PANDEMIC PANDEMIC RESILIENCE: RESILIENCE: GETTING IT GETTING IT DONEDONE
JUNE 30, 2020
A TTSI Technical Advice Handbook V 2.0
EDMOND J. SAFRA CENTER FOR ETHICS AT HARVARD UNIVERSITYHARVARD GLOBAL HEALTH INSTITUTE
A TTSI Technical Handbook for States and Municipalities
By the Massachusetts Testing, Tracing, and Supported Isolation (MA TTSI) collaborative
Mission Statement:
To enable a safe and progressive pathway to a pandemic-resilient, free society
By providing an end-to-end framework with scaled up testing, enabling rapid contact-tracing, and instituting supported isolation
Using the collective capabilities, assets, workforce, and innovative spirit of the regional ecosystem
While continuing to monitor and respond to the needs of our communities which may be impacted by the COVID-19 pandemic in different ways.
Members of this collaborative include:
● Policy ○ Harvard Edmond J. Safra Center for Ethics ○ Harvard Global Health Institute
● Contact Tracing ○ Partners In Health
● Medical Device Manufacturing and Supply Chain ○ Massachusetts Manufacturing Emergency Response Team (M-ERT)
● Diagnostic Testing Development and Capacity Planning ○ Massachusetts Life Sciences Center ○ Ginkgo Bioworks
● Health System Care and Resource Deployment ○ Beth Israel Lahey ○ Partners HealthCare
With assistance from US of Care, Covid-Local, Covid-Act Now, Resolve to Save Lives, Deloitte, Rockefeller Foundation, Center for Health Security at Johns Hopkins, Bloomberg Philanthropies, City of Madison (WI), City of Cambridge (MA), City of New Orleans (LA), National Association of City and County Health Officials, and National Governors Association.
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 1
This handbook defines TTSI programs and reviews how to:
1. Set targets for testing and contact tracing and make sure people have the right metrics for measuring progress on all of these (P. 6);
2. Inventory sample collection modalities; assess capacity; and fill gaps in sample collection capacity and collection kit supply (P. 17);
3. Inventory testing capacity in state and develop a supply chain support strategy and gap filling strategy for test capacity (P. 23);
4. Connect test data to contact tracing programs; and monitor progress in disease mitigation and suppression for decision-making and public communication (P. 29);
5. Set up and run contact tracing programs that successfully connect contacts to tests (P. 33);
6. Build a program of supported isolation (P. 40);7. Inventory and assess test funding mechanisms and fill funding gaps (P. 42);8. Run public communications programs so that the public understands the importance of
participation and how broad confidence and safety are secured this way (P. 44).
It also provides three appendices:
(1) Documentation of a contact tracing program in Madison, WI (P. 48)(2) An inventory of contact tracing resources (P. 52)(3) A CDC checklist for Contact Tracing Programs (P. 66)(4) In a separate document, a framework for supported isolation.
Because COVID response is fast changing with significant learning from week to week, we released a 1.0 version on July 3rd a living document in pdf form. This is the 2.0 release. A full COVID response also includes other non-pharmaceutical interventions from masking to social distancing rules to infection control to de-densification policies to air filtration techniques. This handbook covers only the TTSI element of infection control. TTSI on its own does not suffice but it does provide a critical backbone for COVID response.
Lead Authors include: Ben Linville-Engler (MIT); Danielle Allen (Harvard, Edmond J. Safra Center for Ethics); Divya Siddarth (Microsoft Research); Stefanie Friedhof (Harvard Global Health Institute); Meredith Sumpter (Eurasia Group); Rebecca Kunau (US of Care).
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INTRODUCTION:
What is a TTSI program? A TTSI program uses diagnostic testing (T), contact tracing (T), and supported isolation (SI), to mitigate or suppress highly infectious and dangerous diseases where the diseases have both a long incubation period and a relatively short disease course. A TTSI program requires building a strong interface among health care systems, public health systems, and other civil society organizations, from businesses to non-profits to schools and colleges likely to participate in testing and tracing.
TTSI programs can be used to mitigate the disease. This means that the programs are used to help reduce case incidence of the disease alongside other non-pharmaceutical interventions such as stay-at-home orders. Mitigation does NOT bring case incidence to zero, but only slows disease spread. Mitigation flattens the curve. In the long term, it is more comaintstly in time, testing resources and economic losses than suppression. Moreover, pursuing mitigation will make it hard to open schools, churches, and other congregate contexts without experiencing outbreaks within those organizations.
TTSI programs can also be used to suppress the disease. This means the programs are used at a sufficiently large scale to suppress the disease and drive case incidence to zero or near zero, providing a foundation on which to restore a vibrant economy. Suppression breaks the chain of disease transmission.
TTSI programs have historically been used for diseases like tuberculosis and measles. Testing and contact tracing themselves have also historically been used for syphilis and HIV AIDS. The longer disease course of these latter diseases has meant that isolation has not been a part of the testing and tracing response to those diseases.
In TTSI programs, isolation is “supported” with pay, on an analogy to jury pay and/or income replacement for low wage workers; with residential facilities where necessary; and with access to healthcare, food provision, etc. The reasons for these supports is that these isolation programs are voluntary, not enforced by misdemeanor or criminal penalties. They are incentivized rather than enforced. The reason for this design is to ensure that our disease fighting tools are compatible with maintenance of a free society. We should all expect to contribute to and participate in isolation programs as part of the set of rights and responsibilities that define our roles as members of a free society.
Importantly, the design of TTSI programs reflects specific features of COVID as a disease. With COVID, infected individuals shed virus for roughly two weeks to one month. Moreover, roughly 50% of COVID transmission occurs when individuals are asymptomatic or pre-symptomatic. In other words, many people unwittingly pass COVID on. This is what makes the disease so highly infectious and dangerous.
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A TTSI program is NOT a universal testing program. It is NOT a random testing program.
TTSI is instead the strategic and targeted use of viral testing and contact tracing resources where they will make the greatest marginal contribution to disease suppression and drive case incidence of the disease back as close to zero as possible. It can be supplemented by additional forms of surveillance testing, including antibody testing, to assist in the smart targeting of viral testing resources.
TTSI programs pursue data-driven targeted testing of hotspots, such as eldercare facilities, nursing homes, and correctional facilities. In the context of suppressing an outbreak, it will make sense to test the whole staff and resident population of such facilities.
TTSI programs also pursue contact tracing-based testing. Symptomatic people or people who believe they have been exposed to the disease present at clinics or testing sites for a diagnostic test, or they are found in hotspot testing programs. A positive test result activates a contact tracing team that identifies those who may have been exposed to the virus by the covid-positive individual. Those exposed contacts have a test appointment scheduled for them, regardless of whether they are symptomatic or asymptomatic. Again, participation is voluntary but public messaging needs to drive home the importance of contributing to the fight against COVID through acceptance of getting a test if one has been identified as a contact of an infectious person. As with the originally presenting symptomatic individual, for any contacts who test positive, their positive test result triggers a further round of contact tracing and testing. If the individual testing positive requires healthcare treatment, they are connected to health resources. If they are asymptomatic or only mildly symptomatic, they are connected to the resources necessary for supported isolation.
In addition to viral testing of chains of contacts that start from patients who present with symptoms or individuals who have experienced exposure, a TTSI program may be supplemented by a limited degree of routine testing in critical contexts, where there are highly vulnerable populations or employment contexts with national security implications. Examples of the former would be eldercare facilities, health care sites, correctional facilities, and employment contexts with assembly-line style work environments such as meat-packing plants. It may be reasonable to include other congregate settings such as schools, colleges and universities, and dense offices in such “critical context routine testing” programs.
Routine testing is a highly inefficient form of testing so it should be reserved for contexts of this kind. The goal of a TTSI program is to drive disease case incidence low enough that the general public can feel a strong sense of confidence and safety in resuming ordinary workplace activities.
This visualization captures the TTSI process:
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 4
Governors and state public health officials need to clearly determine whether they are pursuing a path of mitigation or suppression and need to communicate their choice of pathway to the public. The contrast between a suppression strategy (as used in Taiwan and New Zealand) and the current mitigation strategy of the U.S. is visible in these graphs:
SOURCE: https://www.endcoronavirus.org/
Additionally, given the prolonged risk of exposure and comparatively slow rate of case reduction, a mitigation strategy drastically increases the need and demand for personal protective equipment (PPE) both in and outside of healthcare facilities.
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SECTION ONE: SETTING TTSI TARGETS
Step 1: Understand your baseline: Determine whether your jurisdictions are green (near zero case incidence), yellow (low case incidence/potential community spread), orange (moderate case incidence/ dangerous community spread) or red (high case incidence/ unchecked community spread). This information should be routinely communicated to the public.
Case incidence can be best measured and communicated with three measures: new confirmed case trend, case trend as an estimate from the new deaths trend, and new COVID hospitalizations, in each case with a seven day rolling average. All three should be used, and they should be used and communicated to the public together.
Metric 1: New confirmed case trend: New daily cases per 100k pop (seven day rolling average); + trend direction and rate Metric 2: Case trend as an estimate from new deaths trend: New daily deaths per 100k pop * 100 (assuming 1% IFR) (seven day rolling average); + trend direction and rate Metric 3: New daily hospitalizations per 100k pop (seven day rolling average); + trend direction and rate Because case incidence numbers are affected by testing levels and deaths are a lagging indicator, it is important to track and compare both numbers and the information about cases that each provides. Whichever of metric 1 or metric 2 results in a higher estimate for the number of new cases per 100,000 people, should be used to determine the incidence level on the green, yellow, orange, red scale.
The daily case incidence number will determine whether a jurisdiction is green, yellow, orange, or red with the following cut-offs:
Covid Level Case Incidence
Red >25 daily new cases per 100,000 people
Orange 10<25 daily new cases per 100,000 people
Yellow 1<10 daily new cases per 100,000 people
Green <1 daily new case per 100,000 people
The incidence numbers can be used both at county or MSA level, or other local health district jurisdiction level, and at the state level. Policy decisions about which strategies of disease
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response are best for a jurisdiction should be made by looking at both the local level and the state picture and considering the dynamic relationship between them.
These COVID levels provide a map that helps decision-makers and community members know where they are. The green level aligns with the CDC’s low incidence plateau threshold. The levels do not in themselves provide information about how to respond, given where a community is. The levels do, however, communicate the intensity of effort needed for control of COVID at varying levels of community spread. In addition to paying attention to the levels, decision-makers should pay close attention to direction of trend and rate of change. While jurisdictions may plateau in yellow, in the orange level spread tends to have more velocity.
Step 2: Make a strategic choice: Mitigation or Suppression
The goal of a TTSI program used for purposes of suppression is to get to green (<1 new daily case/100,000) and stay green.
To achieve this epidemiologically defined goal, the relevant jurisdiction will need capabilities for (1) testing, tracing, and supporting isolation; (2) protecting the vulnerable; (3) treating the ill; and (4) activating other forms of non-pharmaceutical intervention (NPI) for disease control from masking and 6-ft social distancing rules to infection control and de-densification protocols.
While the green, yellow orange, red color levels help us keep our eye on the target of where we want to be with regard to epidemiologically defined goals, these four categories of capability are best measured via key performance indicators that support evaluation of how well the jurisdiction is doing in deploying all available tools for controlling the disease.
At the green level, jurisdictions are on track for containment so long as they maintain maintenance levels of viral testing (i.e.. this is not a reference to antibody testing) and contact tracing, sufficient to control spikes and outbreaks. Viral testing should be used both for symptomatic and asymptomatic individuals, with the latter need for testing flowing from exposure, role in a congregate setting or other critical context (e.g. elective surgery), or requirements of disease surveillance programs. It is not enough to get to green; one also has to plan to stay green.
At the red level, jurisdictions have reached a tipping point for uncontrolled spread and will require the use of stay-at-home orders and/or advisories to mitigate the disease.
At yellow levels, there may be some initial community spread. At orange levels, community spread has accelerated and is at dangerous levels. At both yellow and orange levels, jurisdictions can make strategic choices about which package of non-pharmaceutical interventions to use to suppress the disease. One jurisdiction may choose stay-at-home orders;
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another may choose more intensive use of viral testing and tracing programs. All jurisdictions will want some combination of social distancing strategies and infection control.
In order to understand optionality at yellow and orange levels, decision-makers should review the different “phasing plans” that policy-makers have developed as guidance. They should be equipped to evaluate whether the “phasing plans” will help them meet their goals, having clearly in mind whether their goals are mitigation or suppression.
Covid Level Case Incidence Intensity of Control Effort Needed
Red >25 daily new cases per 100,000 people
Stay-at-home orders necessary
Orange 10<25 daily new cases per 100,000 people
Strategic choices must be made about which package of non-pharmaceutical interventions to use for control. Stay-at-home orders are advised, unless viral testing and contact tracing capacity are implementable at levels meeting surge indicator standards (see KPIs below).
Yellow 1<10 daily new cases per 100,000 people
Strategic choices must be made about which package of non-pharmaceutical interventions to use for control.
Green <1 daily new case per 100,000 people
On track for containment, conditional on continuing use of viral testing and contact tracing for surveillance and to contain spikes and outbreaks.
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Mitigation = some reduction in the rate of R (the reproduction rate of the virus) through diagnostic testing and contact tracing. Mitigation flattens the curve.
Suppression= an effort to get to zero or near zero case incidence. Suppression breaks the chain.
Both mitigation and suppression require a suite of activities ranging from stay-at-home advisories to 6-foot social distancing to mask wearing to TTSI implementation. TTSI is a tool that can be deployed at either mitigation or suppression levels. However, we strongly recommend jurisdictions that have the capacity to deliver suppression-level surge resources for TTSI to pursue a suppression strategy as they will be on the most efficient path toward a restored economy without future lockdowns.
Step 3: Understand Your Tools and the Definition of Success
TTSI tools consist of four categories:
· viral tests (to find active infections) (see section 2-3)
· contact tracing programs (sections 4-5)
· supported isolation programs (section 6)
· funding and public communications resources (sections 7-8)
These tools will be needed at both maintenance levels and surge levels.
Maintenance levels of TTSI resources are used in jurisdictions that are green to contain spikes and outbreaks. For jurisdictions at the green level, the goal is to have adequate TTSI resources to stop community spread. It continues to be important to measure communities along all capability measures: TTSI capability, other NPI capability, protection capability, treatment capability, and surveillance capability.
Surge levels of TTSI resources are needed once there is community spread. Jurisdictions at the yellow level have spikes that may also indicate community spread. Jurisdictions at Orange and Red levels are contexts with dangerous community spread. These jurisdictions at orange or red need “surge” levels of TTSI resources to drive the disease back close to near zero case incidence. Once a community has progressed along the path to zero and returned to green level status, the levels of testing capacity and contact tracing it needed should dramatically decline. Jurisdictions at the red level also need stay-at-home orders.
A mitigation surge targets broad and accessible testing, a test positivity rate of 10%, and for 60% of positives not coming from critical context testing to have come from contact tracing.
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A suppression surge targets broad and accessible testing, a test positivity rate of <3%, and for 80% of positives not coming from critical context testing to have come from contact tracing.
Successful suppression efforts can work relatively fast to restore jurisdictions to near-zero case incidence in a matter of 1-2 months. In other words, a surge of testing and tracing resources is a temporary need; only maintenance levels are permanent until vaccines become widely available, presuming effective and durable immunity.
