Why Contact Tracing Efforts Have Failed to Curb Coronavirus Disease 2019 (COVID-19) Transmission in Much of the United States

Clark, Eva H.; Chiao, Elizabeth Y.; Amirian, E. Susan

doi:10.1093/cid/ciaa1155

Cited by 66 publications

(59 citation statements)

References 11 publications

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“…Early deficiencies in testing capacity have contributed to poor control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 particularly among minority (ie, Black and Latino/Latina) and socioeconomically vulnerable communities. 2 , 3 Allocating testing resources to locations of greatest need is important to mitigate subsequent waves of coronavirus disease 2019 (COVID-19).…”

Section: Introductionmentioning

confidence: 99%

Disparities in SARS-CoV-2 Testing in Massachusetts During the COVID-19 Pandemic

et al. 2021

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This cohort study was designated as not human subjects research by the Mass General Brigham institutional review board because it used anonymous, publicly available data; thus, informed consent was not sought. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. We compiled weekly SARS-CoV-2 molecular testing data from the Massachusetts Department of Public Health and Boston Public Health Commission for the period May 27 to October 14, 2020, following the initial COVID-19 wave. The Boston Public Health Commission reported tests of unique Boston residents, whereas the Massachusetts Department of Public Health reported total tests, including repeat testing of individuals. Consequently, we performed separate analyses for Massachusetts (351 cities and towns) and for Boston (15 neighborhoods).We defined testing intensity as the number of SARS-CoV-2 tests performed weekly per 100 000 population and epidemic intensity as weekly test positivity. We considered optimal alignment of testing resources to be matching community ranks of testing and positivity. In communities with a testing gap (ie, the testing rank was lower than the positivity rank) in a given week, the gap was calculated as additional testing required to achieve matching ranks. For example, the testing gap for a community with the third highest positivity is the difference between its testing rate and that of the community with the third highest testing intensity.Responses from the American Community Survey (2014-2018) 5 were aggregated to characterize communities. Negative binomial models using robust sandwich estimators to account for repeated measures at the community level were fit to assess associations of the magnitude of the weekly testing gap with time (linearly by week), selected Centers for Disease Control and Prevention Social Vulnerability Index 6 domains (eg, Socioeconomic Status and Minority Status/Language), and large university student population (>10% of residents). Owing to collinearity, the model of Boston neighborhoods only assessed associations with time and socioeconomic vulnerability. Two-sided Wald tests were used to assess significance at a threshold of P < .05. Data analysis was performed using R statistical software version 3.6.1 (R Project for Statistical Computing). ResultsDuring the observation period, 4 262 000 tests were reported. COVID-19 incidence (median [range], 339 [0-6670] cases per 100 000) and testing intensity (median [range], 41 000 [5350-274 000] tests per 100 000) varied considerably between communities, with observed increased testing in Author affiliations and article information are listed at the end of this article.

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Section: Introductionmentioning

confidence: 99%

Disparities in SARS-CoV-2 Testing in Massachusetts During the COVID-19 Pandemic

et al. 2021

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“…Health departments’ capacity and ability to conduct timely and effective case investigation and contact tracing varied widely across the United States. The ideal workforce size to adequately conduct case investigation and contact tracing per jurisdiction §§ likely depends on several factors ( 4 ); however, the inverse relationship between staff member workload and completeness and timeliness of case investigation and contact tracing suggest that increases in staffing capacity might help reduce delays in interviewing patients and identify more contacts. Most state health departments are hiring more staff members to perform contact tracing ¶¶ ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Case Investigation and Contact Tracing Efforts from Health Departments — United States, June 25–July 24, 2020

Spencer¹,

Chung²,

Stargel³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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“…Contacts might have been reluctant to answer phone calls from unknown numbers; 2%–4% who were reached declined health department monitoring. Finally, the high volume of work might have contributed to staff members’ ability to trace contacts ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Contact Tracing in Two Counties — North Carolina, June–July 2020

Lash

Donovan

Fleischauer

et al. 2020

MMWR Morb. Mortal. Wkly. Rep.

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On September 22, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Contact tracing is a strategy implemented to minimize the spread of communicable diseases (1,2). Prompt contact tracing, testing, and self-quarantine can reduce the transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (3,4). Community engagement is important to encourage participation in and cooperation with SARS-CoV-2 contact tracing (5). Substantial investments have been made to scale up contact tracing for COVID-19 in the United States. During June 1-July 12, 2020, the incidence of COVID-19 cases in North Carolina increased 183%, from seven to 19 per 100,000 persons per day* (6). To assess local COVID-19 contact tracing implementation, data from two counties in North Carolina were analyzed during a period of high incidence. Health department staff members investigated 5,514 (77%) persons with COVID-19 in Mecklenburg County and 584 (99%) in Randolph Counties. No contacts were reported for 48% of cases in Mecklenburg and for 35% in Randolph. Among contacts provided, 25% in Mecklenburg and 48% in Randolph could not be reached by telephone and were classified as nonresponsive after at least one attempt on 3 consecutive days of failed attempts. The median interval from specimen collection from the index patient to notification of identified contacts was 6 days in both counties. Despite aggressive efforts by health department staff members to perform case investigations and contact tracing, many persons with COVID-19 did not report contacts, and many contacts were not reached. These findings indicate that improved timeliness of contact tracing, community engagement, and increased use of community-wide mitigation are needed to interrupt SARS-CoV-2 transmission. Routinely collected case investigation and contact tracing data from June 1-30, 2020, for Mecklenburg, and from June 15-July 12, 2020, for Randolph counties were analyzed. Case investigations were conducted for persons with laboratoryconfirmed COVID-19, including the elicitation of persons potentially exposed to the index patient (3). Contact tracing was performed for persons identified as close contacts and included inquiry about COVID-19-compatible symptoms † and instructions to self-quarantine for 14 days since last exposure (3). Health

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Why Contact Tracing Efforts Have Failed to Curb Coronavirus Disease 2019 (COVID-19) Transmission in Much of the United States

Cited by 66 publications

References 11 publications

Disparities in SARS-CoV-2 Testing in Massachusetts During the COVID-19 Pandemic

Disparities in SARS-CoV-2 Testing in Massachusetts During the COVID-19 Pandemic

COVID-19 Case Investigation and Contact Tracing Efforts from Health Departments — United States, June 25–July 24, 2020

COVID-19 Contact Tracing in Two Counties — North Carolina, June–July 2020

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