Coronavirus clusters in Connecticut uncovered by state investigators show virus spreading at restaurants, private homes and places of worship, new data shows

Hartford Courant - 11/12/2020

Connecticut infectious disease specialists have investigated 69 coronavirus clusters since August, outbreaks stemming from everything from graduation parties to college hockey teams, but the most clusters have been found among restaurant workers, information obtained by the Courant shows.

The team identified 20 clusters at restaurants and another 14 at other workplaces -- nearly half the total. The workplaces included factories, a tobacco farm, retail stores and offices. The highest number of infections per cluster came from religious gatherings -- with a median of nine positive cases per cluster.

Family gatherings are also a major source of infection, the data shows. The state identified 12 clusters centered around private homes, with 7.5 infections as the median. In one case, the state identified 17 infections tied to a single residence.

The information is not a complete picture, but a partial snapshot of the sources of infection. Outbreaks at nursing homes and institutions of higher education are not included because they are investigated by separate units within DPH. There have been a number of significant outbreaks both at nursing homes and on college campuses.

The data provides key insights into how the virus is spreading so readily across Connecticut, with cases, hospitalizations and deaths again rising sharply since the summer. The surge in coronavirus infections have forced schools to move to remote footings, sparked hospitals to roll out contingency plans and prompted Gov. Ned Lamont to rollback parts of the states' reopening plan.

The data was gathered by the state Department of Public Health’s “outbreak team,” operated by the Epidemiology Unit. The team tracks possible COVID outbreaks cases through its contact tracing surveillance system known as ContactCT which started in late August.

“Even though our testing capacity has greatly expanded, there is still more disease activity than we can actually measure so this is somewhat of an underestimate,” DPH spokesman Av Harris said. “But we are doing a lot of work to try and track down as much data as we can because it can help us decide where we need to focus and send resources.”

For example, the state’s Deputy Epidemiologist Dr. Lynn Sosa, cautioned that the total number of household transmissions is far higher than the ones the outbreak team has investigated.

“I wouldn’t take what we provided as all of the household transmissions, we know that primarily if someone in a household gets sick you are going to see a lot of other people in that household get sick as well,” Sosa said.

Tracking outbreaks

As the virus spreads, a contact tracing team of close to 750 people, including full time staff, local health departments and volunteers, are interviewing COVID positive residents across Connecticut. The goal is to determine their close contacts and and where they may have contracted the virus so that health officials can try and stop the transmission chain.

In the data obtained by the Courant, restaurants account for about 30 percent of the clusters with each outbreak on average infecting about five people. There was one instance when at least 15 people were infected.

Almost all of the cases are restaurant employees, specifically "back” staff such as cooks rather than patrons, according to Sosa.

“For the most part restaurant outbreaks primarily are among the employees if you think about kitchen staffs its group of people sometimes working in very, very small spaces,” Sosa said, adding in a number of instances they aren’t always wearing masks.

“We did have a few situations where there were few outbreaks of employees and patrons but it is not always easy to figure out if they are related or if the person was infected somewhere else,” she said.

The other two categories with the highest number of clusters are what DPH is calling “workplace” and “home,” with 14 and 12 cases, respectively. The median number of infections for workplace clusters was 4.5. While there were slightly fewer clusters tied to private homes, the number of infections was higher, with a median of 7.5.

DPH breaks the clusters down into 10 categories - others include houses of worship, sports facilities, domestic travel cases, child care cases and other.

DPH also breaks down the cluster by weeks and the data shows that for the past five weeks or since about October 3 - right before Gov. Lamont’s Phase 3 reopening occurred - outbreaks have been increasing, though the numbers have increased dramatically over the last 6-8 weeks. Over the past two weeks there have been over seven clusters each week.

Under Phase 3, restaurants were allowed to increase indoor capacity, but as the virus started to spread more rapidly Lamont rolled back restrictions. Indoor capacity was capped again at 50 percent and restaurants were also required o stop serving by 10 p.m.

“The trajectory is going up in general and it predates the start of Phase 3, which is consistent with the fact that we started seeing cases in the state going up at the beginning of August,” Sosa said.

Most of the home cases are from graduations or family barbecues or involve a family member being infected someplace else and bringing it into the home.

“Recently we have had a few situations where we’ve had backyard get togethers as a cause but it is sometimes it is hard to determine how much of a party was outside. Often times there are people inside and outside and they congregate by the food, so even though they might have been outdoor events there were likely indoor interactions,” Sosa said.

Making contact

The task of contact tracing begins when a person tests positive for COVID-19. Those results are automatically exported to the ContactCT database where the race begins. Local health directors are alerted when there are cases in their districts to try and contact the person. If they are unable to, or as is the case recently, are overwhelmed with cases, the state has 165 full-time and 125 volunteer contact tracers who pick them up.

