidance to stop ongoing transmission,” White House spokesman Judd Deere said.

White House officials said their investigation is unlikely to find the outbreak’s source.

“There were a number of guests who

The Health 202: Genetic tracing could show how coronavirus spread through White House

White House spokesman Judd Deere said tracing has been done for people who had contact with Trump. But it’s the kind recommended by the Centers for Disease Control and Prevention, which involves merely tracking people who were nearby those known to be infected.

“Contact tracing has been done by the White House Medical Unit consistent with CDC guidelines,” Deere said, though The Post has reported many of the hundreds of people potentially exposed to the president found out via media reports of his diagnosis.

Coding coronavirus samples would give a clear picture of whether recent White House events were so-called “superspreaders.”

This is an approach researchers have tried around the country.

They’ve watched the virus accumulate a catalogue of mutations as it moved through Zip codes in the Houston area. They’ve used genetic sequencing to trace how the virus spread outward from a conference in Boston, infecting people from Alaska to Senegal to Luxembourg.

And as detailed by my colleagues Sarah Kaplan, Desmond Butler, Juliet Eilperin, Chris Mooney and Luis Velarde, tumor geneticist Paraic Kenny sequenced samples taken from people in the small town of Postville, Iowa. By looking at variants in their genetic coding, he was able to identify a cluster of cases that all originated from one meatpacking plant.

“Infectious particles swabbed from a patient’s nose carry small but distinctive differences in its genome that can be used, like a molecular bar code, to track where the virus came from and how it had been transmitted,” my colleagues write. “By reading the virus’s RNA, Kenny could unveil how cases were connected to one another, exposing the secret spread of the disease.”

Genetic tracing could play a critical role in seeing how the virus spread – and even whether Trump himself played a role in spreading it. 

They include senior policy adviser Stephen Miller, who tested positive along with several others who helped Trump prepare for last week’s debate. Former New Jersey Gov. Chris Christie, who checked himself into the hospital after testing positive, has said masks were not worn while prepping the president. 

NBC News’s Kelly O’Donnell:

A Coast Guard aide is also infected. Jennifer Jacobs, senior White House reporter for Bloomberg News:

Others who have contracted the virus also include assistant press secretary Jalen Drummond, who attended a Sept. 26 Rose Garden event where Trump announced Amy Coney Barrett as his Supreme Court nominee. While others who attended that event – including Republican Sens. Mike Lee and Thom Tillis – later tested positive, several White House press aides are also infected. 

From the New York Times’s Maggie Haberman:

The Rose Garden event has prompted speculation it may have turned into a so-called “superspreader event” where the virus was transmitted to many people. While that’s less likely to happen outdoors, part of the event was held indoors — and many guests were not wearing masks and were pictured hugging, shaking hands and talking closely together. And during the time they were outside, they were seated close to one

White House not contact tracing Rose Garden event considered possible ‘superspreader’: report

The White House is not contact tracing guests and staff who attended a Rose Garden event for the nomination of Judge Amy Coney Barrett to the Supreme Court, despite many viewing it as a possible spreader of the coronavirus, The New York Times reported on Monday.

The celebration, which took place 10 days ago, is viewed by some as the potential epicenter or “superspreader” of the White House’s coronavirus outbreak because it has been followed by at least 11 attendees testing positive for COVID-19, including President TrumpDonald John TrumpQuestions remain unanswered as White House casts upbeat outlook on Trump’s COVID-19 fight White House staffers get email saying to stay home if they experience coronavirus symptoms White House says ‘appropriate precautions’ were taken for Trump’s outing to see supporters MORE, first lady Melania TrumpMelania TrumpGOP lawmaker calls on Pelosi to apologize for response to Trump contracting coronavirus White House gave New Jersey officials list of 206 people at Trump’s Thursday fundraiser events Photo of Mark Meadows rubbing his head during update on Trump’s health goes viral MORE, adviser Kellyanne ConwayKellyanne Elizabeth ConwayBarr reverses, will quarantine for several days after potential coronavirus exposure White House gave New Jersey officials list of 206 people at Trump’s Thursday fundraiser events Pence tests negative for COVID-19 for third time since Trump’s diagnosis MORE, press secretary Kayleigh McEnany, at least three Republican senators and other White House staff.

An unnamed White House official told the Times on Monday that officials were not contact tracing those connected to the event.

Contact tracing includes public health workers trying to stop COVID-19 transmission by reaching out to people who have tested positive for the disease and asking them to both self-isolate and provide a list of people they had contact with 48 hours before becoming sick, who will, in turn, also get a call. In this way, health officials are able to stop the potential spread of the virus before it can be passed on to someone else.

The White House is still technically following the Centers for Disease Control and Prevention (CDC) guidelines that require contact tracing for the 48 hours leading up to a positive COVID-19 diagnosis, the official told the Times. 

Public health experts have criticized the decision not to contact trace the Rose Garden event, however.

“This is a total abdication of responsibility by the Trump administration,” Boston University public health expert Joshua Barocas told the Times. 

Trump was diagnosed with COVID-19 on Thursday, shortly after it was revealed his close aide Hope HicksHope Charlotte HicksWhite House staffers get email saying to stay home if they experience coronavirus symptoms Trump sought to keep COVID-19 diagnosis secret Thursday as he awaited second test result: WSJ What we know and don’t know about the president’s health MORE had tested positive. In the following days, several others announced positive diagnoses. 

