Saturday, August 15, 2020

#EdBTTTS Back to School and Contract Tracing: Everything de Blasio Touches Turns to Shit

by Norm - Aug. 15, 2020
#EdBTTTS - And the number one reason for not going back to school in NYC IS: 
De Blasio sucks - at everything.  

The total lack of trust teachers for sure - and many parents have in him and his clones at the DOE. No one trusts the entire bureaucracy at DOE for their lies and misinformation and total incompetence in so many areas going back, oh, let's say to the earliest days of the Bloomberg years, followed by the management styles of Farina and Carranza.
Politico: New York City school reopening faces resistance
New York City Mayor Bill de Blasio announced that based on a survey sent to public school parents, about 75% want to send their kids back to school in September. The other 25% explicitly backed remote learning only. Some parents and teachers disputed the meaning behind those numbers. De Blasio also announced that every school will have a certified nurse on-site. However, the reopening plan still faces opposition by unions representing both teachers and administrators, who are asking to delay the start of in-person school – which is currently Sept. 10 – until at least the end of September. Union leaders say school staff don’t have enough time to prepare under the current timeline and still lack guidance on the details of reopening. The New York State Nurses Association joined the call, saying that schools statewide should postpone any return to classrooms. But their concerns are not stopping de Blasio, who said he is still moving ahead with reopening on Sept. 10, while schools Chancellor Richard Carranza continues to say the city isn’t moving too quickly.
When I heard the numbers being reported that 85% of the teachers wanted to go back I laughed out loud just from watching the social media. These distorted numbers as reported by them is a perfect indication of why they are not trusted on anything. Like do we believe there will be adequate cleaning or PPE or real enforcement of any rules?  Leonie reported.
NYC mayor said 700,000 students are ready to come back to school this fall. Really? There is some strong opposition to Mayor Bill de Blasio’s plans.

So, I've been thinking a lot about the going back to school issue, at times torn between both sides for a variety of reasons, which I won't get deep into right now --- you can read all the issues on Arthur's and James' blogs and on facebook. I expect to do a deeper dive. Down below I focus on the contact tracing issue as an example.

I've seen a lot of attacks on Mulgrew for not being militant enough. I reserve judgement as he escalates his criticism as part of the political game he is playing. I do not object to his waiting for the game to come to him. But if you think a strike is in the offing I see no way - unless Unity Caucus itself revolts. But I'll get into that in a separate post.

I've been collecting article after article on just how disorganized the De Blasio admin has been to the point I've lost track and in fact been overwhelmed by the info coming in.

[One offtopic example of how things are screwed up are reports coming in from friends who come into JFK and breeze right through without questions. Quarantine my ass.]

I actually started writing this piece two weeks ago when I read a NYT article on contact tracing which is supposed to be part of the going back to school issue.

I posted this from a NYC teacher
Decoded and Explained - The NYC DOE Reopening Plan - 109 pages of smoke and mirrors - Anonymous NYC Teacher 

And Leonie posted this:
Mayor De Blasio Pledges A Nurse In Every School, But UFT President Says He’ll Fight Reopening If Stringent Safety Isn’t Met – CBS New York
Mulgrew is putting the blame on de Blasio, who, he said, didn’t focus on the problem of school reopening until last month. His message? “We’ve yet to see you actually get your job done. So let’s see you do your job,” he said.
Here I focus on the contact tracing program:
City Praises Contact-Tracing Program. Workers Call Rollout a ‘Disaster.’ programs have presented an array of challenges to government officials everywhere, including difficulties hiring many workers, privacy issues and faulty technology, like apps. And New York City’s seems to have been especially plagued by problems.
some contact tracers described the program’s first six weeks as poorly run and disorganized, leaving them frustrated and fearful that their work would not have much of an impact.

They spoke of a confusing training regimen and priorities, and of newly hired supervisors who were unable to provide guidance. They said computer problems had sometimes caused patient records to disappear. And they said their performances were being tracked by call-center-style “adherence scores” that monitor the length of coffee breaks but did not account for how well tracers were building trust with clients.
Some also bristled at what they described as crackdowns on workers talking to one another.
“It reminds me of an Amazon warehouse or something, where we are judged more on call volume or case volume than the quality of conversations,” one newly hired contact tracer, a public health graduate student, said in an interview.
“To me, it seems like they hired all of us just to say we have 3,000 contact tracers so we can start opening up again, and they don’t really care about the program metrics or whether it’s a successful program,” she said.
Perfect expression of the kind of management those who work for the DOE have been seeing for years.

