COVID-19 Case Investigation and Contact Tracing Programs and Practice: Snapshots From the Field

Abstract

Between Fall 2020 and Spring 2021, the Association of State and Territorial Health Officials conducted 2 rapid queries to collect information from the field regarding the status of COVID-19 case investigation and contact tracing (CI/CT) programs and practice. These short surveys were distributed to senior deputies in state and territorial health agencies, yielding a response rate of 45.8% (November 2020) and 40.7% (April 2021). Findings indicated that CI/CT staff roles and assigned functions varied across jurisdictions, as did staffing levels/capacity, approaches for linking individuals to social supports, and program changes that were planned or underway. Agency-reported staffing levels/capacity and programmatic challenges changed over time, highlighting the dynamic nature of CI/CT program practice and implementation. While findings from the surveys cannot be generalized to the national level, they provide critical insights from the field on CI/CT program implementation, challenges, and changes in response to the evolving COVID-19 epidemic in the United States.

Unified Response to COVID-19 Case Investigation and Contact Tracing, Chicago, December 2020–April 2021

“…Our CI/CT program had several implementation challenges, consistent with the findings of articles on other US contact tracing programs. 15 , 16 First, the time and resources needed to train HCF case investigators and CBO contact tracers were important but might have resulted in missed opportunities for timely CI/CT during the initial part of the analysis period. Second, while the number of COVID-19 cases was increasing, CI/CT program staff at the various organizations were conducting investigations and recording data while the Chicago CARES database was still being developed and modified.…”

Innovative Approaches to COVID-19 Case Investigation and Contact Tracing

“…However, the increased workload quickly became overwhelming. 12 , 18 - 21 The March 2020 US Coronavirus Aid, Relief, and Economic Security Act included an infusion of resources to hire additional public health personnel, including contact tracers. 9 , 16 As described in the case study from Michigan, the CDC Foundation’s COVID-19 Corps expedited the recruitment of contracted telephone-based contact tracers, including people who speak languages other than English, based on the needs of that jurisdiction.…”

“… 19 , 20 Other jurisdictions used a joint staffing approach. 12 At one city’s drive-through rapid testing site, for example, if one car occupant received a positive test result, both case investigation for that person and contact tracing for all other car occupants began concurrently. 22 In another community, integrating these tasks and cross-training field workers to collect nasopharyngeal swab specimens among household contacts also helped improve timeliness and new case detection.…”

“…As the COVID-19 pandemic stretched on, public goodwill to follow public health recommendations lagged. 12 Self-described political ideology, for example, was associated with the likelihood to support using smartphones for public health purposes. 39 Nevertheless, a spring 2021 national survey found high levels of willingness to participate in COVID-19 contact tracing, quarantine, and exposure notification, provided that public health communications were perceived as coming from trusted sources, most notably the personal health care providers with whom people had an established relationship before the pandemic.…”

“…Given the widespread availability of vaccination, at-home antigen test kits, face masks, and other prevention tools, public health strategies changed, endeavoring to empower individuals with messages such as “help protect yourself and others” and “how to talk to your close contacts” (ie, case-driven notification). 12 , 46 , 47 New websites aimed directly at members of the public included a quarantine and isolation calculator 48 and a mechanism to alert close contacts anonymously via email or text ( https://tellyourcontacts.org ).…”