Key Performance Indicators for Contact Tracing are as follows:
Maintenance/ Green Level Suppression/ Yellow, Orange, or Red Levels
Mitigation/ Yellow, Orange, Red Levels
Contact Tracing
Performance
Percent of Positives
from Tracing vs.
Symptomatics >80% >80% >50%
Percent of Index Cases Who Give Contacts
>75% >75% >75%
Percent of Identified
Contacts Traced >90% >90% >80%
Trace Time 24 hours 24 hours 24 hours
Percent of Identified
Contacts Traced >90% >90% >80%
Percentage of
Contacts with
Symptoms at Time of
Trace
close to zero close to zero close to zero
% traced contacts in
quarantine, isolation,
or active monitoring 90% 90% 90%
% traced contacts
receiving supports varies with context; locales should set targets
varies with context; locales should set targets
varies with context; locales should set targets
% traced contacts
assigned to
quarantine, isolation,
or active monitoring
who are fully
compliant with
program
90% 90% 90%
% of traced contacts 90% 90% 0%
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tested
Time from Contact
from Contact Tracing
Program to Test of
Contact
24 hours 24 hours 24 hours
Key Performance Indicators for Viral Testing are as follows:
Maintenance/ Green Level Suppression/ Yellow, Orange,
or Red
Mitigation/ Yellow,
Orange, Red
Viral Testing
Capacity
Access
Anyone should be able to
access a test regardless of
symptoms, without
requirement for a doctor’s
order and without requirement
for government issued ID.
Anyone should be able to access
a test regardless of symptoms,
without requirement for a
doctor’s order and without
requirement for government
issued ID.
Anyone should be able to
access a test regardless of
symptoms, without
requirement for a doctor’s
order and without
requirement for
government issued ID.
Supply
Sufficient to test for
therapeutic purposes; hot spot
testing purposes; contact
tracing purposes for several
links of the chain following
from an index case to further
positives to their contacts, and
so on; surveillance purposes;
and critical context purposes.
Sufficient to test for therapeutic
purposes, hot spot testing
purposes, contact tracing
purposes for several links of the
chain, surveillance purposes,
and critical context purposes.
Sufficient to test for
therapeutic purposes, hot
spot testing purposes,
surveillance purposes, and
critical context purposes.
Performance
Time from Symptom
Onset to Test
Positivity 24 hours 24 hours 24 hours
Turnaround Time 24 hours 24 hours
24 hours
Positive Test Ratio <1% <3%
Less than 10%
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Step 4: Set Your TTSI Program Priorities
Any TTSI program is ultimately built up from a lot of on the ground program decisions. The following priorities for a TTSI program lead to the most efficient progress on the path to zero:
1) Priority 1: Test hotspots, using mobile-labs, walk-in, and drive thru clinics as well as testing of all staff and residents in congregate living facilities with outbreaks;
2) Priority 2: Encourage all symptomatics (regardless of severity of symptoms) to be tested (or to self-quarantine) and all those who have reason to think they have been exposed to the disease to come in for a test.
3) Priority 3: Trace the contacts of all covid-positive individuals throughout the population. 4) Priority 4: Layer in additional surveillance testing in “critical contexts”: congregate
settings where de-densification is not possible or where there are high vulnerability populations and national security settings.
For a TTSI program to succeed, the first three priorities must be broadly advertised and effectively communicated to the public along with information about where to get a test. In addition, funding and payment processes must be streamlined. Health insurance does not cover this non-therapeutic, surveillance testing. Public coverage is necessary, and payment processes should be simple and streamlined.
The first three priorities, taken together, create a double-pronged program of hotspot testing and tracing and state-wide testing and tracing. This double-pronged program depends on actors in the healthcare system and the public health system and in civil society organizations from businesses, to churches and schools, and non-profits. Building an interface that can link them all to a shared TTSI infrastructure is critical.
If supported with a sufficient supply of testing capacity and contact tracers, as well as with ongoing use of other NPIs such as masking and 6-foot social distancing rules, this program should suppress the disease and drive case incidence close to zero, facilitating an open economy that can stay open and minimizing the need for private businesses to build and maintain testing programs. Once case incidence reaches green zone levels, contact tracing and testing capacity levels will fall back to maintenance levels.
N.B.: In contexts that have pursued mitigation rather than suppression and continue to be at yellow or orange levels of covid case incidence, it will be hard to open schools, churches, and other congregate contexts without experiencing outbreaks within those organizations. It might be tempting to envision routine testing in these contexts facilitated by a private market in viral tests. However, resources should not be diverted to this purpose prior to the completion of the public mission to achieve suppression in the community more broadly.
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Once a jurisdiction has returned to green, it may make sense for schools, churches, and other congregate contexts to equip themselves with testing resources to provide early warning of outbreaks in their community. In contexts where people are currently employing routine testing, the frequency for individual testing ranges from daily to every fourth day to once a week. Once a jurisdiction has reached the green level, however, case incidence should be sufficiently low that organizations of this kind could rely on weekly pooled testing to catch outbreaks. (In pooled testing, samples are batched and tested together. If the batch delivers a positive result, the samples are then unbatched and run separately. In low incidence contexts, this is a more efficient approach to viral testing.)
Step 5: Anticipate Your Resource Needs
Some rough rules of thumb can be offered for determining resources needs for contact tracing personnel and viral testing supply.
Contact Tracing Maintenance Capacity for Green Level
Suppression Capacity for Levels Yellow, Orange, or Red
Mitigation Capacity for Levels Yellow, Orange, or Red
Capacity
Number of Tracers 30 tracers per 100k population
(or 1 per 4000 in sparsely
populated areas)
Planning: 30 tracers per 100k
(or 1 per 4000 in sparsely
populated areas)
Activation: Whichever is
higher, 30 per 100k or 5 tracers
per every confirmed new daily
case
30 tracers per 100k
population
Viral Testing
Capacity
Covid Level Maintenance Suppression Mitigation
Green
Conditional on ongoing
infection controls and
de-densification protocols
10 daily tests/100,000
people (Maintenance
Level) n/a n/a
Yellow, Orange,
Red
If high compliance with
masking, 6ft social
distancing rules, and mass
gatherings bans and/or stay
at home orders 600 tests per new daily
death (7 day rolling average)
200 tests per
new daily
death (7 day
rolling
average)
If no stay at home orders
and only moderate
compliance with masking, 1200 tests per new daily
death (7 day rolling average)
300 tests per
new daily
death (7 day
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6ft social distancing rules,
and mass gathering bans rolling
average)
If no stay at home orders
and only minimal
compliance with masking,
6ft social distancing rules,
and mass gathering bans 2500 tests per new daily
death (7 day rolling average)
500 tests per
new daily
death (7 day
rolling
average)
N.B.1: The surge level of contact tracers needed is very substantial. Most jurisdictions will find it valuable to educate the public on how to do DIY contact tracing. This will provide an important expansion to the corps of contact tracing personnel. The volume of resources needed in red jurisdictions explains why the strategy often falls back to mitigation, yet it’s important to remember that suppression can be pursued in orange and yellow zones even if mitigation has been chosen for red zones.
N.B.2: There is a trade-off between volume of tests and time for a mitigation and a suppression strategy. A mitigation strategy may use fewer tests on a daily basis but it will require more testing in aggregate. A suppression strategy involves a bigger investment of workforce and testing supply up front but a lower aggregate investment in disease control. Mitigation is penny-wise but pound foolish.
Using the rules of thumb above for a suppression strategy coupled with moderate compliance with other NPIs results in the following anticipated testing supply need for Massachusetts as of June 28, 2020.
State of Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 2,288 343 ongoing
AND
Mitigation
(Current WH
numbers)
10% 42,882 2,068 From May 15-
indefinite
OR
Suppression 3% 171,529 37,841 July 1 - July 31
Barnstable, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 71 11 ongoing
AND
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Suppression 3% 2,379 537 July 1 - July 31
Berkshire, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 42 6 ongoing
AND
Suppression 3% 943 217 July 1 - July 31
Bristol, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 188 28 ongoing
AND
Suppression 3% 13,044 2,882 July 1 - July 31
Essex, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 263 39 ongoing
AND
Suppression 3% 25,598 5,624 July 1 - July 31
Franklin, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 23 4 ongoing
AND
Suppression 3% 535 123 July 1 - July 31
Hampden, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 155 23 ongoing
AND
Suppression 3% 10,406 2,301 July 1 - July 31
Hampshire, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 54 8 ongoing
AND
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Suppression 3% 1,449 330 July 1 - July 31
Middlesex, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 537 81 ongoing
AND
Suppression 3% 37,731 8,333 July 1 - July 31
Norfolk, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 236 35 ongoing
AND
Suppression 3% 14,054 3,114 July 1 - July 31
Plymouth, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 174 26 ongoing
AND
Suppression 3% 13,716 3,023 July 1 - July 31
Suffolk, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 268 40 ongoing
AND
Suppression 3% 32,160 7,046 July 1 - July 31
Worcester, Massachusetts
Positivity Rate Tests Per Day Tracers Needed Timetable
Maintenance 3% 277 42 ongoing
AND
Suppression 3% 19,514 4,310 July 1 - July 31
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SECTION TWO: INVENTORYING SAMPLE COLLECTION MODALITIES
To run a successful TTSI program, it is important to ensure that there are enough sample collection sites to meet the state’s targets and that all of the sample collection sites are integrated with public health data systems so that key performance indicators for sample collection can be tracked.
Samples are collected in (1) traditional healthcare settings, (2) new public testing clinics, (3) at-home (still to come); and (4) in congregate living settings and businesses, schools, office, and other potential locations of routine collection.
Some sample collection modalities involve sending samples to a lab for analysis. Some involve point-of-care processing of results. It is important to track the volume of both kinds of tests in each jurisdiction.
Sample collection sites that send samples to a central lab for analysis introduce a challenge of the speed at which results are returned as well as questions about whether the samples are fully accessioned at the point-of-collection or in the lab. The former methodology increases lab capacity.
Point-of-care collection sites introduce a challenge for the integration of results data with your public health data systems.
Charts such as the following can assist the effort to synthesize your data:
Sample Collection Modalities for Centralized Processing
Modality
Currently
in use in
state?
Number
of sites
Average
daily # of
samples
collected
Accession
methodology-
individual or
batched
Maximum daily # of
samples that could
be collected
Traditional Health Care Setting
Primary care physicians
Clinics- Urgent Care/ CVS/
Walmart/ Rite-Aid
Community Health Centers,
including Federally Certified
Health Centers
Public Testing Sites
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Drive-thrus
Walk-ups
Mobile Sites
Mobile Pop-up Sites
At-Home Tests
Home Collection- Mail-in
Results
Routine Testing Sites
Businesses
Elder Care Facilities
Correctional Facilities
Schools
Sample Collection Modalities for Point of Care Processing
Modality
Currently
in use in
state?
Number
of sites
Average
daily # of
samples
collected
Data
integrated
with Public
Health
Systems?
Maximum daily # of
samples that could
be collected
Traditional Health Care Setting
Primary care physicians
Clinics- Urgent Care/ CVS/
Walmart/ Rite-Aid
Community Health Centers,
including Federally Certified
Health Centers
Public Testing Sites
Drive-thrus
Walk-ups
Mobile Sites
Mobile Pop-up Sites
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At-Home Tests
Home Collections N
Routine Testing Sites
Businesses
Elder Care Facilities
Correctional Facilities
Schools
Case Study: New Orleans Testing Strategy
New Orleans was one of the first municipalities to develop a city-wide testing strategy in mid-March following confirmation from the Health Department of communal spread. The city’s Phase One strategy featured a traditional testing model of a fixed location with drive through testing staffed by national Health and Human Services (HHS), Federal Emergency Management Agency (FEMA), state and local personnel. New Orleans soon recognized limitations of the Phase One model in reaching residents who could not access the fixed location, who lacked a Louisiana ID or symptom criteria, or who were anxious about visiting the site.
The city quickly moved to implement Phase Two of its testing strategy by deploying mobile testing units to neighborhoods staffed by locals. These units move to areas where the virus is spreading fastest or where barriers to testing are greatest. The mobile units allow for drive through and walk-up testing, providing multiple ways for residents to access tests. Phase Two removed Phase One ID/insurance and symptom requirements to test. Local health personnel provide on-site needs assessment and resources from the mobile units. Trained local personnel provide callbacks on test results and are having more success getting through to residents and directing them to local resources than the national callback center of Phase One. This mobile approach has seen New Orleans testing site demographics generally reflect the city’s demographics. It has also allowed local officials to constantly reassess areas to identify emerging high-risk groups and testing gaps.
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New Orleans’ Phase Three strategy will incorporate “hyper mobile” pop-up testing at locations with the highest risk of outbreak or the highest risk individuals, including nursing homes and senior apartment buildings, homeless shelters, low-income developments, and other congregate settings. The hyper-mobile pop-up model allows for nimble and flexible test site set-up. The hiring of New Orleanians to staff these units provides cultural competence to the testing environment that helps build trust with those being tested.
Public transparency has been critical to the success of New Orleans testing strategy. The New Orleans Health Department created a testing dashboard accessible to the public through the existing municipal government communications channel used by residents to get information on emergencies and natural disasters (https://ready.nola.gov/home/).
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The effectiveness of the city’s rapid testing and tracing strategy is visible through the sharp peak in cases in late March/early April followed by a rapid decline in new cases. With the mobile testing strategy, health department officials can quickly mobilize testing resources to suppress new outbreaks (20 April in below chart).
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SECTION THREE: INVENTORYING OF TEST PROCESSING CAPACITY
The hardest element of establishing a TTSI program may be aligning testing capacity with sample collection volume. It is not reasonable to expect jurisdictions to conduct this inventory below the level of the state. The state should take on responsibility for securing sufficient lab capacity for all jurisdictions within it. Ideally, the state would do this work as a participant in an interstate compact formalized by Congress and funded for procurement of testing capacity.
To achieve this, the state needs to inventory testing capacity available to it and to identify gaps. Importantly, this inventory process should take into account labs available regionally and not just within the state itself. While the need for 24hr turn around on test results puts a geographic limit on how far away a lab can be from a sample collection site, some regional collaboration should be possible, particularly for high density population areas within one of the regions below.
Low population density locations should expect to make much greater use of point-of-care machines.
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States want to have visibility into capacity at the regional level flowing from all of the following testing modalities; they should not rest content with understanding only the capacity in their own state. The chart below provides an assessment of national capacity.
Source, Ginkgo Bioworks.
See also: https://interventions.centerofci.org/pub/covid-testing-assessment/release/14
In this analysis, key performance factors such as clinical accuracy and turnaround time are evaluated as well as key deployment factors such as current and future tests per day projections and supply chain risks. The availability of new or improved testing modalities will continue to be dependent on FDA authorization through their emergency guidance policies. Also, as has been experienced with PPE, the supply chain for key components (e.g. test swabs, reagents, etc) will continue to limit sample collection and processing capacity.
In order to evaluate the potential impact of thest test modalities and evaluate which option(s) are most likely to scale in order to prioritize resources and time, a qualitative-to-quantitative trade-off analysis can be performed. Note that the 2 time horizons chosen for the evaluation are Q3 2020 and Q4 2020 which yield different outcomes based on the selected evaluation factors. For this
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analysis, clinical accuracy, turnaround time, and number of tests per day were evaluated; assigning a value to each factor on a 0 to 5 scale.
