Testing, tracing and the school reopening phase: a Q&A with Dr. Perry Halkitis

When New Jersey needed to create a contact tracing program to deal with the COVID scourge, it turned to a world-class scientist with decades of experience in psychological, behavioral, and public health research.

Perry Halkitis is the Dean of the Rutgers School of Public Health, and he considers this task a call for social justice, echoing the mission statement that has made him an eminent educator and advocate for HIV patients.

It took barely a month to enlist, train, and unleash his massive team of tracers, who are responsible for connecting a person with an infectious disease with close contacts, and helping them all reduce transmission with testing and isolation.

Halkitis spoke with Dave D’Alessandro of the Star-Ledger Editorial Board Friday.

Q. Skip ahead to the bottom line: As a state, how is NJ doing with testing and contact tracing?

A. Let’s separate them: Some labs are testing extremely well. The Rutgers saliva test is returning results within a couple of days. So that’s a check-plus. There are other labs — like Quest and others — that take up to two weeks for results. That’s extremely bad. I had an antibody and viral test two Wednesdays ago, and I still don’t have the result of the viral test.

So contact tracing, while helpful, becomes increasingly less helpful the more time there is between the test and the result. If I were positive — which I’m not, I have antibodies — I could be infecting people because I feel perfectly fine. So we’re not doing well with testing, and I think the pattern we’re seeing in New Jersey is indicative of the patterns we’re seeing nationally.

In terms of tracing — because this goes hand-in-hand — we’re doing fine when the results get back to the local health departments on time. We’re not doing fine when it takes forever for the results to reach them. And that’s our challenge here: getting the info from the lab to the health department for the tracer to do the actual work.

Q. So the moral of that story is that we should assume we’re infected and act accordingly?

A. Right. I use this expression in my HIV work all the time: The only thing you know about HIV for sure is when you are infected. So if you’re waiting for a result, you should assume you’re infected. But as you know, it’s incredibly difficult to isolate yourself, especially when it’s beautiful out.

Q. It’s also hard to find solace in the metrics. We saw 2,000 cases in a four-day period last week, and the rate of transmission crept up to 1.14. Does that keep you up nights?

A. The RT rate does. I never trust cross-sectional data. I always believe in longitudinal data patterns. Yes, people have blips in their virus, and people have dips in their CD4 (white blood cells) once in a while, but when it’s consistently going in the wrong direction, that’s a problem. So yes, the reproduction rate keeps me up because the way it’s being calculated in our state now is based on the date the test result is reported. Remember what I just said about reporting times? That’s a problem. So it may very well be that the rate is even higher, because we’re conflating data from people tested 2 days ago with people tested 2 weeks ago. Not good.

Q. So who’s responsibility is it to recalculate?

A. That’s the state Department of Health, and they need to recalculate the data based on the date of tests every now and then as more results come in. I’ve talked to them about it, the governor’s office understands this. McKinsey (Institute) is guiding DOH a lot, and they should be able to do it easily.

Q. The recent case spike coincided with crowded parties breaking out around New Jersey. How do these gatherings stress-test the system?

A. Here’s what we know about any booze-filled parties and disease transmission: Whenever people have alcohol and use substances, their inhibitions go down. When inhibitions go down, they’re more likely to engage in risk. In this case, they’re probably taking off their mask, kissing people, in close proximity, and the transmission is exacerbated. There’s no doubt in my mind that in those situations, there’s a spike. The one advantage is that being outside makes it a little better. But once it gets colder and these parties go inside, that’s when we’re really going to have huge problems. Human beings are not rational operators, people have a difficult time maintaining behaviors — whether it’s going to the gym 7 days a week or taking their meds — and their emotions and passions get in the way. So what we’re seeing throughout the country is the result of summer.

Q. The governor picked you to build his army of contact tracers, and you’re currently training up to 1,000. What kind of people have you recruited, and how long does it take to train them?

A. We put the word out, 3,000 people applied, and we’ve identified 1,000. There are about 400 already placed, and by the end of August, we’ll have them all out there. Who are they? They’re all grad students, they’re all New Jersey residents, they’re all intelligent and hard workers. The training is 18 hours online, asynchronous (without real-time interaction). New York is only 5 hours. And ours is in three parts. Part 1 is the (Johns) Hopkins Module, which is Tracing 101. The second part is the strength of our program, an education on New Jersey diversity and culture, its people, how to talk to communities of color, immigrants, gay people, etc. Then Part 3 is exposure to CommCare, the data platform.

Q. We heard of the run-and-hide mentality among the young party-goers, but has your tracing team found the community cooperative in general?

A. It’s good, but not great. What we need to do more effectively is get the word out that people must cooperate to get this under control. It’s been good the last month or so, just because we had a lull, so contact tracing can happen. If this were March, it would be difficult. There’s always going to be resistance, but generally we give our students the tools to do this, and the model is working as well as it can. But like I said before, I don’t know how contact tracing works when the tests take 2 weeks to arrive.

Q. At what point can we start to feel comfortable about reopening society a little bit?

A. Well, we should not feel comfortable opening schools at all. For the most part, it’s possible to have some sense of normalcy even if it’s weird for people to wear masks. You can go to Walgreens or Starbucks, and there are systems in place to allow for six feet of distance. That’s not possible in schools. They’re overcrowded to begin with. Thank God Rutgers made the decision not to open. And I know it’s a hard decision to make, but we just had 10 cases on the football team. That’s just the responsible decision.

Q. Six months from now, where do you see the state and the country in the arc of this crisis?

A. If we can get through the fall and not have this get out of control, by early next year we should be in decent shape to open more widely. I don’t think, frankly, that anyone will be going to baseball games or concerts until the summer of 2021 at earliest. But if we can keep people’s behavior under control and get through what I think is a really dark period this fall, I think we’ll be on the other side of it — but only because I also think there will be a vaccine widely available by the summer of 2021.

Q. You have called this a moment of social justice. What did you mean by that?

A. In many ways, it’s like the AIDS epidemic. It has shone a light on the disparities that exist in this country. It has shown how ugly things can get; how differences perpetuate among people of different races and classes; how people with limited health care access suffer more; how frontline workers place their lives at risk without full appreciation; and it has exposed society’s existing fractures. It is a moment of reckoning for us. It is a moment that people understand the need for social justice, movement, and change. Because if we perpetuate the separation between haves and have-nots, which we have for 400 years, it’s never going to get better. In every crisis you have to see a silver lining. We have to ask whether we’re going to continue business as usual and live in a society of such inequity.

Q. And if we trusted science, this could be a moment of triumph.

A. If only we used science, we’d be fine right now. But like I said, human beings are not rational operators. The paper I’m writing now talks about medical care and public health, and neither of those disciplines fully address an understanding that human beings are driven by fears, by loneliness and by experiences of stigma. Doctors and public health doesn’t deal with that. It’s the only way to truly engage with people. So I wish someone would say, ‘This is frightening.’ Just say it, own it, and make it normal. But we don’t deal with those things. We need a redirection so that clinical care and public health deal with the psycho-social stressors — the stigma, the homophobia, the discrimination, all the factors that contribute to health disparities in our country.

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