COVID-19 Case Investigation and Contact Tracing in the US, 2020

Lash, R. Ryan; Moonan, Patrick K.; Byers, Brittany L; Bonacci, Robert A.; Bonner, Kimberly; Donahue, Matthew; Donovan, Catherine; Grome, Heather N; Janssen, Julia M.; Magleby, Reed; McLaughlin, Heather P.; Miller, James S.; Pratt, Caroline; Steinberg, Jonathan; Varela, Kate; Anschuetz, Greta; Cieslak, Paul R.; Fialkowski, Veronica; Fleischauer, Aaron; Goddard, Clay; Johnson, Sara J.; Morris, Michelle Neyman; Moses, Jill; Newman, Allison B.; Prinzing, Lauren; Sulka, Alana; Va, Puthiery; Willis, Matthew; Oeltmann, John E.

doi:10.1001/jamanetworkopen.2021.15850

Cited by 76 publications

(90 citation statements)

References 34 publications

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“…In previous reports, the yield of COVID-19 contact tracing varies widely, with interview success rates ranging 33–100% ( 13 , 18 – 20 , 31 ) and the proportions of cases reporting contacts ranging 7–100% ( 13 , 19 , 20 , 31 ). In our study, missing or incorrect information (e.g., names, phone numbers) was the most significant barrier to Reach , affecting nearly one-third of cases and over half of reported contacts.…”

Section: Discussionmentioning

confidence: 97%

“…When combined with other preventive measures including physical distancing, universal masking, and digital tracking, contact tracing for COVID-19 has been shown to reduce the effective reproductive number (R e ) ( 7 ), secondary attack rates ( 8 ) and case fatality rates ( 9 , 10 ) and to contain outbreaks and generalized epidemics in diverse settings ( 10 – 12 ). Nevertheless, contact tracing has not proven effective everywhere ( 13 , 14 ), and many have questioned its overall usefulness in the recent pandemic ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Lessons Learned From COVID-19 Contact Tracing During a Public Health Emergency: A Prospective Implementation Study

Shelby

Schenck

Weeks³

et al. 2021

Front. Public Health

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Background: Contact tracing is a core element of the public health response to emerging infectious diseases including COVID-19. Better understanding the implementation context of contact tracing for pandemics, including individual- and systems-level predictors of success, is critical to preparing for future epidemics.Methods: We carried out a prospective implementation study of an emergency volunteer contact tracing program established in New Haven, Connecticut between April 4 and May 19, 2020. We assessed the yield and timeliness of case and contact outreach in reference to CDC benchmarks, and identified individual and programmatic predictors of successful implementation using multivariable regression models. We synthesized our findings using the RE-AIM implementation framework.Results: Case investigators interviewed only 826 (48%) of 1,705 cases and were unable to reach 545 (32%) because of incomplete information and 334 (20%) who missed or declined repeated outreach calls. Contact notifiers reached just 687 (28%) of 2,437 reported contacts, and were unable to reach 1,597 (66%) with incomplete information and 153 (6%) who missed or declined repeated outreach calls. The median time-to-case-interview was 5 days and time-to-contact-notification 8 days. However, among notified contacts with complete time data, 457 (71%) were reached within 6 days of exposure. The least likely groups to be interviewed were elderly (adjusted relative risk, aRR 0.74, 95% CI 0.61–0.89, p = 0.012, vs. young adult) and Black/African-American cases (aRR 0.88, 95% CI 0.80–0.97, pairwise p = 0.01, vs. Hispanic/Latinx). However, ties between cases and their contacts strongly influenced contact notification success (Intraclass Correlation Coefficient (ICC) 0.60). Surging caseloads and high volunteer turnover (case investigator n = 144, median time from sign-up to retirement from program was 4 weeks) required the program to supplement the volunteer workforce with paid public health nurses.Conclusions: An emergency volunteer-run contact tracing program fell short of CDC benchmarks for time and yield, largely due to difficulty collecting the information required for outreach to cases and contacts. To improve uptake, contact tracing programs must professionalize the workforce; better integrate testing and tracing services; capitalize on positive social influences between cases and contacts; and address racial and age-related disparities through enhanced community engagement.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Lessons Learned From COVID-19 Contact Tracing During a Public Health Emergency: A Prospective Implementation Study

Shelby

Schenck

Weeks³

et al. 2021

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…Engagement and participation by individuals with COVID-19 and their contacts are also key factors. Health departments across the United States (US) have reported substantial challenges with individual engagement in the contact tracing process and significant variation in rates of contact disclosure (8)(9)(10)(11). Underreporting of close contacts limits the effectiveness of contact tracing (5).…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Contact Tracing Outcomes in Washington State, August and October 2020

Bonacci

Manahan

Miller

et al. 2021

Front. Public Health

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Introduction: Case investigation and contact tracing are important tools to limit the spread of SARS-CoV-2, particularly when implemented efficiently. Our objective was to evaluate participation in and timeliness of COVID-19 contact tracing and whether these measures changed over time.Methods: We retrospectively assessed COVID-19 case investigation and contact tracing surveillance data from the Washington State centralized program for August 1–31, 2020 and October 1–31, 2020. We combined SARS-CoV-2 testing reports with contact tracing data to compare completeness, reporting of contacts, and program timeliness.Results: For August and October respectively, 4,600 (of 12,521) and 2,166 (of 16,269) individuals with COVID-19 were referred to the state program for case investigation. Investigators called 100% of referred individuals; 65% (August) and 76% (October) were interviewed. Of individuals interviewed, 33% reported contacts in August and 45% in October, with only mild variation by age, sex, race/ethnicity, and urbanicity. In August, 992 individuals with COVID-19 reported a total of 2,584 contacts (mean, 2.6), and in October, 739 individuals reported 2,218 contacts (mean, 3.0). Among contacts, 86% and 78% participated in interviews for August and October. The median time elapsed from specimen collection to contact interview was 4 days in August and 3 days in October, and from symptom onset to contact interview was 7 days in August and 6 days in October.Conclusions: While contact tracing improved with time, the proportion of individuals disclosing contacts remained below 50% and differed minimally by demographic characteristics. The longest time interval occurred between symptom onset and test result notification. Improving elicitation of contacts and timeliness of contact tracing may further decrease SARS-CoV-2 transmission.

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“…In previous reports, the yield of COVID-19 contact tracing varies widely, with interview success rates ranging 33-100% (13,(18)(19)(20)31) and the proportions of cases reporting contacts ranging 7-100% (13,19,20,31). In our study, missing or incorrect information (e.g., names, phone numbers) was the most significant barrier to Reach, affecting nearly one-third of cases and over half of reported contacts.…”

Section: Discussionsupporting

confidence: 43%

“…When combined with other preventive measures including physical distancing, universal masking, and digital tracking, contact tracing for COVID-19 has been shown to reduce the effective reproductive number (R e ) (7), secondary attack rates (8) and case fatality rates (9,10) and to contain outbreaks and generalized epidemics in diverse settings (10)(11)(12). Nevertheless, contact tracing has not proven effective everywhere (13,14), and many have questioned its overall usefulness in the recent pandemic (15).…”

Section: Introductionmentioning

confidence: 99%

Data_Sheet_1.docx

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COVID-19 Case Investigation and Contact Tracing in the US, 2020

Cited by 76 publications

References 34 publications

Lessons Learned From COVID-19 Contact Tracing During a Public Health Emergency: A Prospective Implementation Study

Lessons Learned From COVID-19 Contact Tracing During a Public Health Emergency: A Prospective Implementation Study

COVID-19 Contact Tracing Outcomes in Washington State, August and October 2020

Data_Sheet_1.docx

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