Note that supply chain risk was not included as we anticipate supply chain disruption in some form for each test modality. As such, supply chain risk can be mitigated by pursuing more than 1 test modality.
A utility function that combines multiple factors into 1 variable was created to assess the primary trade-offs we are considering when investing time and resources into scaling testing.
Impact = (Clinical Accuracy) x (Turnaround Time) x (Tests/Day)
The derived Impact value can be normalized by dividing by the highest possible product in order to provide a 0 to 1 range for comparison. The Impact value was derived for all test modalities for both Q3 2020 and Q4 2020.
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By plotting the Impact values against the initial dates of Q3 2020 and Q4 2020, an estimated rate of scaling of each test modalities’ Impact can be compared visually.
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As mentioned for supply chain risk, there are additional uncertainties for each of these factors. Additionally, this is a semi-quantitative analysis that injects its own level of uncertainty.
As such, mitigations to these risks also provide an opportunity to improve in the independent Impact of each test modality. Instead of pursuing an either-or strategy of solely using 1 test modality, a great Impact can be achieved through the summative Impact of combining multiple testing modalities into 1 strategy.
The MA TTSI Summative Architecture strategy aims to pursue multiple testing modalities in parallel to maximize Impact and reduce the risks of supply chain disruption or scaling delays. For example, Hologic, Roche, Abbott, and Thermofisher all provide viral RNA testing platforms; however, each platform also requires proprietary or platform-specific consumables such as reagents or deep well plates. Qualifying alternative suppliers of these consumable materials, while necessary, may also take time if they require FDA Emergency Use Authorization amendments. Distributing the supply chain risk across these different platforms through the capacity of clinical laboratories, research laboratories, and healthcare providers is an important strategy.
For Q3 2020, the combination of both RT-qPCR Centralized and RT-qPCR Point of Care testing modalities, is how great impact can be achieved. Similarly, for Q4 2020, the projected availability of high-volume NGS Centralized testing further increases the strategy’s impact by taking advantage of scaled capacity of the RT-qPCR tests. Additionally, the combination of centralized and point of care options allows for targeted deployment or test resources to areas experiencing high rates of transmission.
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Inventorying test processing capacity also requires inventorying the supply chain and logistics that are supporting testing more generally. Establishing a high-volume test processing capacity in a centralized location is only valuable if the need for testing can be matched with the capacity. This is done through sample transporting from likely distributed collection sites and accessioning at the sample collection site to take advantage of high-throughput automation. How this fits into the end-to-end testing, contact tracing, and supported isolation system will be discussed in the next section.
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SECTION FOUR: THE TTSI SYSTEM AS A WHOLE, DATA MANAGEMENT, AND REPORTING
A TTSI system depends on a cycle of Test-Data-Trace-Test. Patient test results must flow both into state public health databases for general disease monitoring and into local jurisdiction contact tracing databases to trigger contact tracing work.
Here is an example from Massachusetts of a complete TTSI Systems map:
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The implementation program consists of both a hotspot program and a state-wide tracing and testing program that provide feedback loops between testing, tracing, and testing of new contacts. The contact tracing organization and/or system can be the same for both the hotspot and state-wide programs.
In addition, surge capacity can flow either through centralized, regional lab processing or through point-of-care or more local lab processing. Either way, data flows and speed are fundamental to success. It is necessary to establish a data management system and infrastructure that enables a state-wide aggregated view while also providing localized information collection through contact tracing. Arranging testing for those that have been in contact with someone who has tested positive completes a feedback loop that drives suppression. The more rapidly this testing-tracing-testing cycle can be completed (e.g. 24 - 48 hours), the lower the likelihood of additional transmission through contacts.
Breaking the Chain: The Temporal Dynamics of Testing and Contact Tracing
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The diagram below illustrates a state-wide testing, tracing, and supported isolation process utilizing a large centralized PCR and/or NGS capacity for test processing in combination with a localized hot spot testing strategy with more deployable and mobile resources.
The key metrics for assessing the operations of a TTSI system were presented above in Section 2.
Due to both the distributed impact of COVID-19 regionally, as well as social isolation requirements, access to data to facilitate testing and tracing activities are vital. Stakeholders that need access to COVID-19 testing data include state emergency management agencies, state departments of public health, local boards of health, community health centers, labs processing tests, and the contact tracing workforce. The Massachusetts Community Tracing Collaborative (MA CTC) (https://www.mass.gov/info-details/learn-about-the-community-tracing-collaborative) ,which includes the Massachusetts Virtual Epidemiologic Network (MAVEN) that was established prior to COVID-19 for case investigation and surveillance purposes for infectious diseases, is an example of how this can be implemented.
Central to this, is the person that has tested positive for COVID-19 and their relationships with local boards of health and the contact tracing work force which includes case investigators, contact tracers, and care resource coordinators whose roles will be described in more detail in Section 5. To facilitate the relationship management, the MA CTC has integrated their MAVEN system with Salesforce, which is utilized for customer resource management (CRM) to track communications through phone calls and emails.
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The integration of testing, tracing, and supporting data enables visibility into the resource needs (e.g. workforce, test kits, etc) and provides opportunities for further analysis to identify delays in the end-to-end system that can be further improved. An example of this is the amount of time it takes to provide information about COVID positive patients to the contact tracing team.
The diagram below illustrates the data management and communication architecture deployed in Massachusetts through the MA CTC.
Note that the steps designated with match superscripts happen in combination during a single call/contact. Additional support steps and data collection for quarantine of persons who came into contact with someone who tested can be added as well.
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SECTION FIVE: IMPLEMENTING CONTACT TRACING PROGRAMS
Contact tracing is a key component of any successful suppression effort to “box in” COVID-19 (see figure below and the “Four Steps” from Resolve to Save Lives Contact Tracing Playbook). In contact tracing, local and state health departments quickly identify people infected with COVID-19 using widely implemented testing programs; instruct infected people to isolate; find and notify their contacts; and support these contacts so they can quarantine for 14 days.
Contact tracing for COVID-19 includes four key steps:
1. Identify and notify cases of their confirmed or probable COVID-19 status. Provide instructions on isolation and treatment.
2. Interview cases and help them identify the people they were in contact with during their infectious period.
3. Locate and notify contacts of their potential exposure, interview them to see if they have symptoms, offer testing if they do (and if they don’t), and arrange for care if they are ill. Provide instructions on quarantine.
4. Monitor contacts and report daily on each person’s symptoms and temperature for 14 days after the person’s last contact with the patient while they were infectious.
This process continues until the end of any possible transmission chain has been reached.
Contact tracing programs may be run directly by departments of health, through contracts to outside vendors (like Partners In Health in Massachusetts), through community organizations recruited by public health departments (as in the NYC Knows program for HIV-AIDS), and
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through the development of staff capacity through private and service year organizations. This work must be supported by public education on contact tracing and the public’s role. See for example Massachusetts’ Community Tracing Collaborative: https://www.mass.gov/info-details/learn-about-the-community-tracing-collaborative.
Because digital tracing apps are still 1-2 months away from viability, we do not review them in this handbook but instead focus on the urgent needs and resources for manual contact tracing.
Successfully breaking the chain of COVID-19 transmission and reopening state economies will require governors and senior health officials to develop a data-driven approach to contact tracing that builds on existing public health capabilities, gets the buy-in of the public as key players in the effort, coordinates stakeholders and resources, and effectively engages public and private partners to scale the workforce necessary to support these efforts in the near and long-term. Regardless of a state’s public health authority structure, it is essential that local public health tie in to a state’s contact tracing strategy.
Contact Tracing workforce development
State and local health departments will need to work together to assess and coordinate workforce capacities and determine additional staffing and infrastructure needed to contact all positive cases within 24 hours, quickly follow-up with their contacts who may have been exposed, and monitor and provide referrals to services for individuals in isolation and quarantine.
The following are steps for developing and supporting a contact tracing workforce (see National Governors Association Contact Tracing Workforce primer):
1. Build on existing state and local public health contact tracing workforce and capacity
2. Determine additional contact tracing workforce needs
3. Develop a recruiting and hiring strategy
4. Train the contact tracing workforce
The CDC’s Interim Guidance on Developing a COVID-19 Case Investigation and Contact Tracing Plan outlines the full public health workforce of epidemiologists, clinical staff, and data managers needed to support the full contact tracing effort. Core contact tracing staff that states will need to recruit and scale include the following (from Resolve to Save Lives COVID-19 Contact Tracing Playbook):
Role Responsibilities Potential Workforce
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Case Investigator Interviewing cases, identifying contacts, providing instructions for isolation and referral to social or medical support*
Public health students and graduates, social workers, community health workers (CHWs), navigators/promotores
Contact Tracer Notifying contacts of potential exposure, providing instructions on quarantine, referral to services,* follow up and symptom monitoring
CHWs, navigators/promotores, college students, volunteers, librarians and other service-oriented professionals
Contact Tracing Team Leads
Supervise teams of case investigators and contact tracers
Disease Investigation Specialists, Supervisor Public Health Nurses
* Some states have identified separate cases manager or resource coordinator roles to support these responsibilities, particularly for complex cases
The estimated number of case investigators, contact tracers, disease investigation specialists, and other personnel needed to conduct robust contact tracing will vary by or within states and should be closely aligned with both disease transmission models and testing strategies. Please refer to the chart in section 2 on tracing personnel needed according to case incidence levels (green, yellow, orange, and red).
States should start by partnering with local community health systems and Federally Qualified Health Centers. For example, contact tracing strategies should incorporate a community’s pre-existing local community health workers and prioritize training additional workers where possible. Community health workers have local and cultural competencies that support effective tracing, outreach, and provision of counseling on social and medical support services in the community. They are also well positioned to conduct sensitive COVID-19 conversations with the local population and to reach minority or at-risk communities.
Even with the deployment of local community health workers as contact tracers, surge capacity will be needed to cover outbreaks that exceed local capacity. Additional contact tracers could come from a variety of sources. Many states are working with nonprofits active in medically-underserved communities to improve contact tracing reach to those in need. Others are contracting with private organizations or local universities to deploy volunteers, including those with backgrounds in public health, social work, and medicine. The City of Baltimore working with The Rockefeller Foundation launched a program to expand workforce capacity through equitable recruitment of representative members of Baltimore’s community. The 276 contact tracers or care coordinators and 33 administrative, management and employment
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development staff will expand outreach capacity by over 31,200 individuals over one year while providing jobs and public health career pathways for Baltimore residents.
State service commissions and service year programs, including Americorps, as well as the National Guard, the Medical Reserve Corps and other service organizations already engaged in a state’s emergency response efforts can provide additional workforce leverage. These programs can work with local and national partners to train and redeploy active service year corps members to support contact tracing efforts, and create new service year positions to recruit and train local residents to meet this need. In Colorado, more than 800 service year corps members will be mobilized through the creation of new positions and redeployment of existing members.
For contact tracing to be effective, care coordination and social support referrals must be built into program design and workforce planning to ensure all are able to safely isolate and quarantine as needed, as demonstrated in the Partners In Health contact tracing graphic below. Please refer to Section Six: Providing Supported Isolation.
An inventory of contact tracing practices, strategies, and resources spanning government, public health, foundation, association, and private groups follows the case study.
Case Study: Massachusetts Community Testing Collaborative
In March, local health departments in Massachusetts wrote to the state identifying a need for assistance with Covid-19 contact tracing. On April 3, 2020, the State of Massachusetts launched the Community Tracing Collaborative (CTC) in partnership with Boston-based global
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public health group Partners In Health. The CTC is the central hub for all contact tracing efforts in Massachusetts, and is the first large-scale coronavirus contact tracing program in the US.
Key CTC actions to date include:
● Partnered with the Commonwealth Connector Authority (CCA) to stand up a virtual call center and create a communications strategy. CCA is typically responsible for outreach and communications surrounding health insurance enrollment.
● Deferred to local health boards to lead complex casework and casework in vulnerable populations. CTC provides workforce (via Partners In Health) and data support (via the state Department of Public Health) as well as guidance on policies and protocols.
● Mobilized academic institutions (e.g. public health programs) to train students to provide immediate contact tracing support while CTC recruited a more permanent workforce.
● Used existing, centralized database repository for all information surrounding testing, contact tracing, and case management. Both the CTC and local health departments can access information.
● Hired 1,500 case investigators and contact tracers and 150 care resource coordinators. CTC emphasized hiring from diverse populations and ensuring local representation in the workforce.
● Developed a training program for workers including role play, scenario-based learning, and self-paced online modules. Hired full time staff to manage the training program.
● Experimented with new avenues to increase phone response including texting, leaving messages, creating an inbound call line, and working with telecom companies to create a single caller ID.
Lessons Learned
● Local Context is Key: In Massachusetts, 10% of people who require isolation need additional supports to do so successfully (in NYC that number is 30%). Hiring local contact tracers and care coordinators is important for both cultural competency and identification/provision of social supports. Locals have knowledge of existing community supports for food, medication, and medical services. Local health boards are well suited to monitor transmission in the highest risk populations.
● Localities Need Access to Shared Data Systems: State-level actors can empower local officials through a shared data system. Massachusetts’ system is “designed for all stakeholders”
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so actors across jurisdictions can both provide inputs to the system and obtain and analyze outputs that help inform decisions on-the-ground.
● Don’t Cut Corners on Training: Training needs to be a robust, continuous process and requires both technical and interpersonal components. Contact tracers receive 15+ hours of training during both on-boarding and at regular intervals.
● Keep Metrics Focused: Metrics tracking should center on comprehensiveness (“Are we reaching everyone we need to?”) and timeliness (“How long does it take to reach someone?”). These serve as important indicators of potential vulnerabilities community spread and inform adjustments to tracing protocols.
Massachusetts’ unified approach to contact tracing has enabled the state to build a robust contact tracing system, enabled by shared data, personnel support, and local knowledge. The CTC serves as a central hub for sharing data from across the state, training the tracing workforce at scale, and developing protocols and communications that support the epidemiological expertise existing within local health boards and their communities.