Note here how the tracing program was moved:
According to her resignation letter, Dr. Oxiris Barbot decided to leave largely because Mayor de Blasio snubbed the Health Department in launching the city's contact tracing program. He gave it to the public hospital system, the Health and Hospitals Corporation, instead.
if the city's economy is ever going to recover, and people are going to get their jobs and their rent money back, people exposed to the virus need to be traced and isolated right away so a case at a workplace doesn't become an outbreak at a workplace, forcing everyone to get laid off again, how well this is done matters a lot.
how is Mayor de Blasio's decision to do contact tracing without the health department at the center of it working out?
And here's the NYT piece:

City Praises Contact-Tracing Program. Workers Call Rollout a ‘Disaster.’

Some also bristled at what they described as crackdowns on workers talking to one another.

The New York Times developed a portrait of the program through interviews with several current and former workers, as well as through an examination of internal documents. Further information was obtained from screenshots of Slack messaging channels used by tracers, which featured numerous conversations about workplace conditions.

“It reminds me of an Amazon warehouse or something, where we are judged more on call volume or case volume than the quality of conversations,” one newly hired contact tracer, a public health graduate student, said in an interview.

“To me, it seems like they hired all of us just to say we have 3,000 contact tracers so we can start opening up again, and they don’t really care about the program metrics or whether it’s a successful program,” she said.

Most of the current workers interviewed for this article spoke only on the condition of anonymity, saying that they feared losing their jobs if they spoke out publicly.

The complaints mounted so quickly that on July 9, Dr. Neil Vora, one of the leaders of the program, apologized during a virtual town-hall-style meeting with hundreds of workers.

“We are sorry for, like, the heartache and the pain and the inconvenience that this has caused,” Dr. Vora said, according to a recording of the meeting. “I know that basically 100 percent of you have experienced that.”

The challenges are perhaps understandable. The city has long had a small contact-tracing team of about 50 people, but has never undertaken a tracing operation of this magnitude. Any plan to hire, train and equip 3,000 people for any kind of effort will inevitably run into difficulties — let alone an initiative started during one of the worst crises in memory.

The mayor himself may have added obstacles in May when he abruptly stripped the program from the city’s Department of Health, which has long handled contact tracing, and moved it to the city’s public hospitals agency, which had no experience in contact tracing. The mayor has had a strained relationship with the Health Department, though the department’s contact tracing experts are working with Health and Hospitals to design and manage aspects of the initiative.

Contact-tracing programs tend to be effective only when the number of cases drops, as has occurred in New York City since the peak in April. When an outbreak is surging, as is currently happening in the South and West, tracers can become overwhelmed.

In the city’s Test and Trace Corps, remote workers, known as case investigators, try to call all people who have tested positive for the virus in the city. They do in-depth interviews that seek demographic information and details about symptoms. Perhaps most important, the case investigators ask whom the infected person may have exposed to the virus.

Field workers, known as community engagement specialists, try to visit people who have not been reached by phone. And case monitors do daily follow up calls, to check if people are quarantining and to connect them with help.

Dr. Ted Long, executive director of the Test and Trace Corps, said in an interview that many of the early problems had been remedied. He said new hires were having a smoother experience.

“Our tracers have always been the right, mission-oriented New Yorkers who are here to save New Yorkers; that has never been a question,” Dr. Long said. “It took a couple of weeks before they got their feet wet, and I think that’s OK.”

Early on, data showed that the tracers were having difficulty reaching many people, but the latest statistics suggested improvement. The Test and Trace Corps has completed interviews with 64 percent of the 19,995 New Yorkers who have tested positive between June 1 and July 25.

But in a worrying sign, only 42 percent of infected people provided the tracers with the name of even a single contact they might have exposed, a level that epidemiologists consider too low for the program to be broadly effective.

After The Times sought a response from the mayor’s office about problems in the program, the mayor’s press office issued a news release on Monday declaring that the program had reached 96 percent of people in the city who had tested positive in the last two weeks, meaning a team member had a conversation with the infected person.

But the release did not mention an important fact: how many of those people had actually provided tracers with the name of a contact who may have been exposed.

It was the continuation of a pattern of putting a positive spin on data that some epidemiologists have criticized.

“It is critically important to put forth a set of agreed-upon ways in which the data will be presented,” said Dr. Wafaa El-Sadr, a professor of epidemiology at Columbia University’s Mailman School of Public Health. “Avoiding even the perception of ‘cherry-picking’ is critical to generating trust in the Test and Trace Program.”

Dr. El-Sadr, on behalf of a New York coalition called the Covid-19 Working Group, called on the de Blasio administration to provide a fair and accurate interpretation of data in order to enhance the program’s performance.

Despite their complaints, some workers said they felt gratified that they could connect sick people with resources for food and medicine delivery, or with hotels where they could isolate.

