Philadelphia Health Commissioner Dr. Thomas Farley lamented "fear and mistrust" around COVID-19 contact tracing efforts in the city, saying Thursday that as many as one-third of residents reached are not cooperating with health department staff.
With Philadelphia's case numbers falling in recent weeks, the benefits of contact tracing have become more tangible in preventing possible spread of the coronavirus.
Farley provided an updated snapshot of data from the seven-day period ending on Aug. 8.
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During that time, the city recorded 718 new COVID-19 infections, including 653 cases that were handled through the health department's contact tracing program. The remaining 65 were managed by independent partners.
Among the cases handled by the city, 65% were reached and agreed to participate, while 4% refused outright. Another 4% did not have a publicly available phone number and 25% could not be reached.
Those who cooperated with the health department yielded an average of three contacts per cases. The city was able to reach 77% of those contacts and they agreed to quarantine.
But about one-third of the COVID-19 patients who were reached and who initially agreed to participate ultimately told contact tracers that they either had no contacts or couldn't name any.
"I don't think that they're being totally truthful," Farley said. "I think they're basically not cooperating. People are reluctant to give us the names of folks that they've been around. There's a lot of fear and mistrust out there, so we are encouraging people to work with us.
"We hope that over time, people get familiar with this and understand that our contact tracers are only helping. But there is definitely reluctance to participate."
Still, Farley acknowledged that most people have come forward with useful information that has enabled the city to reach others who may have been exposed to the virus. The data, which is kept anonymous, helps the health department understand trends in COVID-19 transmission.
During the most recent period, for instance, 41% of patients said they believe they know the person who gave them the infection. Most of the time, this was a family member.
Additionally, 18% of patients said that they had traveled out of the state, a decrease from the 27% who said they did so during the last data period shared by the health department.
Farley said contact tracers have not yet encountered any large "super-spreader" events in Philadelphia, as often reported in other cities and towns. There have been cases that were linked to smaller clusters of three or four people that turned up through contact tracing.
With roughly 100 staff members, Farley said the health department is still evaluating and honing the contact tracing program. There are no current plans to expand the staff.
"If we feel like hiring more makes sense within our budget, we will do that," Farley said. "But we also need to recognize that contact tracing is just one piece of an overall strategy. As you see from this, it's not a perfect strategy. You're not going to be able to find every case. You're not going to be able to get everybody to cooperate. It needs to work with other parts of the strategy."
Philadelphia reported 185 new cases of COVID-19 on Thursday, bringing the citywide total to 31,910 since the start of the pandemic. That number is higher than it has been in recent days. The test positivity rate of 5%, of 3,719 tests administered, also represents an increase.
There were no new deaths reported Thursday, although nine fatalities attributed to COVID-19 were confirmed on Wednesday, bringing Philadelphia's death toll 1,709. Severe outcomes — including deaths, hospitalizations and infections among vulnerable residents — all have declined significantly in the city over the past two months.
For the time being, the city has not signaled any pending changes to its current modified green phase restrictions, including the question of indoor dining at restaurants.
Farley said it "unlikely" that the city's restrictions on larger gatherings will be loosened before Sept. 20, when the Philadelphia Eagles are scheduled to play their home opener at Lincoln Financial Field.
Under the current guidelines, fans would not be allowed to attend games at the Linc. The city left the door open last month, clarifying that the decision is separate from the moratorium on public events, but any approval will require the city's stamp.
Though the Eagles have maintained hope that spectators may be allowed in the stadium at limited capacity, several other NFL teams already have ruled out fans to start the season, at a minimum. Some teams, including the Dallas Cowboys and New England Patriots, have said they intend to allow fans to attend games in accordance with their respective state regulations.
Moving forward, Farley said that face mask use in Philadelphia remains "as important as ever" to prevent the spread of COVID-19.
The CDC recently updated its guidelines on masks, urging the use of tightly woven cloth material in favor of masks with valves or vents, or neck gaiters, which can potentially allow viral droplets to exit through openings.
Philadelphia will soon provide its own updated guidelines on masks, but Farley thanked all residents who have committed to the habit of wearing them regularly. He also offered a reminder that face masks must cover the nose in order to be effective.
"When you're wearing any type of mask, make sure it covers both your mouth and your nose," Farley said. "I see a lot of people with good masks that are letting them drop down and it's not covering their nose. It doesn't do you any good, or it doesn't do the people around you any good, if you've got a great piece of material for your mask but it's not covering your nose."
The city is now selling the masks seen its public campaign, which say, "Love Your Neighbor. Wear a Mask." A portion of the proceeds from the masks will support the Black Doctors COVID-19 Consortium, an organization providing pandemic resources and testing access to Black residents in Philadelphia.