Additional Contract Tracing Resources
CDC Contact Tracing Explanation and Resources: https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/contact-tracing/index.html
CDC Interim Guidance on Developing a Covid-19 Case Investigation and Contact Tracing Plan: https://www.cdc.gov/coronavirus/2019-ncov/downloads/case-investigation-contact-tracing.pdf
CDC Checklist for Developing a Covid-19 Case Investigation and Contact Tracing Plan: https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/health-department-checklist-final.pdf
CDC Case Investigation Workflow: https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/COVID-19-Case-Investigation-workflow.pdf
CDC Contact Tracing Workflow: https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/COVID-19ContactTracingFlowChart.pdf
Association of State and Territorial Health Officials: Making Contact: A Training for COVID-19 Contact Tracers Introductory Online Course: https://learn.astho.org/p/ContactTracer
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National Association of County & City Health Officials: Building COVID-19 Contact Tracing Capacity in Health Departments to Support Reopening American Society Safely: https://www.naccho.org/uploads/full-width-images/Contact-Tracing-Statement-4-16-2020.pdf
National Governors Association Building a Covid-19 Contact Tracing Workforce: hhttps://www.nga.org/memos/contact-tracing-covid-19/
Partners In Health Part 1: Testing, Contact Tracing, and Community Management of Covid-19: https://www.pih.org/sites/default/files/PIH_Guide_COVID_Part_I_Testing_Tracing_Community_Managment_4_21.pdf
The Rockefeller Foundation National Covid-19 Testing Action Plan: https://www.rockefellerfoundation.org/national-covid-19-testing-action-plan/
Resolve to Save Lives Covid-19 Contact Tracing Playbook: https://contacttracingplaybook.resolvetosavelives.org/
Inventory of Contact Tracing Practices and Resources
An inventory that spans contact tracing practices and resources from the Centers for Disease Control and Prevention (CDC), Partners In Health (PIH), Johns Hopkins University Center for Health Security (JHU), Deloitte, Resolve to Save Lives/Vital Strategies, The Rockefeller Foundation, and the National Governors Association is available in the appendix and via this link:
https://docs.google.com/spreadsheets/d/1nvkzEeQ_ebQxlv0BiTXe-JwzJQOTWtx4SRkzdKmnjKQ/edit#gid=1230785837
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SECTION SIX: PROVIDING SUPPORTED ISOLATION
Every TTSI effort must involve the creation of a robust supported isolation network. Most people facing COVID-19 infection or exposure are able to self-isolate in their own home, but some cannot do so safely or do not have a home. Those with mild to moderate symptoms–who may be travelers, essential workers, people who live with immunocompromised individuals, people in group living settings, or without shelter–can all benefit from supported isolation.
For any effort to be successful, each isolation site must offer more than just shelter. Quality of life, including mental well-being and physical safety, must be accounted for in order to appropriately incentivize and reassure those isolating. To that end, effective supported isolation sites will include no-cost access to:
● Three meals per day that satisfy any dietary restrictions, allergies, and cultural needs. ● Hygiene products and cleaning services, such as laundry services, janitorial services,
and deep-cleaning room turnover teams. ● Building security measures and staff. ● Behavioral health care, including regular check-ins; incorporation of essential mental
health care may involve the hiring of additional staff, as well as offering training for those unfamiliar with working with unique adult populations. It may also be valuable to weave in telehealth services, which are expanding as reimbursement improves and behavioral health needs rise.
● Substance use disorder care, which can range from retaining the support of an on-call pharmacist to starting people on methadone, if necessary.
● Thoughtful prioritization of quality-of-life resources, including robust internet access, to make the lengthy stay more tolerable and allow people to complete the recommended length of their stay.
When establishing sites and resources for supported isolation, care must also be taken to ensure that people will be able to use and access them. It is essential for the locations of the sites to be spread throughout the area served to ensure equitable access. These sites should also be connected to the population by a variety of transportation options. Connection to both transit and the sites themselves will be best managed through referrals from a centralized intake service managed by the local government or public health service.
Staying in an isolation center must also be fiscally possible; wage replacements and small cash incentives are both useful in making isolation a viable option. Workers can also be protected with expanded paid and unpaid sick leave; New York & New Jersey adopted legislation to this effect in March, and federal action expanding family and medical leave soon followed.
A small sample of locations offering supported isolation facilities that can serve as models: - California is offering emergency housing for sick and medically vulnerable individuals
experiencing homelessness, as well as providing support to isolated individuals through volunteer efforts.
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- Chicago, IL is offering access to Covid-19 Isolation Facilities for unsheltered individuals and anyone experiencing symptoms.
- King County, WA, which faced waves of COVID-19 infection before much of the U.S., built a robust network of isolation, quarantine, and recovery spaces in response.
- Massachusetts set up COVID-19 isolation facilities for homeless individuals in hotels across the state.
For additional information, see “USofCare Playbook: Isolation and Quarantine Solutions to Serve At-Risk Populations during COVID-19.”
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SECTION SEVEN: FUNDING TTSI
Currently, there are several proposals for funding state TTSI programs (eg, Rockefeller, Edmond J. Safra Center for Ethics) including block grants to states for implementation of contact tracing, collaborative networks of states, and formal interstate compacts funded by Congress for test procurement. The goal of these proposals is to increase testing capacity and foster TTSI initiatives, recognizing that these are public goods that will continue to be critically important for months to come. AEI’s “Roadmap to Reopening,” for example, proposes linking supplemental funding to healthcare providers to increased surge capacity and stronger partnerships with public health authorities in order to contain ongoing and future outbreaks.
Testing the Insured
The Families First Coronavirus Response Act (FFCRA) mandates that testing and related services be entirely covered by all government and private insurance plans. The CARES Act expanded the range of tests and services that insurers must cover at no cost to subscribers, including reimbursing out-of-network providers. CMS increased its reimbursement for COVID tests from $51 to $100 to support testing capacity.
Testing the Uninsured
The FFCRA allocated $1 billion to the National Disaster Medical System to reimburse medical providers for testing uninsured patients, permitting providers to bill the government directly for such services. States and local governments can seek reimbursement for eligible expenses associated with coronavirus testing through FEMA’s Public Assistance program.
A big challenge for TTSI programs is that while healthcare payment and financial structures, particularly with the adjustments described above can address the needs for therapeutic testing, they do not address surveillance testing.
We are still in need of stable funding structure and payment processes for testing that flows from hotspot programs, state-wide contact tracing programs, and surveillance testing in congregate settings. We recommend that for surveillance testing, states shall grant funds in the form of vouchers to be delivered by contact tracing programs and routine testing programs to those needing tests. Vouchers shall be priced at cost + 5-8%. They should be funded by a federal appropriation.
Contact Tracing
Local and state public health agency funds, including federal emergency response funding/CDC PHEP grants. New funding will be essential to recruiting these individuals at scale. ASTHO has requested an appropriation of $3.6 billion for a 12-month effort. Entry-level personnel could be identified from government employees in other agencies, particularly where
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these employees have experience working in communities, and where previous workstreams have been limited by the pandemic - including librarians, teachers and other school personnel.
CDC has designated $50 million in a cooperative agreement for an organization to support COVID-19 workforce development. It is unclear if that funding is being used to support this recruitment. To achieve the scale needed to restart and reopen most local and state jurisdictions, more funding will be needed to support these professional positions in addition to this initial federal investment. [Source: ASTHO Guide]
Supported Isolation
Effective Supported Isolation will require provision of care packages of food, medical supplies, and PPE, assistance with internet access and other services, and/or financial support or paid leave. The FFCRA requires certain employers to provide up to two weeks of paid leave for when an employee is unable to work due to quarantine pursuant to public health orders. State authorities could work with hotels, restaurants and other food services, local internet service providers, and local businesses to provide these services.
Senator King (I-ME) is advocating appropriations in support of this element as follows:
o Voluntary self-isolation facilities ($4.5 billion): Some people will not be able to self-isolate in their homes because of the number of people living there or the physical structure of their dwelling. We can use idle hotels and other hospitality infrastructure to deliver this essential public service. o Voluntary self-isolation income support ($30 billion): We must disincentivize infected individuals from engaging with their communities during the period of isolation. For many people, the need to earn money outweighs taking steps to protect their own health and the health of their communities. We must provide income support during the period of self-isolation to ensure maximum effectiveness.
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SECTION EIGHT: PUBLIC COMMUNICATIONS IN SUPPORT OF TTSI
The success of a voluntary TTSI program depends on the public’s understanding of their role in the mitigation and suppression of the disease. Coordinated communication efforts are essential for people to understand why they may be called by a contract tracer, when and where to get tested, who will pay for the test, and how those who test positive allow their community to stay open by entering supported isolation.
TTSI communication campaigns need to come from both state agencies and local health departments. States should develop and share with communities communication materials to support TTSI efforts, such as brochures, posters, op-eds, blogs, public service announcements and success stories, and work with media and community engagement specialists to ensure public understanding, appreciation and buy-in for contract tracing as a critical measure for stopping the spread of the disease. See below for a detailed communication strategy.
The Path to Zero Is the Path of Hope
It’s in your power to reduce the death and harm in your community.
What's Our Case Incidence Level/Trend?
What's the #1 most important individual action?
What's our collective policy goal with regard to the virus?
What's our collective goal with regard to the health care system?
Red Stay at home Flatten the Curve
Get PPE to the Frontlines
Get Ventilators
Keep the Healthcare System from Getting Overwhelmed
Orange/Yellow
Stay 6 ft apart
Wear a Mask
Wash your hands
Take the Call Break the Chain
Enlist communities to support contact tracing
Train communities to do contact tracing
Enroll contact tracers
Support Isolation
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Know Your Status
Get a Test
Warn Friends and Neighbors about Exposure
Activate all our labs
Green
Know Your Status
Take the Call
Get a Test
Warn Friends and Neighbors about Exposure
Contain the Spike
Block a Second Wave
Keep the contact tracing going
Build community health
Components of a TTSI Communication and Community Engagement Strategy:
1. Provide your contact tracing corps and skilled contact tracers with training and materials that ensure people who engage with contact tracers feel supported and protected and receive empathetic, culturally appropriate engagement in an accessible language.
2. Determine messages and channels for relaying messages to different audiences.
a) cases, contacts, high risk settings and health care providers.
● Support cases and contacts while in isolation and quarantine to ensure they have the information needed to stay safe and adhere to public health recommendations.
○ Share new information on the COVID-19 situation in the area. ○ Reiterate and update on health and safety recommendations. ○ Link to information sources, including official websites, press briefings and
hotline. ○ Consider using email or text messages for sharing messages (or digital
apps as relevant). ○ Provide fact sheets, FAQs and other educational resources
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● Target messages to specific audiences, including COVID-19 cases and contacts, high-risk communities such as long-term care facilities and group homes, and health care providers and hospitals.
● Make materials available in multiple languages according to local needs. ● Send notifications to health care providers when there are changes to procedures
or policies relating to provision of health care, laboratory testing, treatments, or vaccines.
b) the general public
● Communicate widely via public information campaigns, using mass media, web sites and digital media to explain contact tracing and its impact.
● Engage journalists and consider journalist briefing calls to ensure journalists understand the program and are reporting factual and timely information.
● Use mass media and digital communication campaigns to build awareness of how contact tracing is helping us all get to a better tomorrow.
● Use official health department social media handles to amplify messaging. ● Develop communications campaigns that explain the contact tracing and testing
process and how personal information is protected. ● Develop a “Take the call” campaign that shows the importance of answering calls
and engaging honestly with contact tracing staff in the era of spam calls. 3. Engage community leaders by identifying people that communities trust, such as faith
and ethnic group leaders, business leaders, leaders within vulnerable populations, teachers, public officials and others. Build relationships with them, and enlist them as validators of your contact tracing messages. You can engage community leaders by:
○ Establishing a mechanism for feedback to refine messaging and tactics ○ Sharing communication plans and approaches ○ Sharing official fact sheets and other communication tools ○ Encouraging them to participate in press briefings ○ Encouraging and supporting them to share official public health notifications,
recommendations and other messages with their communities. Community leaders can use existing communication channels (such as social media and email newsletters) and establish new channels
4. Understand risk communication principles and apply them. ● Express empathy often. COVID-19 is scary, and spokespeople should
acknowledge that. People may find it invasive to consider sharing information about who they’ve been in contact with. Be sure to empathize with the public about the downsides of contact tracing, while reminding people of the benefits to their family, neighbors, friends and communities.
● Communication that expresses empathy, is credible, provides anticipatory guidance, promotes action, and shows respect will help build trust.
5. Respect confidentiality. Communication on every level needs to address and allay public concerns about privacy and confidentiality.
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 46
6. Establish a centralized mechanism to manage communication. ● Depending on the size of the community and communication needs, a small team
may be needed to support the various activities and coordinate with external stakeholders (e.g., community leaders, media outlets).
● The centralized mechanism should be linked with health department staff responsible for monitoring and analyzing the epidemic science and situation. This will ensure communications are accurate and up-to-date.
7. Evaluate and improve communication effort. Assess what’s working and what’s not working to improve communication messages and strategies.
Comments, suggestions, corrections should be directed to:
[email protected] with subject line TTSI Handbook.
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 47
APPENDIX
Example of guidance and process for following up with contacts during the tracing process provided by Public Health Department for Madison & Dane County, Wisconsin.
2019 Novel Coronavirus Follow-Up for
Contacts to COVID-19
Updated 6/17/2020 @ 3:25 pm
Onboarding Guide for Case Follow up and Contact Tracing
1. Contacts will be assigned by headmin and will be assigned via email. These emails will likely have no content in the body of the email, just a WEDSS ID number for you to look up, and Contact or COVID or Coronavirus as well as possibly the client initials.
2. Review record, looking at monitoring tab to see risk level and exposure date assigned by the PHN working with source patient. Also, check the investigation tab for any notes that may be entered that are applicable to the contact exposure. The contact should be linked to the case (located in the investigation tab), you can also look up the case record to gain more clarity on the exposure (Note: can only view case record if a Dane Co case)
3. Notify contacts that they may have been exposed to someone with 2019-nCoV.
· Reference this phone script which may be helpful as you make calls
4. If no risk level was determined prior to interview review the following in order to determine during your interview:
v level of exposure to the person diagnosed with 2019-nCoV using CDC’s guidelines. (Scroll down to the 1st table for applicable info!) algorithm also helpful
v Recommendations for People in US Communities Exposed to a person with known or suspected COVID, other than HCW or Essential Workers
v Healthcare personnel with potential exposure in a health care setting
5. Medium and high risk contacts should use the Wisconsin monitoring form to record their symptoms – PHMDC will NOT be checking in daily for temperatures and symptoms
· Instructions for Individuals with Medium-Risk Exposure, P-02598A available in multiple languages
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 48
· Instructions for Individuals with High-Risk Exposure, P-02598 available in multiple languages
6. If contacts develop fever and/or respiratory symptoms, they should call their health care provider and report their symptoms, exposure to a positive COVID-19 case and ask to be tested for COVID-19. Ensure individual has a plan for seeking health care. If seeking emergency care and/or transportation client should inform providers that they have been exposed to COVID-19 and wear a mask during transport if they have one available.
7. If contact is asymptomatic, recommend testing no earlier than day 12 of quarantine, with the understanding that 14-day quarantine period must be completed even if test is negative.
8. For symptomatic contacts of confirmed cases, they should be considered a “probable”. To track these, they need to be converted to a DI. Once they are converted to a DI, it will appear in your case load as “new”, you will do any future documentation in the new DI and then close it as final.
9. Contacts who work in a health care organization will be managed by the health care organization’s infection prevention staff to ensure health care providers and patients are identified and notified of their exposure. Per CDC guidance health care worker guidance, health care facilities could consider allowing asymptomatic HCP’s who have had an exposure to work with restrictions (mask and active symptom monitoring by a designated person at the facility). Definition of a Health Care Worker (HCW): Anyone who works at a healthcare facility, including environmental services, lab techs, receptionists, etc.
10. Per CDC guidance dated April 8, 2020, Essential workers who have been exposed to COVID may work during their monitoring period, with restrictions. https://www.cdc.gov/coronavirus/2019-ncov/community/critical-workers/implementing-safety-practices.html However, Wisconsin and PHMDC are NOT following CDC’s guidance. In order to best protect the community, all contacts should quarantine and not go to work. The only exception is health care workers.
11. Provide your contact information to the client in case they have questions. PHMDC staff do not need to contact client for regular symptom monitoring.
