In an interview with Gothamist, Distinguished Professor Denis Nash discussed New York City Mayor Bill De Blasio’s decision to put the hospital system, NYC Health + Hospitals, in charge of the city’s new COVID-19 Testing and Tracing Program, rather than the New York City Department of Health and Mental Hygiene (NYC DOHMH), the nation’s preeminent municipal health department.
Critics Castigate Mayor De Blasio’s New “Testing and Tracing Corps”
Mayor Bill de Blasio’s launch of the city’s new Testing and Tracing Program is alarming both the political and public health establishments.
The mayor said the program will ramp up to 50,000 coronavirus tests a day and build a corps of 5,000 to 10,000 contact tracers in the coming months.
But he’s drawing fire for putting the nation’s largest public hospital system, NYC Health + Hospitals, in charge of the large-scale initiative, rather than the nation’s preeminent municipal health department.
“It fits the sheer operational scope and capacity of Health and Hospitals,” de Blasio said during the announcement on Friday. “They provide health care directly to people, and so they understand what it means to put together a process that’s going to be not just testing a lot of people and tracing a lot people, but then ensuring a lot of people get to their hotels, get the health care they need, all the pieces.”
He said officials from the city Department of Health and Mental Hygiene would be “deeply integrated into this effort” and would be “coordinated … under the rubric of Health and Hospitals.”
Criticism, though, has been swift and strong.
“This plan raises a lot of alarm bells,” City Council Speaker Corey Johnson wrote in a news release. “Contact tracing is a core function of the Department of Health and Mental Hygiene, and has been for years. This is a distraction when we need to be focused on battling this virus.”
Johnson said the Council would hold a hearing in the coming weeks “to get to the bottom of this and chart the best path forward.”
Other Council Members and their counterparts in the state legislature were even more harsh.
“It is startling that months into the worst public health crisis our City has ever faced, the de Blasio administration is undertaking a bureaucratic reshuffling that creates new and unnecessary obstacles for the critical, complicated and sensitive work of contact tracing,” wrote the chairs of the City Council, State Assembly and State Senate committees on health and hospitals, in a rare joint letter.
“There is no doubt that DOHMH should be the lead here,” wrote Council members Carlina Rivera and Mark Levine, Assemblyman Richard Gottfried, and Senator Gustavo Rivera. “This is what the agency is built for and its expertise and a century and a half of experience in contact tracing cannot be duplicated. We call on Mayor de Blasio to reconsider this decision and to ensure that the vital work of contact tracing is under the unified leadership of our world-class health department.”
City Comptroller Scott Stringer also released a letter asking for the mayor to reconsider.
“Tasking H+H with leading the City’s ‘Test and Trace Corps’ is both contrary to historical precedent and to the established expertise already housed within DOHMH,” Stringer wrote. “At a time when H+H should be focused on providing medical care, especially if infections spike in coming months, operating a new program could further strain their administrative and managerial capacity.”
The mayor’s decision to tap Health + Hospitals officials to lead the effort has rankled members of the city’s Health Department, according to a New York Times story. The department has traditionally handled contact tracing for diseases such as tuberculosis, H.I.V. and Ebola. De Blasio has reportedly butted heads with Health Department officials, who were said to have wanted him to treat the crisis with more urgency in the early weeks.
On Friday, the city health commissioner, Dr. Oxiris Barbot, who has normally attended the mayor’s press briefings through video conference, was absent. Asked about why she was not there, de Blasio said Friday’s briefing topics did not pertain to her.
Pressed on why he was choosing the public hospital system over his closest health experts, the mayor said that testing and tracing represented a vastly larger undertaking that would require more resources and the ability to execute contracts more quickly than a traditional agency.
“Health and Hospitals, also, because of its nature as an independent agency, is able to move very quickly—major contracts, make things happen in terms of personnel operations faster than traditional mayoral agencies,” de Blasio said.
Stringer said the mayor currently has all the emergency authority he needs to fast-track contracts via the Health Department.
Public health experts said they were gobsmacked.
Health and Hospitals, staff and leadership, and have phenomenal infectious disease doctors and epidemiologists that think about diagnosing and treating patients,” said Lorna Thorpe, professor of epidemiology at NYU and the city’s former Deputy Commissioner of Health. “But when I think about what’s needed for contact tracing, it’s the Health Department that thinks about the role of community transmission; that has the relationships with the state, the CDC, other health departments; that has the playbooks on how to do contact tracing; that has the best practices already baked into their DNA.”
She said it’s a little bit like putting officials from a veterinary hospital in charge of a zoo.
“Clearly, they both know a lot about animals, and there’s a tremendous amount of overlap in expertise between the two,” she said. “But running a hospital and running a zoo are two pretty different things. So, I’m just not clear why the decision was made for this transition of responsibility.”
Denis Nash, an epidemiology professor at the CUNY Graduate School of Public Health and Health Policy, said he thought putting the hospital system in charge would slow down deployment of contact tracing, because they lack infrastructure and experience.
“It’s incredibly important to get this off the ground and get it off the ground fast,” Nash said. “And I can’t see how anyone could ever do it as quickly or as well as the New York City Health Department.”
Nash said he was concerned about the people from Health + Hospitals being put in charge, Dr. Ted Long, the system’s Vice President of Ambulatory Care; Dr. Andrew Wallach, who plays a similar role at Bellevue Hospital; and Jackie Bray, the director of the Mayor’s Office to Protect Tenants
“As someone who’s been doing public health in this city for four decades, I have no idea who they are,” Nash said. “They may be great administrators or health care providers and leaders in the health care system. But putting people with no public health experience in charge of this effort is just really wrongheaded. I worry that it’s another one of these huge missteps by our mayor.”
Asked about reports that Health Department officials were unhappy with the move, de Blasio said, in effect, that’s their problem.
“My job is not to ensure people’s happiness,” he said. “This is about effectiveness. It’s about serving people. This is about fighting a pandemic. I’m not going to get overly focused on anyone’s personal opinions in the midst of that.”