DPH deputy outlines contact-tracing system, flags testing delays and equity gaps

Susan Phillip, deputy health officer who directs the disease prevention and control branch at the Department of Public Health, briefed the San Francisco Health Commission on July 7 about the city's case investigation and contact-tracing program.

Phillip said the department has sustained continuous case investigation and contact tracing since the outbreak began in March by using a centralized database called Comcare, provided by Dimagi. "Comcare has been really a key tool that has enabled us to do this work and go back and measure our outcomes," she said.

Phillip summarized how the program works and why it matters: cases (people who test positive) are interviewed about close contacts, those contacts are notified and urged to quarantine, and wraparound supports are offered to help people isolate safely. The DPH prioritizes "client-centered" interviews and language concordance so people can get services, she said.

On staffing and capacity, Phillip said the DPH frontline team includes about 142 staff with 26 in case investigation and roughly 85 in contact tracing; 45% of staff are bilingual or multilingual. For April through June, 52.8% of case interviews were conducted in Spanish and about 42% in English. Phillip described training requirements (around 30 hours of didactic and role-play before taking calls) and said the team operates seven days a week to reach cases promptly.

Phillip gave recent outputs and performance indicators: from April through June 21 the city completed 1,867 case interviews, identified 2,968 contacts and notified 2,285 contacts. On two-week metrics, the percent of cases reached was about 82%, and the percent of named contacts reached was 88%—below the regional aspirational goal of 90%.

"The goal is 90%," Phillip said. She and commissioners discussed the limits of that target and whether it is realistic given testing delays and people's willingness to name contacts. Phillip said about 80% of successfully notified contacts during the mid-April to mid-June review were household contacts, and that privacy concerns, immigration status, and employer retaliation likely depress naming of workplace contacts.

Phillip emphasized technological and program supports that have strengthened DPH's work: text-messaging integration that allows daily symptom checks, Internet-based phone systems to manage callbacks, and work with community-based organizations to expand culturally appropriate outreach. She also pointed to the Right to Recover program as a potential facilitator of isolation by providing wage replacement for people who must stay home.

On testing, Phillip said CityTest SF sites at the Embarcadero and SOMA were experiencing roughly a seven-day wait for appointments; some San Francisco Health Network sites serving uninsured patients can still offer same-day testing. She warned that delays from test appointment to result reduce the effectiveness of tracing: "The faster we can get someone tested and notify results, the better," she said.

Phillip described several operational steps the DPH is pursuing: onboarding CBOs into Comcare with core data elements to maintain a unified dataset; training for language concordance; iterative PDSA (plan-do-study-act) quality-improvement cycles to shorten timelines; and exploring ways to fast-track tests for identified contacts.

Next steps Phillips outlined included expanding community partnerships, monitoring the impact of Right to Recover on people's ability to isolate, improving measures for whether contacts actually follow quarantine, and further integrating testing access with outreach efforts. She said DPH will report back with more detail on matching contact-tracing records to testing outcomes and other performance metrics.

The presentation set the stage for the commission's broader COVID-19 update on city indicators and for later questions from commissioners about outcomes, equity, and operational improvements.