12. Send client HIPPA, (see link at bottom of document for HIPPA folder with languages other than English) appropriate fact sheets via email, and appropriate notification letter (sending COVID letter guidance )via secure email. Instruct client to check junk email folder if they don’t find it in their inbox.
o Instructions for Individuals with Low-Risk Exposure, P-02598B available in multiple languages
o Instructions for Individuals with Medium-Risk Exposure, P-02598A available in multiple languages
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 49
o Instructions for Individuals with High-Risk Exposure, P-02598 available in multiple languages
o High risk household contact instructions
o PHMDC Symptom Tracker
13. If an interpreter is needed, here is the information to use Pacific Interpreters:
· Dial: 1-XXX-XXX-XXXX
· Access Code: XXXX
o Indicate Language
o Phone Number
o Program Name (COVID-19)
14. Assure isolation/quarantine based on risk level – convey importance of social distancing and isolation, what it means for the population and family and friends around them
· If hospitalization is not necessary, client may isolate at home. See CDC guidance for client and others in the household.
· Explain what isolation recommendations will be if the client is tested and has a negative or positive test result (if a negative test, still must remain isolated for 14 days due to contact status
· If a letter is needed for employment, use template letter here. Give to contact, who can provider employer with letter. Upload a copy of this letter into the contact’s filing cabinet in WEDSS
15. Client should monitor their symptoms daily using the appropriate PHMDC Symptom Tracker. We will NOT be checking in with them daily for their temperatures and symptoms – only an initial phone call.
16. Confirm individual has a plan for seeking care if symptoms worsen. Client should call their health care provider before seeking care. If seeking emergency care and/or transportation client should inform providers that they are under evaluation for Novel Coronavirus.
17. Recommend testing no earlier than day 12 of the quarantine period. Assure clients that if they do test positive, PHMDC will work with them to notify their contacts and assure proper follow up, they should NOT be doing this without our guidance.
18. Provide education regarding infection control at home. General cleaning guidance fact sheet here
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 50
19. Enter info into WEDSS based on this guidance. Be sure to document ALL attempts to contact in WEDSS.
20. Once initial contact has been made and education on isolation provided, case can be closed.
· There is no need to keep the record open for the duration of the 14-day monitoring period. If the contact ends up calling back with questions/concerns, etc. the record can be re-opened so documentation can occur.
· If contact is experiencing symptoms, they must be converted to a DI.
21. Other Information
· Unable to contact- attempt contact 3 separate times, with at least 2 different types of contact (i.e. phone call, email, texting is least preferred method- reference text protocol for script) in the same business day (if referral comes in after 2pm, you may attempt 1 or more contacts the next morning)
· If you are not scheduled to work the next day and you have not heard back from contact, please email headmin ([email protected]) and ask for it to be reassigned to a contact tracer for the next day.
· If, after the above attempts to contact do not work, a notification letter (Using COVID letter guidance) needs to be mailed to the contact at the address listed in WEDSS.
§ Be sure notification letter has your contact information in it so client can get in touch with you
§ Follow letter delivery instructions, attaching letter for client to email
· Document all attempts (unsuccessful and successful) to contact in WEDSS.
· Once a referral is received, you must make an attempt to contact as soon as possible. If this can’t be done, email headmin asking to have it reassigned. If you have tried to contact during your scheduled shift, and are not working the next day, email headmin to have it reassigned to someone on the next day. No referrals will be assigned after 3:30pm
· Minors -If the contact is a child under the age of 18 years old, tell the child you need to get in contact with a parent and get parent contact information.
· Negative Test Results: If a contact is tested and the results are negative, a separate DI will be created in WEDSS for this. No charting is needed in the DI. Just know that there will be two records, a CI (which you will have done your charting in) and a DI.
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 51
APPENDIX
Contact Tracing Inventory of Best Practices and Resources
TTSI Technical Advice Handbook v. 2.0- June 30, 2020 52
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
1
Con
tact
Tra
cing
Inve
ntor
y of
Pra
ctic
es a
nd R
esou
rces
Rec
ruiti
ng
pers
onne
lH
iring
CD
CW
orkf
orce
est
imat
ion
calc
ulat
or: h
ttps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-n
cov/
php/
cont
act-
traci
ng/C
OV
IDTr
acer
.htm
lP
artn
ers
In H
ealth
Full-
time
paid
con
tact
trac
ing
staf
f is
the
mos
t effe
ctiv
e an
d ef
ficie
nt a
ppro
ach
to b
uild
ing
surg
e ca
paci
ty.
Em
phas
is o
n hi
ring
from
div
erse
pop
ulat
ions
and
ens
urin
g lo
cal r
epre
sent
atio
n in
the
wor
kfor
ce.
Hiri
ng
loca
l con
tact
trac
ers
and
care
coo
rdin
ator
s is
impo
rtant
for b
oth
cultu
ral c
ompe
tenc
y an
d id
entif
icat
ion/
prov
isio
n of
soc
ial s
uppo
rts. L
ocal
s ha
ve k
now
ledg
e of
exi
stin
g co
mm
unity
sup
ports
for
food
, med
icat
ion,
and
med
ical
ser
vice
sJH
UJo
hns
Hop
kins
CO
VID
-19
Con
tact
Tra
cing
Cou
rse
on C
ours
era:
http
s://w
ww
.cou
rser
a.or
g/le
arn/
covi
d-19
-con
tact
-trac
ing?
edoc
omor
p=co
vid-
19-c
onta
ct-tr
acin
gD
eloi
tteH
iring
pub
lic h
ealth
stu
dent
s vi
a in
tern
ship
s, v
olun
teer
and
pra
ctic
um o
ffers
opp
ortu
nitie
s to
cre
ate
addi
tiona
l ave
nues
for s
kille
d pe
rson
nel,
whi
le p
rovi
ding
wor
kfor
ce d
evel
opm
ent o
ppor
tuni
ties
Res
olve
/Vita
l Stra
tegi
esA
che
cklis
t for
est
ablis
hing
a s
cale
d-up
pub
lic h
ealth
wor
kfor
ce fo
r CO
VID
-19
cont
act t
raci
ng: h
ttps:
//con
tact
traci
ngpl
aybo
ok.re
solv
etos
avel
ives
.org
/che
cklis
ts/w
orkf
orce
Con
tact
trac
ing
staf
fing
calc
ulat
or: h
ttps:
//pre
vent
epid
emic
s.or
g/co
vid1
9/re
sour
ces/
cont
act-t
raci
ng-
staf
fing-
calc
ulat
or/
See
4.b
"Sam
ple
job
desc
riptio
ns":
http
s://c
onta
cttra
cing
play
book
.reso
lvet
osav
eliv
es.
org/
chec
klis
ts/w
orkf
orce
Sam
ple
cont
act t
raci
ng s
taff
supe
rvis
ion
tool
: http
s://v
ital.e
nt.b
ox.
com
/s/k
6x5l
7jb4
hazw
h61x
3ch4
uu0e
rzyg
kzb
Roc
kefe
ller
In o
rder
to b
uild
trus
t, pu
blic
hea
lth a
utho
ritie
s sh
ould
con
side
r em
ploy
ing
(eith
er a
s hi
res
or v
olun
teer
s)
cont
act t
race
rs w
ho c
ome
dire
ctly
from
the
regi
onal
are
as th
ey w
ill w
ork
with
, and
hav
e st
rong
cul
tura
l aw
aren
ess,
ling
uist
ic a
bilit
ies,
and
com
mun
ity c
onne
ctio
ns.
NG
AG
over
nors
, sta
te h
ealth
offi
cial
s, a
nd s
tate
wor
kfor
ce b
oard
s ca
n al
ign
effo
rts b
y re
train
ing
and
reem
ploy
ing
disl
ocat
ed w
orke
rs a
s co
ntac
t tra
cers
, pot
entia
lly p
rovi
ding
on-
ram
ps to
car
eer p
athw
ays
in
publ
ic h
ealth
. Sta
te a
nd lo
cal w
orkf
orce
dev
elop
men
t boa
rds
(WD
Bs)
can
ass
ist h
ealth
dep
artm
ents
in
recr
uitin
g, id
entif
ying
, and
trai
ning
new
con
tact
trac
ing
hire
s. W
DB
s ca
n m
atch
elig
ible
job
seek
ers
with
co
ntac
t tra
cing
job
oppo
rtuni
ties
and
conn
ect t
hem
with
requ
ired
train
ing.
N
umer
ous
stat
es h
ave
opte
d to
exp
and
hirin
g un
der p
ublic
-priv
ate
partn
ersh
ips
with
ent
ities
with
de
mon
stra
ted
com
pete
ncie
s an
d ex
perie
nce
in w
orkf
orce
hiri
ng, r
ecru
itmen
t, an
d w
orkf
orce
m
anag
emen
t. R
edep
loym
ent o
f pu
blic
em
ploy
ees
CD
C
Par
tner
s in
Hea
lthJH
UD
eloi
tteR
esol
ve/V
ital S
trate
gies
Pub
lic h
ealth
pro
fess
iona
ls w
orki
ng in
oth
er a
reas
of t
he h
ealth
dep
artm
ent o
r in
othe
r priv
ate
or
orga
niza
tions
or p
ublic
age
ncie
s m
ay b
e av
aila
ble
to s
uppo
rt. S
ee 2
.b "E
xist
ing
publ
ic h
ealth
sta
ff th
at
can
fill c
onta
ct tr
acin
g ro
les"
: http
s://c
onta
cttra
cing
play
book
.reso
lvet
osav
eliv
es.o
rg/c
heck
lists
/wor
kfor
ce
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
2
Red
eplo
ymen
t of
publ
ic e
mpl
oyee
s
Roc
kefe
ller
Pub
lic h
ealth
pro
fess
iona
ls w
ho a
re te
mpo
raril
y de
ploy
ed fo
r con
tact
trac
ing
serv
e an
impo
rtant
brid
ging
ro
le a
s st
ates
and
citi
es ra
mp
up c
onta
ct tr
acin
g. T
hey
ofte
n ha
ve th
e ne
cess
ary
expe
rtise
. How
ever
, as
they
are
ofte
n te
mpo
rary
wor
kers
, thi
s re
crui
tmen
t stra
tegy
is n
ot s
usta
inab
le a
nd th
ey m
ight
lack
the
requ
isite
loca
l kno
wle
dge
and
inte
rper
sona
l con
nect
ions
. N
GA
Sev
eral
sta
tes,
suc
h as
Ala
bam
a, h
ave
reas
sign
ed s
taff
from
with
in it
s he
alth
dep
artm
ent t
o in
crea
se
cont
act t
raci
ng c
apac
ity. W
hile
vol
unte
ers
and
reas
sign
ed s
tate
em
ploy
ees
play
an
impo
rtant
sur
ge ro
le,
such
tim
e-lim
ited
depl
oym
ents
may
pos
e ch
alle
nges
for m
anag
emen
t and
acc
ount
abili
ty. S
tate
s w
ill
need
to b
alan
ce v
olun
teer
s an
d te
mpo
rary
sur
ge w
orkf
orce
with
effo
rts to
bui
ld a
nd s
usta
in a
pai
d,
skill
ed c
onta
ct tr
acin
g w
orkf
orce
mov
ing
forw
ard.
Ser
vice
per
sonn
elC
DC
Wor
k w
ith S
tate
Ser
vice
Com
mis
sion
s an
d A
mer
icor
ps p
rogr
am. G
over
nor-
appo
inte
d S
tate
Ser
vice
C
omm
issi
ons
adm
inis
ter a
nd o
vers
ee A
mer
iCor
ps p
rogr
ams
in th
eir s
tate
s. T
hese
sta
te-b
ased
par
tner
s,
man
y of
whi
ch a
re a
ctiv
ely
enga
ged
in th
eir s
tate
’s e
mer
genc
y re
spon
se e
fforts
, can
be
leve
rage
d fo
r ad
ditio
nal h
uman
reso
urce
s ne
eds:
http
s://w
ww
.cdc
.gov
/cor
onav
irus/
2019
-nc
ov/d
ownl
oads
/php
/nat
iona
l-ser
vice
-res
ourc
es-s
uppo
rt.pd
f O
ther
ser
vice
org
aniz
atio
ns, s
uch
as th
e M
edic
al R
eser
ve C
orps
, the
US
Dig
ital R
espo
nse,
and
mor
e ar
e m
akin
g th
eir v
olun
teer
s av
aila
ble
to a
ssis
t with
CO
VID
-19
effo
rts: h
ttps:
//ww
w.c
dc.
gov/
coro
navi
rus/
2019
-nco
v/ph
p/op
en-a
mer
ica/
staf
fing-
guid
ance
.htm
lP
artn
ers
in H
ealth
JHU
Mob
ilize
med
ical
stu
dent
s fo
r CO
VID
-19
resp
onse
, inc
ludi
ng c
onta
ct tr
acin
g: h
ttps:
//jam
anet
wor
k.co
m/jo
urna
ls/ja
ma/
fulla
rticl
e/27
6442
7D
eloi
tteC
onsi
der c
olle
ge s
tude
nts
taki
ng a
gap
yea
r. N
ote
that
thes
e ar
e su
rge
reso
urce
s an
d no
t lon
g te
rm fu
ll tim
e em
ploy
ees.
Res
olve
/Vita
l Stra
tegi
esN
atio
nal g
uard
or o
ther
vol
unte
ers
may
bew
illin
g to
sup
port
cont
act t
raci
ngR
ocke
felle
rD
eplo
ying
the
natio
nal g
uard
and
vol
unte
ers
is a
cos
t-effe
ctiv
e w
ay to
sta
nd u
p a
cont
act t
raci
ng
wor
kfor
ce b
ut th
ey o
ften
lack
the
loca
l con
nect
ions
and
nec
essa
ry ti
me
allo
tmen
t for
con
tact
trac
ing
effo
rts. A
lso
cons
ider
Ser
vice
Yea
r, P
eace
Cor
ps a
nd o
ther
Am
eriC
orps
per
sonn
el w
ho c
an b
e de
ploy
ed
quic
kly.
N
GA
The
Ohi
o D
epar
tmen
t of H
ealth
is a
ugm
ente
d tra
cing
cap
acity
of i
ts 1
13 lo
cal h
ealth
juris
dict
ions
by
conn
ectin
g lo
cal h
ealth
dep
artm
ents
with
vol
unte
ers,
sup
porti
ng o
nboa
rdin
g an
d tra
inin
g, a
nd
deve
lopi
ng a
sta
tew
ide
pool
that
can
sur
ge to
cov
er o
utbr
eaks
that
may
exc
eed
loca
l cap
acity
.M
ore
than
40,
000
Nat
iona
l Gua
rd m
embe
rs h
ave
been
dep
loye
d fo
r CO
VID
-19
relie
f wor
k ac
ross
the
coun
try, w
ith s
tate
s su
ch a
s Io
wa,
Nor
th D
akot
a, R
hode
Isla
nd, W
ashi
ngto
n an
d W
est V
irgin
ia a
ctiv
atin
g th
e N
atio
nal G
uard
to c
ondu
ct c
onta
ct tr
acin
g.