Lamont’s Chief Operating Officer, Josh Geballe, said contact must be made with the infected within 48 hours. He said the latest data shows that in 98 percent of the cases the tracers have made contact with the infected person in that time period.

Geballe said two-thirds of those contacted answer the questions needed to complete the survey. The tracer then inputs the data into the system so epidemiologists can review it. The state’s response rate is about the same as neighboring states.

Sosa said the “numbers are pretty good considering that this is a voluntary process and you can’t make people cooperate.”

“For the most part I think people understand the importance,” Sosa said. “There’s always going to be people who say yeah I know I’m positive and then they won’t tell you anything else and then there are people who already made sure their friends and neighbors know they are positive.”

Geballe said contact tracing is particularly difficult in cities. To try and improve communications with members of minority communities who are most at risk for the virus, the state has hired bi-lingual contact tracers and hired people who live in 11 cities through a community outreach program.

Sosa said the outreach program has helped in recent outbreaks in Danbury and Norwich.

“We know especially when we started having the Danbury or Norwich issues a lot of people were worried and didn’t want to talk to contact tracers because they have to go to work, have to support my family,” Sosa said.

“The idea is to ask specific questions about where they work and any venues or restaurants they may have gone to and then we can look at common venues where people say they were to determine if there’s an outbreak,” Sosa said.

Religious gatherings an issue

The data on clusters investigated by the state is a partial look at the overall picture; it doesn’t include outbreaks in nursing homes or schools because they are investigated by separate units within the state Department of Public Health.

There have been several long-term care outbreaks in the past few weeks, from Colchester to Canaan, as the number of cases within long-term care facilities rises along with community spread of the virus.

There have also been multiple outbreaks on college campuses.

Just this week UConn quarantined more than 540 students in five dorms due to an increase in COVID-19 cases. The school said there were 34 new cases, the highest number since August. Last week Quinnipiac University quarantined the entire campus for two weeks after getting 115 new COVID-19 cases in just 48 hours.

There also have been outbreaks at schools as well, although state officials maintain schools aren’t a super spreader of the virus even as some school systems announced this week they were going to remote learning because of a spike in cases.

“What we’ve seen with schools is limited transmissions where one or two get the virus and then it stops,” Sosa said. “We’re not hearing about more transmissions within the classroom or the school so if a teacher is positive we aren’t seeing a lot of their students testing positive as well.”

The location with the highest average number of cases per outbreak is houses of worship, according to the data. While there have been only six clusters, the average number of cases in each one is about 10, records show.

But Sosa said those outbreaks haven’t occurred in large churches or cathedrals but instead “storefront churches” primarily found in cities.

“Don’t envision the big cathedral type thing it’s more smaller storefront type churches in communities where there are a group of people in a small setting with maybe not the best ventilation,” Sosa said.

One of the largest outbreaks that DPH has investigated was the Yale Men’s Hockey team which earlier this month had an outbreak in which there were a total of 18 COVID-19 cases out of 19 team members. Hockey in general has been a source of several outbreaks and recently Gov. Lamont said the COVID-19 spread in and around hockey has led to at least 45 infections in the state. The Yale hockey outbreak was included because the team practices at a community facility.

Hockey is included in a category called “sports facilities,” which also includes gyms and fitness centers. DPH has investigated four clusters with the largest being 21 cases.

Apple and Google

The state’ is set to announce a new contact tracing tool launched by Apple and Google designed to automatically alert users to potential coronavirus exposures.

The state has been testing it out on college students the last few weeks and Geballe said earlier this week more would be revealed at the Governor’s weekly Thursday press conference.

The new tool sends notifications to users if they’ve recently been in contact with another user in the last two weeks who has tested positive for COVID-19. The alerts will be anonymous but people can’t get them unless they activate the app on their cellphones.

Once they activate the alert, people will get a notification on their phone notifying them that someone they were within six feet of recently has tested positive for COVID-19. The alert will have a link people can click to see what steps they can take next.

Several states have already started using the system but Connecticut was waiting because of concerns about whether it would violate people’s privacy and they also wanted to see how it worked in the field, Geballe said.

Geballe called it “another tool” for contact tracing which will become more important as the virus spreads. The state has expanded it’s testing capabilities but all of the testing isn’t helpful if someone isn’t tracking down those that are infected to stop the spread.

“It (tracing data) is used for several purposes one is for the case investigations and the outbreak work that Lynn and local health teams do to trace the contacts to try and make sure that people who have been exposed are quarantining to break those chains of transmission,” Geballe said.

“But then also we are increasingly looking at the aggregate date to help form public policy. Are there certain areas where we are seeing more risk or more transmission?”

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