Baker’s ‘test and trace’ gambit

Gov. Charlie Baker, a data and systems guy from way back, has placed a big bet that a methodical approach to the coronavirus pandemic is what it will take to limit the virus’s spread and get the state up and running again. Specifically, he has hitched his wagon to a system known in public health circles as “test and trace.”

In this case, it means testing lots of people for the novel coronavirus and isolating those who are infected, while deploying an army of 1,000 interviewers to find out who those people had recent contact with and then reaching out to encourage those contacts to quarantine for 14 days to help break the chain of transmission of the contagion.

In announcing the effort on April 3, Baker said the state was “breaking new ground in the fight against COVID-19,” boasting that Massachusetts was the first state to launch such a system.

But will the approach work?

A lot depends on “issues of timing, planning, and scale that are still being figured out,” according to a report issued today by the Center for State Policy Analysis at Tufts University. The policy brief says the strategy is fraught with elements that could fall short, and it involves lots of tradeoffs between privacy and quickly gaining access to thorough information.

The Massachusetts effort, being carried out in collaboration with the Boston-based global nonprofit Partners in Health, was spurred largely by the successful test and trace approach used in South Korea, Singapore, and Taiwan. But those countries’ approaches are highlighted by enormous government intrusion to quickly access information, an invasion of privacy that seems unlikely to be tolerated here.

The report says a huge increase in testing is needed for the Massachusetts approach to be effective. The state would need to roughly double its testing from the current level of 5,000 to 8,000 tests per day to 10,500 to 17,000, according to the Tufts analysis. The need to ramp up testing is made clear, the report says, by the high rate of positive findings in US testing — about 20 percent nationally, with an even higher rate of 25 percent in Massachusetts. Those figures suggest testing has been too narrowly focused on only those showing possible COVID-19 symptoms.

In addition to a lot more testing, the report says it will be crucial that the state effort quickly determine an infected person’s recent contacts and then reach those people to let them know they’ve been exposed to the virus. “The fact that asymptomatic people can spread Covid-19 complicates the work of contact tracing — and puts a premium on speed,” says the report. The efforts in Asian countries largely relied on “digital footprints” from cellphones through which massive amounts of data about the movement of people can be quickly harnessed. But that ‘“raises serious concerns about privacy and surveillance,” the report says.

The Massachusetts effort is relying instead on one-on-one phone interviews to obtain that information. The state initiative was the subject of a lengthy story in the New York Times last week. In it, Partners in Health cofounder Paul Farmer, a physician acclaimed for his public health work in developing countries, said the human contact from interviewers is invaluable in helping form a bond of trust with frightened patients.

But it can also slow the process down compared with the Asian models that have relied on technology to map contacts. A Brigham and Women’s Hospital physician who worked on the Ebola crisis in Africa told the Times that the interview-based approach means you have to “manually figure out where someone went,” giving more time for virus transmission among unsuspecting contacts.

The Asian experience also shows that even the best conceived plans can fail when there are holes in them.

After a highly successful first-wave effort put a lid on the virus by using contact tracing and making testing widely available, Singapore was jolted by a sudden doubling of cases in recent days, a surge centered in dormitories housing migrant laborers. The experience of the prosperous Southeast Asian city-state now stands as a harrowing cautionary tale for the US and other countries.

The goal of the Massachusetts effort is to help the state return to some semblance of normal life. The sudden surge of cases in Singapore, the New York Times reported on Monday, “suggests it might be difficult for the United States, Europe, and the rest of the world to return to the way they were anytime soon, even when viral curves appear to have flattened.”

MICHAEL JONAS


BEACON HILL

Gov. Charlie Baker closes schools for the rest of the year, saying a reopening on May 4 would be too early and too dangerous. (CommonWealth) Spring sports for students are another casualty of the closure. (The Salem News)

Baker uses a sports metaphor to explain where the state is in its struggle against COVID-19. “We’re in the third or fourth quarter and we’re holding our own here. Don’t let the virus win the game. Play it all the way to the end.” (CommonWealth)

State officials say the omission of nursing home death data from a new COVID-19 dashboard on Monday was just a technical glitch. New data released on Tuesday indicates nursing homes now account for 54 percent of COVID-19 deaths in the state. (CommonWealth) But the state is temporarily halting the shipment of testing kits to nursing homes, which it said are ill-prepared to administer tests. (Boston Globe)