Rec
ruitm
ent o
f co
mm
unity
or
gani
zatio
ns
CD
CS
ome
com
mun
ities
iden
tify
volu
ntee
rs a
nd/o
r phi
lant
hrop
ic o
rgan
izat
ions
will
ing
to a
ssis
t the
CO
VID
-19
resp
onse
. Mat
chin
g th
eir k
now
ledg
e, s
kills
, and
abi
litie
s w
ith k
ey ro
les
in c
ase
inve
stig
atio
n an
d co
ntac
t tra
cing
and
pro
vidi
ng re
leva
nt tr
aini
ng c
an e
xpan
d th
e w
orkf
orce
. P
artn
ers
in H
ealth
Eng
age
and
rein
forc
e ex
istin
g co
mm
unity
hea
lth w
orkf
orce
mem
bers
and
cad
res—
incl
udin
g C
omm
unity
H
ealth
Wor
kers
. Eng
age
FQH
Cs
as k
ey im
plem
enta
tion
and
staf
fing
partn
ers
whe
re p
ossi
ble
JHU
John
s H
opki
ns C
OV
ID-1
9 C
onta
ct T
raci
ng C
ours
e on
Cou
rser
a: h
ttps:
//ww
w.c
ours
era.
org/
lear
n/co
vid-
19-c
onta
ct-tr
acin
g?ed
ocom
orp=
covi
d-19
-con
tact
-trac
ing
Del
oitte
Mob
ilize
d ac
adem
ic in
stitu
tions
(e.g
. pub
lic h
ealth
pro
gram
s) to
trai
n st
uden
ts to
pro
vide
imm
edia
te
cont
act t
raci
ng s
uppo
rt w
hile
a m
ore
perm
anen
t wor
kfor
ce is
recr
uite
d
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
3
Rec
ruitm
ent o
f co
mm
unity
or
gani
zatio
ns
Res
olve
/Vita
l Stra
tegi
esP
artn
erin
g w
ith a
priv
ate
orga
niza
tion,
suc
h as
a lo
cal u
nive
rsity
or n
on-p
rofit
org
aniz
atio
n, to
man
age
hirin
g an
d/or
wor
kfor
ce o
pera
tions
may
be
quic
ker a
nd e
asie
r tha
n do
ing
this
thro
ugh
heal
th d
epar
tmen
t m
echa
nism
s.C
onsi
der c
omm
uniti
es a
nd p
opul
atio
ns d
ispr
opor
tiona
tely
impa
cted
by
CO
VID
-19
and
hirin
g fro
m w
ithin
th
ese
com
mun
ities
. Con
sult
with
com
mun
ity-b
ased
org
aniz
atio
ns a
nd c
omm
unity
lead
ers
who
hav
e ea
rned
loca
l com
mun
ity tr
ust.
Roc
kefe
ller
Eng
agin
g a
trust
wor
thy
loca
l com
mun
ity g
roup
, wel
l-net
wor
ked
non-
prof
it an
d/or
rigo
rous
rese
arch
ac
adem
ic in
stitu
te to
trai
n an
d hi
re c
onta
ct tr
acer
s, in
clud
ing
to p
rovi
de s
uppo
rt se
rvic
es fo
r sel
f-iso
latio
n an
d ad
min
istra
tive
man
agem
ent,
can
ease
the
wor
kloa
d of
ove
rwhe
lmed
pub
lic h
ealth
dep
artm
ents
. H
iring
as
loca
lly a
s po
ssib
le is
the
corn
erst
one
of e
ffect
ive
cont
act t
raci
ng.
NG
AS
ever
al s
tate
s in
clud
ing
Ariz
ona
have
par
tner
ed w
ith u
nive
rsiti
es o
r med
ical
sch
ools
to d
eplo
y vo
lunt
eers
with
bac
kgro
unds
in p
ublic
hea
lth, s
ocia
l wor
k, a
nd m
edic
ine.
Man
y st
ates
are
par
tner
ing
with
loca
l com
mun
ity h
ealth
sys
tem
s, F
eder
ally
Qua
lifie
d H
ealth
Cen
ters
, an
d no
n-pr
ofits
ser
ving
med
ical
ly-u
nder
serv
ed c
omm
uniti
es to
hel
p bu
ild in
-roa
ds to
har
d-to
-rea
ch
com
mun
ities
that
wou
ld o
ther
wis
e no
t be
poss
ible
if re
lyin
g on
tech
nolo
gy a
nd re
mot
e w
orke
rs a
lone
. O
rgan
izat
iona
l st
affin
gC
DC
Con
side
ratio
n sh
ould
be
give
n to
the
alig
nmen
t of s
taff
assi
gnm
ents
and
sup
ervi
sion
with
wor
kflo
w.
Thos
e ac
tiviti
es re
quiri
ng k
now
ledg
e of
and
acc
ess
to p
ublic
hea
lth s
urve
illan
ce s
yste
ms
(e.g
., su
rvei
llanc
e tri
age,
cas
e in
vest
igat
ion)
may
be
bette
r int
egra
ted
into
the
heal
th d
epar
tmen
t’s w
orkf
low
. S
ome
juris
dict
ions
hav
e fo
und
it us
eful
to m
obili
ze a
cad
re o
f sta
te c
ase
inve
stig
ator
s to
bol
ster
loca
l ef
forts
in th
e ev
ent o
f clu
ster
s or
out
brea
ks.
Par
tner
s in
Hea
lthD
epen
ding
on
loca
l law
s an
d go
vern
ance
stru
ctur
es (i
n ho
me-
rule
s st
ates
vs.
sta
tes
with
mor
e ce
ntra
lized
con
trol o
ver p
ublic
hea
lth),
optio
ns fo
r how
to ra
mp
up s
urge
sta
ffing
var
y. S
tate
s an
d lo
calit
ies
need
to d
eter
min
e w
hat k
ind
of s
taffi
ng s
trate
gy (c
entra
lized
ver
sus
dece
ntra
lized
). S
ome
stat
es a
nd c
ities
hav
e op
ted
to h
ire a
cen
traliz
ed s
urge
wor
kfor
ce to
be
depl
oyed
upo
n re
ques
t to
loca
l de
partm
ents
, or a
re o
pera
ting
virtu
al c
all c
ente
rs w
ith fu
ll st
atew
ide
cove
rage
; oth
er ju
risdi
ctio
ns a
re
prov
idin
g gr
ant f
undi
ng to
loca
l hea
lth d
epar
tmen
ts to
hire
and
man
age
surg
e st
aff l
ocal
ly; o
ther
s ar
e co
ntra
ctin
g lo
cal C
BO
s to
acc
ompa
ny lo
cal h
ealth
dep
artm
ent s
taff
with
sur
ge s
uppo
rt JH
UD
eloi
tteR
esol
ve/V
ital S
trate
gies
If w
orki
ng w
ith a
net
wor
k of
vol
unte
ers,
asc
erta
in th
eir c
omm
itmen
t to
ensu
re a
relia
ble
wor
kfor
ce; i
f re
liabl
e, c
onsi
der l
ever
agin
g th
eir e
xist
ing
infra
stru
ctur
e fo
r per
sonn
el o
nboa
rdin
g an
d m
anag
emen
t. C
onsi
der h
ow to
han
dle
staf
fing
whe
n co
ntac
t tra
cing
nee
ds c
hang
e, fo
r exa
mpl
e us
ing
hour
ly w
ages
an
d re
serv
ing
the
right
to re
duce
or s
cale
hou
rs a
s ne
eded
.R
ocke
felle
rC
onsi
der t
he a
dmin
istra
tive
burd
en fo
r pub
lic h
ealth
dep
artm
ents
whe
n re
crui
ting,
trai
ning
and
dep
loyi
ng
cont
act t
race
rs.
NG
AS
ever
al s
tate
s em
ploy
ed s
urve
ys o
f loc
al h
ealth
dep
artm
ents
to d
eter
min
e cu
rren
t wor
kfor
ce c
apac
ity
and
enga
ged
loca
l hea
lth d
epar
tmen
ts a
nd o
ther
key
sta
keho
lder
s in
pla
nnin
g an
d on
goin
g co
ordi
natio
n th
roug
h en
titie
s lik
e th
e M
assa
chus
etts
and
Nor
th C
arol
ina
Com
mun
ity T
raci
ng C
olla
bora
tives
.If
the
num
ber o
f rep
orte
d da
ily c
ases
out
pace
s th
e ab
ility
to c
ondu
ct c
ase
inte
rvie
ws
with
in 2
4 ho
urs,
st
ates
may
nee
d to
con
side
r stra
tegi
es fo
r hiri
ng a
dditi
onal
sta
ff, s
hifti
ng th
e co
mpo
sitio
n of
the
cont
act
traci
ng w
orkf
orce
, pro
vidi
ng te
mpo
rary
sur
ge re
sour
ces,
or c
onsi
derin
g ot
her f
orce
-mul
tiply
ing
tech
nolo
gy in
vest
men
ts to
aut
omat
e or
aug
men
t man
ual c
onta
ct tr
acin
g.
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
4
Trai
ning
pe
rson
nel
Cou
rser
a / M
assi
ve
Ope
n O
nlin
e C
ours
es
CD
CC
onta
ct tr
acin
g tra
inin
gs fo
r con
tact
trac
ers,
cas
e in
vest
igat
ers,
and
sup
ervi
sors
: http
s://w
ww
.cdc
.go
v/co
rona
viru
s/20
19-n
cov/
php/
cont
act-t
raci
ng/in
dex.
htm
lA
-Z li
st o
f tra
inin
g re
sour
ces
for c
onta
ct tr
acin
g: h
ttps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-
ncov
/dow
nloa
ds/p
hp/c
onta
ct-tr
acin
g-tra
inin
g-pl
an.p
dfC
DC
Cov
id-1
9 tra
inin
g re
srou
ces
also
ava
ilabl
e on
the
TRA
IN L
earn
ing
Net
wor
k he
re.
Par
tner
s in
Hea
lthJH
UJH
U C
ovid
-19
Con
tact
Tra
cing
: http
s://w
ww
.cou
rser
a.or
g/le
arn/
covi
d-19
-con
tact
-trac
ing?
edoc
omor
p=co
vid-
19-c
onta
ct-tr
acin
gD
eloi
tteA
STH
O h
as tr
aini
ng m
ater
ials
that
mos
t Sta
te a
nd L
ocal
Hea
lth D
epar
tmen
ts u
se. M
akin
g C
onta
ct: A
Tr
aini
ng fo
r Cov
id-1
9 C
onta
ct T
race
rs: h
ttps:
//lea
rn.a
stho
.org
/p/C
onta
ctTr
acer
Res
olve
/Vita
l Stra
tegi
esP
ublic
Hea
lth F
ound
atio
n's
TRA
IN L
earn
ing
Net
wor
k C
atal
og o
f Cov
id-1
9 C
onta
ct T
raci
ng C
ours
es
Roc
kefe
ller
NG
AR
efer
ence
s A
STH
O, C
DC
, and
JH
U c
onta
ct tr
acin
g co
urse
s (a
bove
). S
choo
ls o
f pub
lic
heal
thC
DC
Par
tner
s in
Hea
lthJH
UJH
U is
pro
vidi
ng tr
aini
ng fo
r con
tact
trac
ers
thro
ugh
its C
ours
era
cour
se.
Del
oitte
Wor
king
with
Sch
ools
of p
ublic
hea
lth to
dev
elop
fiel
d ep
idem
iolo
gy tr
aini
ngs
for c
onta
ct tr
acin
g.R
esol
ve/V
ital S
trate
gies
Roc
kefe
ller
In a
dditi
on to
oth
er p
ublic
hea
lth s
choo
ls m
entio
ned
abov
e, Y
ale
Uni
vers
ity is
als
o of
ferin
g a
cour
se
used
for C
T co
ntac
t tra
cers
. N
GA
Haw
aii h
as p
artn
ered
with
the
Uni
vers
ity o
f Haw
aii t
o in
crea
se tr
aini
ng p
rogr
ams
for c
omm
unity
hea
lth
wor
kers
, as
wel
l as
prov
idin
g tra
inin
g fo
r an
addi
tiona
l 300
con
tact
trac
ers.
O
ther
offe
rings
CD
CC
onta
ct tr
acin
g ex
plan
atio
n an
d re
sour
ces:
http
s://w
ww
.cdc
.gov
/cor
onav
irus/
2019
-nco
v/ph
p/op
en-
amer
ica/
cont
act-t
raci
ng/in
dex.
htm
lC
onta
ct tr
acin
g an
d ca
se in
vest
igat
ion
"how
-to" o
verv
iew
: http
s://w
ww
.cdc
.gov
/cor
onav
irus/
2019
-nc
ov/p
hp/p
rinci
ples
-con
tact
-trac
ing.
htm
lP
artn
ers
in H
ealth
Cro
ss-tr
ain
staf
f in
case
inve
stig
atio
n an
d co
ntac
t tra
cing
to m
axim
ize
wor
kfor
ce fl
exib
ility
Dev
elop
ed a
trai
ning
pro
gram
for w
orke
rs in
clud
ing
role
pla
y, s
cena
rio-b
ased
lear
ning
, and
sel
fpac
ed
onlin
e m
odul
es. H
ired
full
time
staf
f to
man
age
the
train
ing
prog
ram
. Tr
aini
ng n
eeds
to b
e a
robu
st, c
ontin
uous
pro
cess
and
requ
ires
both
tech
nica
l and
inte
rper
sona
l co
mpo
nent
s. M
assa
chus
etts
con
tact
trac
ers
rece
ive
15+
hour
s of
trai
ning
dur
ing
both
on-
boar
ding
and
at
regu
lar i
nter
vals
.JH
UD
eloi
tteR
esol
ve/V
ital S
trate
gies
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
5
Oth
er o
fferin
gs
Roc
kefe
ller
Con
side
r cap
acity
bui
ldin
g fo
r com
mun
ity g
roup
s on
pub
lic c
omm
unic
atio
ns a
nd b
ehav
ior c
hang
e ar
ound
con
tact
trac
ing.
NG
A
Cul
tura
l co
mpe
tenc
yC
DC
To h
elp
build
trus
t, ju
risdi
ctio
ns s
houl
d try
to e
mpl
oy p
ublic
hea
lth s
taff
who
are
of t
he s
ame
raci
al a
nd
ethn
ic b
ackg
roun
d as
the
affe
cted
com
mun
ity a
nd c
an c
omm
unic
ate
in th
eir p
refe
rred
lang
uage
. Whe
n th
at is
not
pos
sibl
e, it
is im
porta
nt to
pro
vide
inte
rpre
ters
for i
ndiv
idua
ls w
ho h
ave
limite
d E
nglis
h pr
ofic
ienc
y an
d co
nsid
er tr
ansl
atin
g th
e da
ta c
olle
ctio
n in
stru
men
ts.
Par
tner
s in
Hea
lthJH
Uht
tps:
//joh
nsho
pkin
ssph
.libs
yn.c
om/h
ealth
-equ
ity-in
-cov
id-1
9-br
eaki
ng-d
own-
long
stan
ding
-bar
riers
-to-
save
-live
sD
eloi
tteC
olla
bora
te w
ith ra
cial
/cul
tura
l equ
ity c
ente
rs (i
.e. C
ente
r Urb
an a
nd R
acia
l Equ
ity) t
o he
lp d
evel
op
mat
eria
ls th
at a
re th
ough
tful,
guid
ed in
form
atio
n on
cul
tura
l com
pete
ncy,
soc
ial j
ustic
e an
d he
alth
equ
ity.
