Rapid COVID-19 Testing and On-site Case Investigation and Contact Tracing in an Underresourced Area of Salt Lake City, Utah, December 2020–April 2021

Abstract

This case study describes how we paired free SARS-CoV-2 rapid antigen testing with on-site case investigation and contact tracing at a drive-through site in an underresourced area of Salt Lake City. Residents of this area had lower rates of employment and health insurance and higher rates of poverty than in the Utah general population. People were given an option to remain on-site and wait until their test results were ready. If a vehicle occupant received a positive test result, the case investigation occurred on-site; contact tracing with the other vehicle occupants was also initiated. People were provided resources to support isolation and quarantine. Bilingual staff who spoke Spanish were incorporated into the workflow. From December 2020 through April 2021, public health staff administered 39 587 rapid tests; 4094 people received a positive test result and 1133 stayed for on-site case investigation. More than half (60.5%) of people with a positive test result who agreed to stay for on-site case investigation were Hispanic or self-reported belonging to a non-Hispanic racial minority group (American Indian/Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, or other racial identities). Pairing rapid antigen testing with on-site case investigation and contact tracing is feasible and improved the timeliness of case investigation by ≥1 day. On-site vaccination services were later integrated. Future emergency responses might consider assisting underresourced communities with on-site services that provide convenient and accessible public health interventions. By providing dependable and reliable services, we were able to achieve buy-in and become a consistent resource for those in the community.

Innovative Approaches to COVID-19 Case Investigation and Contact Tracing

“… 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. 23 …”

“…Early in the pandemic—before health departments were able to hire new staff—undergraduate and graduate students in the United States volunteered to serve as case investigators and contact tracers. 19 , 20 , 22 , 36 , 37 Their willingness to work outside traditional business hours and to staff virtual call centers was particularly valuable to the health departments that they supported. One recommendation for more efficient deployments during future public health emergencies is to have preexisting service/learning programs and memoranda of understanding between public health entities and academic partners that include credentialing public health students to train with student response teams and assist health departments with data entry, epidemiologic analyses, or other short-term needs.…”

“…35 The free COVID-19 testing location situated in a demographically diverse part of Salt Lake City included staff who could discreetly initiate case investigation and contact tracing through the car window, in either English or Spanish, immediately after the positive test result; more than half of people who received these services self-identified as either Hispanic or non-White. 22…”

“…20 Ensuring staff fluency in additional languages also characterized effective community outreach in New York City, Phoenix, and Salt Lake City. [19][20][21][22]…”

“…Because COVID-19 case investigation and contact tracing had to be implemented rapidly, public health jurisdictions generally devised their own approaches, [8][9][10][11][12][13][14][15][16][17] limiting later assessments of their effectiveness in curtailing SARS-CoV-2 spread to metrics such as the proportion of people with positive test results who completed a case interview within a certain time frame or the number of close contacts elicited per interview. 9,12,[19][20][21][22][23]35,38,41 Many case interviews appear to have resulted in no or few named close contacts 9,35,41 ; whether a bifurcated or joint staffing model was more productive remains unclear. 12,15 Even less is known about whether this resource-intensive activity affected isolation and quarantine decisions or, ultimately, reduced transmission.…”