Some of those involved in fieldwork, which kicked off at the end of June, reported receiving more extensive training.

“It’s a slow start for now, but it will be picking up,” said Oluwatomi Oluwasanmi, a supervisor in southwest Queens, who said fieldworkers made only a few house calls each in their first week.

After being told by the mayor to take over the program in May, the city’s Health and Hospitals agency ended up outsourcing most of the initial hiring to the Bachrach Group, a recruiting firm.

The agency contracted with Optum, a subsidiary of UnitedHealth Group, to help set up the call center at the core of its tracing program and to provide much of its day-to-day management.

Tyler Mason, an Optum spokesman, said Optum was using its experience in call handling, operations and training to support the tracers. This is Optum’s only contact-tracing contract, he said.

Health and Hospitals said that Optum’s role would decrease over time, and that Health and Hospitals supervisors would eventually take over all supervising responsibilities.

“Optum is giving us their expertise in how to run a call center until we get our feet under us,” Dr. Long said.

Recruiters for the program described flexible positions that were largely remote and paid $57,000 to $65,000 a year. An online training course from the Bloomberg School of Public Health at Johns Hopkins University portrayed the role as one in which tracers made repeated calls to sick people and their families, building trust.

But as the program started, management was confusing and chaotic, tracers said in interviews.

Supervisors were as inexperienced as the tracers. The tracers began to reach out to one another for help after an orientation email included the email addresses of more than 300 of the new hires, perhaps inadvertently.

“I really do not have a clue what I am expected to do,” one new supervisor wrote to the group on May 27.

To share notes, one tracer invited hundreds of others to a private Slack group, which soon filled with questions, gripes and concerns.

Tracers were frequently confused about what to do with different types of calls. For example, many said they were told to ignore pediatric coronavirus cases. Then they said they were told they could interview parents of the children. (Health and Hospitals said pediatric calls were initially routed to a special team those tracers did not know about.)

The program went back and forth about whether it was OK to interview a sick person’s health care proxies, or what to say when a worker at a nursing home answered the phone.

“I feel like all of this is such a disaster,” one tracer wrote in Slack on June 10.

Tracers were marked as “bilingual” if they spoke a language other than English, but in a move that seemed to make no sense, bilingual case investigators all had to make calls to Spanish-speakers, even if they didn’t speak Spanish, according to a July 3 email from a supervisor. (Translation services are also available.)

One tracer, who asked to be called by a nickname, El, was marked as bilingual, though El spoke only English.

“I have never had a more dysfunctional workplace, or more disrespect anywhere — and at one point, I washed hotel towels,” said El, a 27-year-old with a master’s degree in infectious disease management.

Because of the siloed structure of the call center operation, which does not allow case investigators to hold on to specific clients, five or six tracers might call the same person.

In one exchange captured on video, a tracer describes how instead of reaching a woman with Covid-19, she had reached her daughter, who said her mother was in the hospital. The daughter was infuriated because she had been contacted repeatedly by different tracers after saying she did not want to talk, the tracer said.

When tracers called people infected with the coronavirus, they had to take them through a 16-step script that began with questions about race, ethnicity and sexual orientation, and that took about 45 minutes.

The question about whom they may have exposed to the virus — the crucial part — was step No. 11.

“You get to the end of the call, step 11, and by that time, people are so fed up that they are not willing to provide that information,” one tracer said.

Tracers asked those reached over the phone to name anyone they had been in close contact with, defined as within six feet for at least 10 minutes. But they did not ask where patients might have exposed someone outside their homes, making it harder to identify clusters.

On July 17, the Trace Corps rolled out changes that responded to some of these concerns.

The demographic questions, which some patients found off-putting, were moved to the end of the call. Interviews were shortened, in part because they can be now marked as complete even if people do not answer the last eight of 21 sections, tracers said.

People infected with the coronavirus are now being asked where they work and if they visited a restaurant, bar or house of worship in the two weeks before they got tested or began having symptoms.

Unable to get clear answers about many of their questions, some of the workers found their private Slack channels the easiest way to share guidance. On June 30, they were told to shut them down because of concerns about patient privacy. Shelly Tenor, Optum’s director of operations for the program, said at the July 9 meeting that tracers could only communicate with one another through approved channels.

Some of the tracers have continued to quietly share notes on another platform, Discord, which is popular with gamers, two tracers said.

“I’m pretty shocked that this huge city initiative is acting this way,” a 22-year-old tracer said. “I still speak to co-workers, but it’s like we are fugitives.”

The tracer whose nickname is El quit on June 22, citing concerns about poor treatment of workers and patient privacy.

“We were so frustrated, all of us,” El said.

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