The Download: Feature Articles
DETER Tracks Touch: A Coronavirus Study
By Victoria Lubas | November 17, 2020
Debra Laefer and Thomas Kirchner Lead Research Team to Track Touch Behavior
When the COVID-19 pandemic hit New York, students across the Big Apple stocked up on groceries, figured out Zoom, and prepared to spend the foreseeable future working and learning from home. With the hope of shedding light on the disease's transmission and tracking the virus's spread, the students involved in CUSP Professor Debra Laefer and CUSP and GPH Professor Thomas Kirchner's Developing Epidemiology mechanisms in Three-dimensions to Enhance Response (DETER) project braved the unknown landscape of COVID-19 by agreeing to gather data on people's touch behaviors after leaving hospitals and medical centers. This project, spanning from March to May, tracked changes as the curve flattened and the weather warmed, earning the team a New York State GIS Applications/Dashboard Award.
Finding Funding through a RAPID Grant
The National Science Foundation (NSF) put out a call for proposals in early March, just as the city was shutting down in preparation for a peak of coronavirus cases. Laefer knew she and Kirchner wanted to contribute research to the coronavirus pandemic that would track more than just geospatial movements. They ultimately decided to study individuals' touch behaviors. The team applied for an NSF RAPID grant, which is meant to aid in capturing perishable data, such as in the case of natural disasters.
They received the grant and prepared to begin collecting data in mid-March, at a time when circumstances surrounding the virus and the city's response to it were still unknown. Laefer recalled that at this time China was completely locked down, while Spain and Italy were under stay-at-home orders that prohibited people from leaving their apartments. These global developments raised concerns among the team that similar restrictions would be imposed on New York. Despite the uncertainty, Laefer and Kirchner sought students to work as data collectors as soon as safely possible, posting the position to NYU Handshake and reaching out to the NYU student body and to Kirchner's Global Public Health students. They hoped to begin collecting data early in the course of the virus to allow more opportunities for revealing changes in behavior over time.
The anxiety about the virus that now weighs heavy on most people’s minds was new and unfamiliar at the start of this project. Laefer explained that two students turned down the job after their family expressed concerns or their roommates threatened to kick them out. Ultimately, Laefer and Kirchner hired 16 brave student researchers to venture into four of the five boroughs and track touch behaviors while also acquainting themselves with the switch to online learning and coping with the coronavirus anxieties that heightened as the city that never sleeps became known as a hotbed. Reflecting, Laefer expressed "a huge amount of respect for those students going out during this scary time and being stationed at these hospitals where the death toll was so high that temporary mortuary trucks were brought in just across from where our student researchers were standing each day. What a hard thing to look at, yet they persevered."
Students Gather Data, Preserve Privacy
During the months of March, April, and May, many patients going to a hospital were sick with COVID-19. Patients with most other ailments were avoiding the hospital as much as possible, even if facing a heart attack or stroke. The danger associated with hospitals meant one could assume that anyone who'd been inside a hospital could be carrying the virus outside of the building with them.
The student researchers began their data collection on March 23, the first full day of the governor's PAUSE order that closed businesses and suspended in-person contact. To gather data on which surfaces were the most touched, student researchers started by stationing themselves across the street from a hospital or medical center's exit. Laefer explained that they were instructed to begin by "looking down at their phone, noting the time, then looking up and following the next person out of the building." Sometimes this meant idling across the street from a medical facility for long stretches.
The student researchers always stayed across the street in order to be discrete in their tracking and followed their subjects for up to twenty minutes, one mile, or until they entered a subway station or building. To maintain the anonymity and privacy of the people being observed, student researchers did not take any photos or videos of their subjects and did not record any information other than their gender, touch behaviors, and PPE habits. As they followed them on foot, the student researchers recorded their subjects' location and, more importantly, what they touched using Bluefield GIS' Draw Maps app. During the project, Draw Maps would not auto-export on iPhones, but for the sake of the DETER project, Worth Sparks from Bluefield GIS worked with Laefer to change the development schedule. Students conducted ten to twenty hours of research a week at various times and during all kinds of weather, yielding a large data set of more than 5,000 records on 6,000 people over the course of nine weeks.
