Objectives: We conducted a survey to understand how people’s willingness to share information with contact tracers, quarantine after a COVID-19 exposure, or activate and use a smartphone exposure notification (EN) application (app) differed by the person or organization making the request or recommendation. Methods: We analyzed data from a nationally representative survey with hypothetical scenarios asking participants (N = 2157) to engage in a public health action by health care providers, public health departments, employers, and others. We used Likert scales and ordered logistic regression to compare willingness to take action based on which person or organization made the request, and we summarized findings by race and ethnicity. Results: The highest levels of willingness to engage in contact tracing (adjusted odds ratio [aOR] = 1.74; 95% CI, 1.55-1.96), quarantine (aOR = 1.91; 95% CI, 1.69-2.15), download/activate an EN app (aOR = 1.30; 95% CI, 1.16-1.46), and notify other EN users (aOR = 1.43; 95% CI, 1.27-1.60) were reported when the request came from the participant’s personal health care provider rather than from federal public health authorities. When compared with non-Hispanic White participants, non-Hispanic Black participants reported significantly higher levels of willingness to engage in contact tracing (aOR = 1.32; 95% CI, 1.18-1.48), quarantine (aOR = 1.49; 95% CI, 1.37-1.63), download/activate an EN app (aOR = 2.19; 95% CI, 2.01-2.38), and notify other EN users (aOR = 1.63; 95% CI, 1.49-1.79). Conclusions: Partnering with individuals and organizations perceived as trustworthy may help influence people expressing a lower level of willingness to engage in each activity, while those expressing a higher level of willingness to engage in each activity may benefit from targeted communications.

During the COVID-19 pandemic, public health agencies implemented an array of technologies and digital tools to support case investigation and contact tracing. Beginning in May 2020, the Association of State and Territorial Health Officials compiled information on digital tools used by its membership, which comprises 59 chief health officials from each of the 50 states, 5 US territories, 3 freely associated states, and the District of Columbia. This information was presented online through a publicly available technology and digital tools inventory. We describe the national landscape of digital tools implemented by public health agencies to support functions of the COVID-19 response from May 2020 through May 2021. We also discuss how public health officials and their informatics leadership referenced the information about the digital tools implemented by their peers to guide and refine their own implementation plans. We used a consensus-based approach through monthly discussions with partners to group digital tools into 5 categories: surveillance systems, case investigation, proximity technology/exposure notification, contact tracing, and symptom tracking/monitoring. The most commonly used tools included the National Electronic Disease Surveillance System Base System (NBS), Sara Alert, REDCap, and Maven. Some tools such as NBS, Sara Alert, REDCap, Salesforce, and Microsoft Dynamics were repurposed or adapted for >1 category. Having access to the publicly available technology and digital tools inventory provided public health officials and their informatics leadership with information on what tools other public health agencies were using and aided in decision making as they considered repurposing existing tools or adopting new ones.

Until COVID-19, the greatest national public health crisis was the 1918 influenza pandemic, which was covered extensively by Public Health Reports. [1][2][3][4][5][6] Extrapolating from their knowledge of tuberculosis, public health authorities at that time exhorted ill people to remain home to break the chain of respiratory transmission. 7 Other contemporaneous appeals that reverberate a century later include "avoid needless crowding," "stay in the open air," "wear a gauze mask over the nose and mouth," and "keep away from houses where there are influenza cases." 2 In 2020, COVID-19 spurred case investigation and contact tracing at levels never seen in the United States. [8][9][10][11][12] Until vaccines, therapeutics, and SARS-CoV-2 tests became available, mitigation measures were strictly nonpharmaceutical. These included physical distancing, wearing face masks, and enhancing ventilation. In this context, state, tribal, local, and territorial health departments relied on asking people with COVID-19 to isolate and share information about close contacts (ie, case investigation) so that exposed people could be notified and asked to quarantine, ideally before they themselves became infectious (ie, contact tracing). [13][14][15][16][17] This supplemental issue of Public Health Reports provides firsthand examples of how public health departments across the United States reprioritized workflow and redirected staff to accommodate fluctuating COVID-19 incidence during 2020-2021, incorporated new partners to augment case investigation and contact tracing, evolved processes to improve outreach to disproportionately affected community groups, used digital tools for case and contact management and for proximity technology or exposure notification, and evaluated the effectiveness of these innovative strategies.