On Monday, Trump returned to the White House from Walter Reed National Military Medical Center after three days of treatment.

Op-Ed: Trust and Tracing | MedPage Today

The fight against COVID-19 requires regaining and maintaining immigrants’ trust in our public health system. The Trump administration’s public charge rule, which empowers the U.S. government to deny green cards to immigrants who receive welfare benefits, could prove to be a public health problem by reducing immigrants’ willingness to engage in contract tracing and testing and trust leaders.

With 70% of immigrants in the labor force serving as essential workers, whether it be as healthcare providers or meatpacking plant workers, immigrants are at greater risk of being exposed to COVID-19. In fact, reports across the country show that migrant farmworker communities face not only higher COVID-19 exposure, but also more damaging effects from the current West Coast wildfires.

This news is concerning as immigrants are more likely to lack health insurance, with 23% of immigrants with legal status and 45% of undocumented immigrants lacking insurance, compared with 8% of citizens.

If this trend wasn’t bad enough, reports have shown that Trump’s public charge rule has made immigrants afraid to seek healthcare. The Kaiser Family Foundation has found that immigrants are disenrolling in healthcare benefit programs like Medicaid. A report from the Chicano Federation shows that this is not a theoretical issue as places like San Diego county struggle to convince community members to share personal information with contact tracers: it is an urgent one, with potentially catastrophic public health implications.

This lack of confidence is exactly why improving immigrants’ trust in the U.S. public health system is an issue of public concern. If immigrants distrust testing and contact tracing programs, there is an increased likelihood that COVID-19 will spread undetected in all communities — hampering states’ abilities to re-open their economies and contain the pandemic.

As individuals in the medical field and the children of immigrants, ensuring that immigrants trust COVID-19 testing and contact tracing programs is medically necessary and deeply personal. This understanding is why we have outlined some immediate policy steps to rebuild immigrants’ trust in public health systems during the COVID-19 pandemic.

  • First, the public charge rule should be rescinded. This would ensure that immigrants are not afraid to use the many community clinics that serve people regardless of citizenship status or ability to pay. These clinics are often key resources for necessary testing that must take place. In addition, immigrants wouldn’t withdraw their children from important insurance programs, like the Children’s Health Insurance Program, that provide access to care for low-income children. Furthermore, removing green card penalties for obtaining necessary food and housing assistance programs will increase immigrants’ willingness to access testing and contact tracing programs
  • Second, the federal government should make good on its promise to cover testing fees for all citizens and residents. This is very important as those who lack insurance face exorbitant testing costs. Covering the costs of testing fees will make it more likely that immigrant communities are able to access tests
  • Third, on the state level, public health departments should work with community organizations to share information and emphasize the

Contract Tracing, Key to Reining in the Virus, Falls Flat in the West

LONDON — As the coronavirus stampeded across Europe and the United States this spring, governments made their depleted citizens a tantalizing promise: Soon, legions of disease detectives would hunt down anyone exposed to the virus, confining them to their homes and letting everyone else get on with their lives.

Nearly eight months on, as a web of new infections spreads across Europe and the United States, that promise has nearly evaporated.

Despite repeated vows by Western nations to develop “world-beating” testing and tracing operations, those systems have been undone by a failure of governments to support citizens through onerous quarantines or to draw out intimate details of their whereabouts. That has shattered the hope of pinpoint measures replacing lockdowns and undermined flagging confidence in governments.

Beholden to privacy rules, Western officials largely trusted people to hand over names to contact tracers. But that trust was not repaid, in large part because governments neglected services that were crucial to winning people’s cooperation: a fast and accurate testing system, and guarantees that people would be housed, fed and paid while they isolated.

“Public health leaders fell in love with the idea of contact tracing as an important tactic — and it is — but that’d be like if you’re going into war and were just talking about the tanks,” said Brian Castrucci, president of the de Beaumont Foundation, a public health charity in Maryland.

Just as important, officials overlooked the impact of raging mistrust in government and a thicket of conspiracy theories about the virus’s spread. Fearful of plunging themselves or their friends into a painful period off work, infected patients have handed over a paltry number of contacts and often flouted self-isolation rules. Contact tracers are struggling to reach people who test positive, and being rebuffed once they do.

In theory, countries were to build mass testing programs that would provide quick diagnoses. Then a group of tracers would find others who had crossed paths with the infected person and tell them to stay home.

Elected officials presented the system as a critical bridge between lockdown and a vaccine, allowing them to contain small outbreaks without shutting down large parts of society. But construction of that bridge has been rocky, at best.

The West’s public health systems have not matched the success in parts of East Asia where the fear of epidemics became more ingrained after SARS and MERS.

Following those outbreaks, places like Taiwan and South Korea built robust tracing systems and legal frameworks for limiting civil liberties during an epidemic. Some contact tracers have used cellphone and credit card data to identify people who were potentially exposed.

But in Europe and the United States, which have largely relied on the public to provide information and follow quarantine rules voluntarily. The response has been spotty

The West also ran up against the blunt fact that contact tracing, while useful in containing limited cases, has become overwhelmed by a new explosion of infections. In the past week, Europe has averaged about