Prevention and Spread: Masks and Mobile Phones
The DETER project's researchers noted some trends and big behavior changes over the course of the data collection window. The length of the project and rapidly-changing guidelines and mandates at the time allowed the project to document the effect of changing weather, government policies, and COVID-19 fatigue on people's use of personal protective equipment (PPE) and their touch behaviors.
During the first three weeks of the pandemic in New York in mid-to-late March, the data shows that over half of the women observed wore masks but the percentage of men wearing masks was significantly smaller. Once the New York State mask mandate was enacted on April 17, the percentage of people wearing masks jumped dramatically to nearly full compliance, allowing Laefer to "see the impact of government policies." Even so, student researcher Weiyi Qiu was surprised by how many people wore "a mask made of some fabrics that do not offer protection from viruses…[or] wore the mask in the wrong way (leaving their noses outside), which indeed turned PPE useless."
Laefer was surprised to learn that 15%-16% of subjects "left the hospital to use the phone, walk around the block, [or] go for food...and went back into the hospital" which they hadn't anticipated. The DETER researchers also noticed some touch-avoidance behaviors proved problematic, such as early in the pandemic when hospital doors were typically touched in the exact same spot by every person exiting. As the study progressed, student researchers noticed that people began attempting to touch as few things as possible and eventually some doors ceased being touched altogether, leading the team to believe that an automatic sensor or button to open must have been installed.
In late spring, the weather warmed, the news began reporting a successful flattening of the curve (e.g., a reduction in new cases), and more businesses began to reopen. During these weeks, student researchers reported increased outings to coffee shops or food trucks and a decrease in cautious touch behaviors among those being tracked. After the project's completion, the DETER team tied their data to other relevant information, such as weather data. Student researcher Darlene Cheong explained that as it began getting warmer late in the study, the majority of people stopped wearing gloves. Laefer said that humidity, rather than higher temperatures, had the greatest effect on mask-wearing, with humid days reporting the least consistent mask use.
Regardless of temperature, weather, or number of reported cases, one behavior that remained consistent throughout the study was cell phone use. Laefer explained that medical personnel's frequently touched items, such as cell phones, pens, and computer mice, are all highly likely to be covered in germs. The CDC explains that COVID-19 spreads most commonly through close contact to respiratory droplets but still considers touching virus-covered surfaces before touching your mouth, nose, or eyes to be a possible form of spread. Even so, the first thing many people did when exiting the hospital was take out their cell phone, leading Laefer to believe that cell phone use is so ingrained in our daily lives that phones are "not [even] perceived as touching something…[and not] seen as a risk."
Looking Back and Looking Forward
For their observations, the student researchers were assigned hospital or urgent care facilities close to where they lived to avoid exposure to public transportation. The behaviors they observed so close to home made them more cautious in their everyday lives. Darlene Cheong and Nikki Tai both explained that they often followed people to grocery stores or McDonalds straight from medical facilities, reminding them to always be cautious even at non-medical locations. Data collection prompted Tai to double-up on masks or gloves at that time as she realized most people going "in-and-out of New York were [the same] people in-and-out of medical facilities." Cheong "started trying not to use [her] phone when out, and cleaning [her] phone whenever [she] came home" after seeing how many people immediately touched their germ-covered phone to their face to make a call.
Cheong and Tai both noted the effect the pandemic is having on New York City’s homeless population as they saw several homeless people pick up items, including a cigarette, almost immediately after they'd been discarded by someone leaving a medical center. Cheong and Tai are now working with data regarding the virus' flow inside cars and the dangers of riding in a shared car during the pandemic, such as the "risk of getting in an Uber with a hospital visitor," which Tai pointed out. Cheong feels that based on their findings "rolling down windows [in a shared car] should be a mandate."
Laefer explained that one next step of this project will be scanning the observed areas with Light Detection and Ranging (LiDAR) technology, and then "to take this data and make 3D models so hospital administrators can see…[the] hotspots of where people [are] touching more surfaces." This information could help hospitals reduce the frequency with which certain items are touched and inform the public of safer virus-avoidance practices. Laefer is currently coordinating with the National Science Foundation to extend the study at half of the original New York City locations as well as in additional cities in the U.S. and abroad. This second leg of the study will be more streamlined in terms of data collection with the goal of finding the most effective procedures for cities of varying cultures, sizes, and densities. For more information on this study as it progresses, visit the NYU Libraries Spatial Data Repository.