IDEAS: Stephen Crosby, Ira Jackson, and George Bachrach reimagine what life and policy could be like post-COVID-19. (CommonWealth)

MUNICIPAL MATTERS

Fall River and New Bedford have significantly lower rates of confirmed coronavirus cases than other Massachusetts cities, but the explanation is not clear. (Boston Globe)

Mayor Marty Walsh says there’s no timeline for when Boston will be ready to open up again. (Boston Globe)

HEALTH/HEALTH CARE

The director of the Centers for Disease Control and Prevention says a second wave of the pandemic will likely coincide with next winter’s flu season and prove even more devastating than the current one. (Washington Post)

Some workers provide a glimpse of what’s going on at the Holyoke Soldiers’ Home, where 63 veterans have died over the last four weeks, 52 of them from COVID-19. (WBUR) Columnist Peter Lucas says the deaths at the Holyoke Soldiers’ Home represent another in a string of sometimes deadly administrative failures under Baker. (Boston Herald) The death toll at the Mary Ann Morse Health Care Center in Natick rises to 17. (MetroWest Daily News) Current and former nurses at Life Care Center of Raynham say work conditions and a lack of communication affect their ability to care for residents and prevent the spread of the virus around the nursing home, which has 10 coronavirus deaths. (The Enterprise)

The National Institutes of Health says the drug combination often promoted by President Trump is not a good idea and increases the risk of sudden cardiac death. (NPR) A study conducted by the Veterans Administration and other researchers reached a similar conclusion. (Washington Post)

Human service workers who work for private nonprofits with state contracts say they should also be eligible for the hazard pay that is being given to state-employed health care workers. (Gloucester Daily Times)

North Shore communities are adopting robust programs to trace the path of the coronavirus. (Eagle-Tribune)

WASHINGTON/NATIONAL/INTERNATIONAL

US House Ways and Means Chairman Richard Neal hails money for hospitals in the stimulus bill that is currently being considered by Congress but says more money is needed to help state and local governments. (MassLive) Massachusetts hospitals are losing $46 million a day while fighting COVID-19. (The Salem News)

Joyce Ferriabough Bolling says the next federal stimulus bill must steer money to minority-owned businesses that largely missed out on the first round of funding. (Boston Herald)

Massachusetts firms lagged toward the back of the pack in obtaining funding through the $349 billion Paycheck Protection Program. (Boston Globe)

IMMIGRATION

Gov. Charlie Baker, who normally shies away from criticizing President Trump, says the president’s new plan to ban immigration doesn’t make sense or promote safety. (CommonWealth) Massachusetts’ congressional delegation pledges to fight Trump’s plan. (MassLive)

BUSINESS/ECONOMY

Clammers, who generally sell their clams to restaurants, are being devastated by COVID-19. (Gloucester Daily Times)

More businesses shift production to mask-making. (Herald News)

More people are buying chicks during the coronavirus pandemic – likely so they can have their own fresh eggs. (Telegram & Gazette)

EDUCATION

Harvard University denies President Trump’s claim that it took money meant for small businesses. (WBUR)

Boston Public Schools superintendent Brenda Cassellius joined Boston Public Radio to discuss remote learning for students. (WGBH)

ARTS/CULTURE

Norwell caregiver collects children’s art for isolated seniors (Patriot Ledger)

TRANSPORTATION

The Woods Hole, Martha’s Vineyard and Nantucket Steamship Authority wrote to Gov. Charlie Baker asking for help to keep service to Nantucket and Martha’s Vineyard going past May 31. (Cape Cod Times)

CRIMINAL JUSTICE/COURTS

The Supreme Judicial Court orders a new trial for a man covicted of murder in 1972. (Dorchester Reporter)

The State Police Academy in New Braintree shuts down and sends trainees home after two trainees test positive for COVID-19. (Telegram & Gazette)

The Stow police chief is placed on leave after he is accused of soliciting teenagers. (MassLive)

A jailed mobster from Longmeadow is among those seeking early release due to the coronavirus. (MassLive)

PASSINGS

An employee at Star Market in Belmont died from coronavirus, raising new concerns about the safety of grocery store workers. (MassLive)