Trai
ning
s: h
ttps:
//ww
w.tr
ain.
org/
mai
n/co
urse
/107
8759
/; tra
inin
gs o
n im
plic
it bi
as a
nd s
yste
mic
raci
sm:
http
s://w
ww
.mitr
aini
ngce
nter
.org
/cou
rses
/ibph
a121
9R
esol
ve/V
ital S
trate
gies
Roc
kefe
ller
Cul
tura
l com
pete
ncy
is k
ey to
reac
hing
som
e of
the
mos
t affe
cted
and
vul
nera
ble
com
mun
ities
. Tra
inin
g an
d hi
ring
prac
tices
for c
onta
ct tr
acer
s m
ust e
mph
asiz
e cu
ltura
l sen
sitiv
ities
, and
be
faci
litat
ed b
y co
mm
unity
gro
ups,
trus
ted
lead
ers
and
faith
org
aniz
atio
ns.
NG
AS
tate
s ar
e pa
rtner
ing
with
loca
l uni
vers
ities
, com
mun
ity c
olle
ges,
Are
a H
ealth
Edu
catio
n C
ente
rs
(AH
EC
s), a
nd n
onpr
ofit
orga
niza
tions
to s
uppo
rt ta
ilore
d tra
inin
g fo
r con
tact
trac
ers.
Cal
iforn
ia G
over
nor
Gav
in N
ewso
m’s
Cal
iforn
ia C
onne
cted
is a
col
labo
ratio
n be
twee
n th
e C
alifo
rnia
Dep
artm
ent o
f Hea
lth,
loca
l hea
lth d
epar
tmen
ts, t
he U
nive
rsity
of C
alifo
rnia
San
Fra
ncis
co a
nd U
nive
rsity
of C
alifo
rnia
Los
A
ngel
es to
sup
port
train
ing
for a
cul
tura
lly c
ompe
tent
and
ski
lled
wor
kfor
ce.
Proc
ess
Man
agem
ent &
Su
ppor
t Too
lsC
all c
ente
rsC
DC
The
first
con
nect
ion
can
be m
ade
thro
ugh
diffe
rent
cha
nnel
s su
ch a
s ph
one,
text
, em
ail o
r (if
nece
ssar
y)
in-p
erso
n in
the
prim
ary
lang
uage
of t
he in
divi
dual
. Thi
s pr
oces
s ca
n be
man
ual,
auto
mat
ed, o
r sem
i-au
tom
ated
bas
ed o
n ju
risdi
ctio
nal c
apac
ity. P
roto
col s
houl
d cl
early
out
line
the
prim
ary
and
seco
ndar
y m
eans
of r
each
ing
a cl
ient
and
add
ress
con
fiden
tialit
y at
the
star
t of c
omm
unic
atio
n.
Par
tner
s in
Hea
lthIn
Mas
sach
uset
ts, p
artn
ered
with
the
Com
mon
wea
lth C
onne
ctor
Aut
horit
y (C
CA
) to
stan
d up
a v
irtua
l ca
ll ce
nter
and
cre
ate
a co
mm
unic
atio
ns s
trate
gy. C
CA
is ty
pica
lly re
spon
sibl
e fo
r out
reac
h an
d co
mm
unic
atio
ns s
urro
undi
ng h
ealth
insu
ranc
e en
rollm
ent.
Rob
ust c
all c
ente
r ope
ratio
ns in
tegr
ated
with
an
und
erly
ing
best
-pra
ctic
e C
RM
(cus
tom
er re
latio
nshi
p m
anag
emen
t) to
ols.
The
plat
form
of t
he s
tate
sys
tem
of r
ecor
d of
cas
es a
nd th
e ca
ll ce
nter
pla
tform
mus
t be
inte
grat
ed o
r in
terfa
ced
Exp
erim
ente
d w
ith n
ew a
venu
es to
incr
ease
pho
ne re
spon
se in
clud
ing
text
ing,
leav
ing
mes
sage
s,
crea
ting
an in
boun
d ca
ll lin
e, a
nd w
orki
ng w
ith te
leco
m c
ompa
nies
to c
reat
e a
sing
le c
alle
r ID
. JH
UD
eloi
tteTh
ink
of 'c
all c
ente
rs' m
ore
like
'con
tact
cen
ters
'; W
hile
initi
al o
utre
ach
may
be
by p
hone
, fol
low
-up
and
ongo
ing
cont
act c
an b
e do
ne b
y te
xt, e
mai
l or o
ther
aut
omat
ed o
ptio
ns, b
ased
on
user
pre
fere
nce.
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
6
Cal
l cen
ters
Res
olve
/Vita
l Stra
tegi
esId
entif
y w
hich
com
mun
icat
ion
with
con
tact
s ca
n be
pas
sive
onl
y (e
.g. b
y w
eb, e
mai
l, te
xt, o
r app
in
terfa
ce),
or, i
f res
ourc
es a
llow
, by
phon
e.D
eter
min
e pr
otoc
ols
for c
ases
and
con
tact
s w
ho d
o no
t res
pond
to te
xts
or p
hone
cal
ls (b
y ris
k le
vel).
D
eter
min
e pr
otoc
ol fo
r in-
pers
on v
isits
and
inco
rpor
ate
PP
E c
onsi
dera
tions
for i
n-pe
rson
co
mm
unic
atio
ns.
Roc
kefe
ller
NG
A
In p
erso
n co
ntac
tC
DC
Talk
ing
with
the
patie
nt: a
cas
e in
vest
igat
or's
gui
de to
Cov
id-1
9: h
ttps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-
ncov
/php
/con
tact
-trac
ing/
case
-inve
stig
ator
-gui
de.h
tml
Not
ifica
tion
of E
xpos
ure:
a C
onta
ct T
race
r's G
uide
to C
ovid
-19:
http
s://w
ww
.cdc
.gov
/cor
onav
irus/
2019
-nc
ov/p
hp/n
otifi
catio
n-of
-exp
osur
e.ht
ml.
Clie
nts
in s
peci
al p
opul
atio
ns a
nd/o
r con
greg
ate
setti
ngs
(nur
sing
hom
es, c
orre
ctio
nal f
acili
ties,
she
lters
) re
quire
add
ition
al c
onsi
dera
tions
and
sho
uld
be tr
iage
d an
d as
sign
ed to
a s
peci
al in
fect
ion
cont
rol t
eam
, if
avai
labl
e.
Par
tner
s in
Hea
lthH
uman
con
nect
ion
is e
ssen
tial i
n th
is p
roce
ss–n
ot e
very
one
is re
acha
ble
via
tech
nolo
gy, e
spec
ially
the
mos
t vul
nera
ble.
Pho
ne c
alls
and
follo
w u
p ar
e la
borin
tens
ive,
but
crit
ical
to a
robu
st e
quita
ble
appr
oach
JHU
Del
oitte
Res
olve
/Vita
l Stra
tegi
esS
ee D
raft
Con
tact
Tra
cing
Pro
toca
ls fo
r Mas
s G
athe
rings
und
er "I
mpl
emen
tatio
n": h
ttps:
//con
tact
traci
ngpl
aybo
ok.re
solv
etos
avel
ives
.org
/che
cklis
ts/p
roto
cols
#3-c
ases
-for-
inte
rvie
w-a
nd-c
onta
ct-
elic
itatio
nR
ocke
felle
rH
uman
con
tact
and
abi
lity
to a
dmin
iste
r "ps
ycho
logi
cal f
irst a
id" w
here
nee
ded
mak
e fo
r suc
cess
ful
cont
act t
raci
ng e
fforts
. N
GA
Com
mun
ity H
ealth
Wor
kers
, or f
ront
line
publ
ic h
ealth
wor
kers
with
dee
p co
mm
unity
exp
ertis
e th
at s
erve
as
a li
nk b
etw
een
com
mun
ities
and
hea
lth a
nd s
ocia
l ser
vice
s, m
ay b
e w
ell-p
ositi
oned
to s
erve
in
cont
act t
raci
ng o
r car
e co
ordi
natio
n ro
les.
S
crip
tsC
DC
Key
info
rmat
ion
to c
olle
ct d
urin
g a
case
inte
rvie
w a
nd s
ampl
e qu
estio
ns: h
ttps:
//ww
w.c
dc.
gov/
coro
navi
rus/
2019
-nco
v/ph
p/co
ntac
t-tra
cing
/key
info
.htm
lS
ampl
e pu
blic
mes
sagi
ng s
crip
ts fo
r pho
ne a
nd s
ocia
l med
ia o
n co
ntac
t tra
cing
"Ans
wer
the
call
to s
low
th
e sp
read
": ht
tps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-n
cov/
php/
cont
act-t
raci
ng-c
omm
s.ht
ml
Par
tner
s in
Hea
lthTh
e pu
blic
hea
lth w
orkf
orce
con
duct
ing
cont
act t
raci
ng a
nd c
ase
inve
stig
atio
n ne
ed to
rely
on
clea
r and
pr
ecis
e fo
rms
and
scrip
ts to
gui
de a
ctiv
ities
and
com
mun
icat
ion
with
cas
es a
nd c
onta
cts.
S
ee M
assa
chus
etts
Com
mun
ity T
raci
ng C
olla
bora
tive
sam
ple
cont
act t
raci
ng s
crip
ts: h
ttps:
//ww
w.m
ass.
gov/
doc/
cont
act-t
raci
ng-s
crip
ts/d
ownl
oad
JHU
Del
oitte
Dev
elop
scr
ipts
that
hav
e in
terv
iew
ing
tech
niqu
es e
mbe
dded
to s
uppo
rt th
e in
terv
iew
er. C
olla
bora
te w
ith
publ
ic h
ealth
exp
erts
to re
view
and
edi
t scr
ipts
to a
ssur
e th
at in
terv
iew
s in
clud
e ra
ppor
t bui
ldin
g an
d in
terv
iew
ing
tech
niqu
es.
Res
olve
/Vita
l Stra
tegi
esC
ovid
-19
case
inte
rvie
w d
raft
cont
act e
licita
tion
form
: http
s://v
ital.e
nt.b
ox.
com
/s/7
frd3r
gu6f
i2qz
caed
iqfc
32xe
5xh4
1q
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
7
Scr
ipts
Roc
kefe
ller
Inte
rvie
w s
crip
ts s
houl
d al
low
for f
ollo
w-u
p on
sup
port
serv
ices
dur
ing
the
self-
isol
atio
n pe
riod.
N
GA
Oth
erC
DC
Dig
ital c
onta
ct tr
acin
g to
ols:
http
s://w
ww
.cdc
.gov
/cor
onav
irus/
2019
-nco
v/do
wnl
oads
/dig
ital-c
onta
ct-
traci
ng.p
dfP
relim
inar
y cr
iteria
for e
valu
atin
g di
gita
l con
tact
trac
ing
tool
s: h
ttps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-
ncov
/dow
nloa
ds/p
hp/p
relim
-eva
l-crit
eria
-dig
ital-c
onta
ct-tr
acin
g.pd
f
CO
VID
Trac
er to
ol a
llow
s lo
cal a
nd P
H o
ffici
als
to a
sses
s up
to th
ree
diffe
rent
con
tact
trac
ing
stra
tegi
es,
incl
udin
g es
timat
ing
plan
's p
oten
tial e
ffect
iven
ess,
the
aver
age
num
ber o
f con
tact
s pe
r cas
e, a
nd th
e tim
e ne
eded
for c
ase
inte
rvie
ws
and
cont
act f
ollo
w-u
p ac
tiviti
es: h
ttps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-
ncov
/php
/con
tact
-trac
ing/
CO
VID
Trac
er.h
tml
Par
tner
s in
Hea
lthC
onta
ct tr
acin
g ha
s a
regi
onal
focu
s. T
he g
oal i
s fo
r com
mun
ities
that
sha
re p
ublic
hea
lth n
urse
s an
d ar
e in
the
catc
hmen
t are
as o
f hos
pita
ls a
nd c
omm
unity
hos
pita
ls w
ill b
e w
orki
ng w
ith th
e sa
me
cont
act
traci
ng s
taff.
Usi
ng d
ata
to e
valu
ate
effe
ctiv
enes
s an
d gu
ide
qual
ity im
prov
emen
t is
nece
ssar
y fro
m th
e on
set o
f the
pr
ogra
m. C
aref
ully
des
igne
d da
ta d
ashb
oard
s, w
ith d
ata
min
imal
ly d
isag
greg
ated
by
race
, eth
nici
ty,
gend
er, a
ge, a
nd lo
catio
n pr
ovid
e re
al-ti
me
insi
ght i
nto
how
the
dise
ase
is s
prea
ding
, and
whe
re to
di
rect
reso
urce
s.JH
UA
Nat
iona
l Pla
n to
Ena
ble
Cas
e Fi
ndin
g an
d C
onta
ct T
raci
ng in
the
US
: http
s://w
ww
.ce
nter
forh
ealth
secu
rity.
org/
our-
wor
k/pu
bs_a
rchi
ve/p
ubs-
pdfs
/202
0/20
0410
-nat
iona
l-pla
n-to
-con
tact
-tra
cing
R
evie
w o
f m
obile
app
licat
ion
tech
nolo
gy to
enh
ance
con
tact
trac
ing
capa
city
: http
s://w
ww
.cen
terfo
rhea
lthse
curit
y.or
g/re
sour
ces/
CO
VID
-19/
CO
VID
-19-
fact
-she
ets/
2004
08-c
onta
ct-tr
acin
g-fa
ctsh
eet.p
dfD
eloi
tteP
oten
tial f
or u
sing
AI t
o su
ppor
t con
tact
trac
ing
and
to a
naly
ze d
ata.
Res
olve
/Vita
l Stra
tegi
esC
onta
ct tr
acin
g pr
otoc
ols
and
form
s: h
ttps:
//con
tact
traci
ngpl
aybo
ok.re
solv
etos
avel
ives
.or
g/ch
eckl
ists
/pro
toco
lsC
onta
ct tr
acin
g st
eps
for C
ovid
-19:
http
s://v
ital.e
nt.b
ox.c
om/s
/4v6
8nm
oq4f
v2kn
tbag
xsv9
6vjw
w2l
ogk
A c
heck
list f
or u
sing
tech
nolo
gy s
olut
ions
to in
crea
se e
ffici
ency
and
effi
cacy
of c
onta
ct tr
acin
g ef
forts
: ht
tps:
//con
tact
traci
ngpl
aybo
ok.re
solv
etos
avel
ives
.org
/che
cklis
ts/te
chno
logy
Roc
kefe
ller
Mon
itorin
g of
con
tact
trac
ing
prog
ram
s is
cru
cial
to a
llow
pub
lic h
ealth
care
exp
erts
to g
ain
real
-tim
e kn
owle
dge
and
twea
k th
eir e
fforts
. Sta
tes
need
to tr
ack
and
shar
e th
eir c
omm
on m
etric
s to
det
erm
ine
wha
t suc
cess
look
s lik
e.
NG
AA
s st
ate
auth
oriti
es d
evel
op c
onta
ct tr
acin
g st
rate
gies
, an
esse
ntia
l ste
p is
coo
rdin
atin
g w
ith lo
cal h
ealth
de
partm
ents
to d
eter
min
e ba
selin
e ca
paci
ty, t
echn
olog
ical
sup
port
need
s, o
ppor
tuni
ties
to m
inim
ize
dupl
icat
ion
of e
fforts
and
exi
stin
g or
gani
zatio
nal s
truct
ures
. Sta
tes
may
als
o co
nsid
er lo
cal c
omm
unity
ne
eds,
dem
ogra
phic
s, c
ultu
re a
nd la
ngua
ge, a
s w
ell a
s ep
idem
iolo
gica
l tre
nds
to in
form
impl
emen
tatio
n st
rate
gies
. In
tegr
atio
n w
ith
Publ
ic H
ealth
Sy
stem
Rel
atio
n to
test
ing
(mak
e ap
pts,
do
test
ing)
CD
CFo
r are
as w
ith b
lend
ed s
tate
, reg
iona
l and
/or l
ocal
hea
lth d
epar
tmen
t aut
horit
ies,
det
erm
ine
whi
ch e
ntity
w
ill b
e re
spon
sibl
e fo
r cas
e pr
iorit
izat
ion.
Thi
nk th
roug
h ho
w n
on-la
bora
tory
-con
firm
ed c
ases
will
be
repo
rted
by p
rovi
ders
and
man
aged
by
the
heal
th d
epar
tmen
t for
onw
ard
traci
ng. T
his
may
requ
ire a
m
odifi
catio
n of
pro
vide
r rep
ortin
g re
quire
men
ts.
CD
C C
ovid
-19
case
inve
stig
atio
n hi
erar
chy
to p
riorit
ize
cont
act t
raci
ng c
ases
(pag
e 14
): ht
tps:
//ww
w.
cdc.
gov/
coro
navi
rus/
2019
-nco
v/do
wnl
oads
/cas
e-in
vest
igat
ion-
cont
act-t
raci
ng.p
df
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
8
Rel
atio
n to
test
ing
(mak
e ap
pts,
do
test
ing)
Par
tner
s in
Hea
lthQ
uick
ly tr
ain
all h
ealth
car
e w
orke
rs in
sta
ndar
d In
fect
ion
Pro
tect
ion
and
Con
trol (
IPC
) mea
sure
s fo
r C
OV
ID-1
9 an
d pr
ovid
e ge
nera
l edu
catio
n to
pat
ient
s at
hea
lth fa
cilit
ies.
JHU
Del
oitte
Res
olve
/Vita
l Stra
tegi
esS
ee c
onta
ct tr
acin
g pr
otoc
ols
for m
ass
gath
erin
gs u
nder
Impl
emen
tatio
n To
ols:
http
s://c
onta
cttra
cing
play
book
.reso
lvet
osav
eliv
es.o
rg/c
heck
lists
/pro
toco
ls#3
-cas
es-fo
r-in
terv
iew
-and
-con
tact
-el
icita
tion
Roc
kefe
ller
Con
tact
trac
ing
mus
t be
a pa
rt of
a m
ulti-
pron
ged
stra
tegy
that
incl
udes
test
ing,
soc
ial d
ista
ncin
g an
d is
olat
ing/
quar
antin
e.
NG
A
Rel
atio
n to
qu
aran
tine/
isol
atio
nC
DC
Sel
f-iso
latio
n gu
idan
ce s
houl
d be
revi
ewed
with
the
clie
nt a
nd in
stru
ctio
nal m
ater
ials
pro
vide
d (h
ttps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-n
cov/
dow
nloa
ds/1
0Thi
ngs.
pdf)
Che
cklis
t for
con
tact
trac
er u
se to
det
erm
ine
clie
nt a
bilit
y to
saf
ely
self-
isol
ate
or s
elf-q
uara
ntin
e, a
nd
asse
ss s
uppo
rt ne
eds:
http
s://w
ww
.cdc
.gov
/cor
onav
irus/
2019
-nco
v/do
wnl
oads
/php
/sel
f-qu
aran
tine_
form
Em
phas
is s
houl
d be
pla
ced
on h
elpi
ng c
lient
s id
entif
y an
y ne
ed fo
r soc
ial s
uppo
rt du
ring
self-
isol
atio
n an
d co
nnec
ting
them
to re
sour
ces.
Loc
al p
artn
ersh
ips
can
help
sup
port
clie
nts
and
cont
acts
in n
eed
of
hous
ing
and
othe
r sup
port
serv
ices
dur
ing
self-
isol
atio
n an
d se
lf-qu
aran
tine
Par
tner
s in
Hea
lthC
onta
ct tr
acin
g, li
nked
to re
sour
ces,
is th
e w
ay to
mak
e th
e re
spon
se m
ore
equi
tabl
e. F
or c
onta
ct
traci
ng to
ben
d th
e cu
rve,
it m
ust b
e lin
ked
to p
rovi
sion
of r
esou
rces
---fo
od, h
ousi
ng, s
uppo
rt--fo
r tho
se
who
can
not q
uara
ntin
e.JH
UD
eloi
tteC
olla
bora
te w
ith P
H o
ffici
als
and
staf
f to
deve
lop
prot
ocol
s th
at c
an s
uppo
rt co
ntac
t tra
cing
per
sonn
el in
re
latio
n to
qua
rant
ine/
isol
atio
n; o
ffer t
rain
ings
with
upd
ated
lega
l res
pons
es fo
r sta
ff: h
ttps:
//ww
w.tr
ain.
org/
cdct
rain
/cou
rse/
1090
658/
Res
olve
/Vita
l Stra
tegi
esId
entif
y la
ndsc
ape
of a
genc
ies
or lo
cal o
rgan
izat
ions
that
alre
ady
wor
k in
the
com
mun
ity p
rovi
ding
si
mila
r ser
vice
s an
d ex
plor
e co
ntra
ctin
g w
ith th
em to
faci
litat
e so
cial
sup
port
for c
onta
cts
in
quar
antin
e/is
olat
ion.
Thi
s m
ay in
clud
e he
alth
car
e pr
ovid
ers
or s
ocia
l ser
vice
s pr
ovid
ers,
relig
ious
gr
oups
, foo
d ba
nks,
etc
. See
tem
plat
e sc
ope
of w
ork
for s
ocia
l sup
port
and
wra
p-ar
ound
ser
vice
s:
http
s://v
ital.e
nt.b
ox.c
om/s
/fx0s
lbao
qpkc
s4ip
zjls
lztm
dqpj
z3sx
A c
heck
list f
or s
ettin
g up
pol
icie
s an
d fa
cilit
ies
for o
ut-o
f-hom
e is
olat
ion
and
quar
antin
e: h
ttps:
//con
tact
traci
ngpl
aybo
ok.re
solv
etos
avel
ives
.org
/che
cklis
ts/is
olat
ion
Roc
kefe
ller
Trai
n co
ntac
t tra
cers
to lo
ok fo
r com
mon
them
es in
inte
rvie
ws
and
esca
late
them
to re
leva
nt e
ntiti
es
whi
ch p
rovi
de s
ocia
l ser
vice
s to
inre
ase
resp
onse
rate
s an
d im
prov
e tru
st.
NG
A
Rel
atio
n to
act
ive
mon
itorin
gC
DC
Whi
ch s
taff
in th
e ju
risdi
ctio
n w
ill c
ondu
ct m
edic
al m
onito
ring?
Will
cer
tain
cas
es b
e de
lega
ted
to a
sta
ff-
mem
ber w
ith c
linic
al e
xper
tise
(e.g
., co
mpl
ex o
r hig
h-ris
k ca
ses)
? D
eter
min
e w
heth
er la
bora
tory
and
pr
ovid
er re
porti
ng re
quire
men
ts s
houl
d be
alte
red
to a
lert
loca
l and
sta
te h
ealth
dep
artm
ents
of c
ritic
al
data
ele
men
ts to
aid
in p
riorit
izat
ion.
If
a ju
risdi
ctio
n’s
reso
urce
s do
not
allo
w fo
r act
ive
daily
mon
itorin
g, c
lient
s w
ill b
e as
ked
to s
elf-m
onito
r an
d co
mm
unic
ate
rem
otel
y (e
mai
l, vi
deo,
pho
ne, t
ext,
mon
itorin
g ap
ps) t
o no
tify
publ
ic h
ealth
aut
horit
ies
of th
eir h
ealth
sta
tus
and
sym
ptom
s.Fo
r tho
se s
elf-m
onito
ring
and
shar
ing
repo
rts re
mot
ely,
repo
rts m
ust b
e re
ceiv
ed b
y th
e ag
reed
upo
n tim
e ea
ch d
ay, a
nd p
roto
col m
ust a
ddre
ss fo
llow
-up
actio
ns fo
r clie
nts
who
do
not r
epor
t out
.
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
9
Rel
atio
n to
act
ive
mon
itorin
gC
DC
Whi
ch s
taff
in th
e ju
risdi
ctio
n w
ill c
ondu
ct m
edic
al m
onito
ring?
Will
cer
tain
cas
es b
e de
lega
ted
to a
sta
ff-
mem
ber w
ith c
linic
al e
xper
tise
(e.g
., co
mpl
ex o
r hig
h-ris
k ca
ses)
? D
eter
min
e w
heth
er la
bora
tory
and
pr
ovid
er re
porti
ng re
quire
men
ts s
houl
d be
alte
red
to a
lert
loca
l and
sta
te h
ealth
dep
artm
ents
of c
ritic
al
data
ele
men
ts to
aid
in p
riorit
izat
ion.
If
a ju
risdi
ctio
n’s
reso
urce
s do
not
allo
w fo
r act
ive
daily
mon
itorin
g, c
lient
s w
ill b
e as
ked
to s
elf-m
onito
r an
d co
mm
unic
ate
rem
otel
y (e
mai
l, vi
deo,
pho
ne, t
ext,
mon
itorin
g ap
ps) t
o no
tify
publ
ic h
ealth
aut
horit
ies
of th
eir h
ealth
sta
tus
and
sym
ptom
s.Fo
r tho
se s
elf-m
onito
ring
and
shar
ing
repo
rts re
mot
ely,
repo
rts m
ust b
e re
ceiv
ed b
y th
e ag
reed
upo
n tim
e ea
ch d
ay, a
nd p
roto
col m
ust a
ddre
ss fo
llow
-up
actio
ns fo
r clie
nts
who
do
not r
epor
t out
. P
artn
ers
in H
ealth
JHU
Del
oitte
Res
olve
/Vita
l Stra
tegi
esC
onta
ct m
onito
ring
form
: http
s://v
ital.e
nt.b
ox.c
om/s
/yu9
zsm
ged5
0kvq
2ly7
e1xb
ubnd
r974
uiR
ocke
felle
rN
GA
Car
e m
anag
ers
or c
are
reso
urce
coo
rdin
ator
s w
ill n
eed
stro
ng lo
cal c
onne
ctio
ns w
ith c
omm
unity
-bas
ed
orga
niza
tions
to c
onne
ct a
t-ris
k po
pula
tions
in n
eed
of s
elf-i
sola
tion
or q
uara
ntin
e se
rvic
es to
exi
stin
g re
sour
ces.
R
elat
ion
to
com
plia
nce
of
cont
acts
with
pub
lic
heal
th d
epar
tmen
t or
ders
CD
CD
eter
min
e un
der w
hat c
ircum
stan
ces
will
isol
atio
n be
man
dato
ry (u
nder
pub
lic h
ealth
ord
ers)
as
oppo
sed
to v
olun
tary
and
mak
e th
is d
istin
ctio
n cl
ear t
o th
e cl
ient
. If a
clie
nt re
fuse
s to
com
ply
with
vo
lunt
ary
isol
atio
n in
stru
ctio
ns, s
tate
and
loca
l jur
isdi
ctio
ns h
ave
the
auth
ority
to m
anda
te is
olat
ion.
N
eed
to d
eter
min
e w
hat s
teps
will
be
take
n fo
r con
tact
s un
der s
elf-m
onito
ring
who
do
not r
epor
t as
requ
ired.
How
inte
nsiv
e w
ill th
e ou
treac
h be
(e.g
., sa
me-
day
hom
e vi
sit)?
Par
tner
s in
Hea
lthJH
UD
eloi
tteC
olla
bora
te w
ith p
ublic
hea
lth o
ffici
als
and
staf
f to
deve
lop
prot
ocol
s th
at c
an s
uppo
rt co
ntac
t tra
cing
pe
rson
nel o
n co
mpl
ianc
e m
atte
rs.
Res
olve
/Vita
l Stra
tegi
esS
tate
s an
d ci
ties
may
hav
e di
ffere
nt a
ppro
ache
s. C
onfir
m w
hich
aut
horit
y ha
s ju
risdi
ctio
n to
issu
e an
or
der d
epen
ding
on
whe
re th
e ca
se o
r con
tact
is fo
und,
resi
des,
or n
eed
to b
e is
olat
ed/q
uara
ntin
ed.
Whe
re is
olat
ion
or q
uara
ntin
e gu
idel
ines
can
be
man
date
d by
law
, est
ablis
h pr
otoc
ols
with
pro
cess
es
and
cons
eque
nces
if s
omeo
ne re
fuse
s to
com
ply.
S
ee s
ectio
n 2
Lega
l aut
horit
y ov
er is
olat
ion
and
quar
antin
e: h
ttps:
//con
tact
traci
ngpl
aybo
ok.
reso
lvet
osav
eliv
es.o
rg/c
heck
lists
/pro
toco
lsS
ee S
elf I
sola
tion
& S
elf Q
uara
ntin
e E
nfor
cem
ent a
nd C
ompl
ianc
e: P
rinci
ples
and
Con
side
ratio
ns fo
r U
S C
onta
ct T
raci
ng P
rogr
ams:
http
s://v
ital.e
nt.b
ox.c
om/s
/osc
6r3t
jaz9
414b
twm
uvh1
z3o0
gxef
snR
ocke
felle
rN
GA
Inte
ract
ions
be
twee
n co
ntac
t tra
cing
team
s an
d lo
cal a
nd s
tate
pu
blic
hea
lth
depa
rtmen
ts
CD
CD
eter
min
e w
hat t
ype
of c
olla
bora
tive
agre
emen
ts c
an b
e se
t in
plac
e fo
r dat
a sh
arin
g be
twee
n co
ntac
t tra
cing
team
s an
d lo
cal a
nd s
tate
pub
lic h
ealth
dep
artm
ents
. How
will
priv
acy
and
conf
iden
tialit
y be
m
aint
aine
d? H
ow w
ill c
ase
inve
stig
ator
s do
cum
ent a
nd tr
ansf
er th
e lis
t of c
onta
cts
to th
e co
ntra
ct
trace
r?W
ork
out h
ow to
tran
sfer
con
tact
info
rmat
ion
from
one
juris
dict
ion
to a
noth
er to
ens
ure
notif
icat
ion
of
expo
sure
for c
onta
cts
outs
ide
of y
our j
uris
dict
ion.
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
10
Inte
ract
ions
be
twee
n co
ntac
t tra
cing
team
s an
d lo
cal a
nd s
tate
pu
blic
hea
lth
depa
rtmen
tsP
artn
ers
in H
ealth
Coo
rdin
ate
cont
act t
raci
ng w
ith o
ther
sta
te C
OV
ID-1
9 C
omm
and
Cen
ter a
ctiv
ities
(e.g
. tes
ting,
su
ppor
ts).
Cre
ate
capa
bilit
ies
that
are
add
itive
to a
nd c
oord
inat
ed w
ith lo
cal p
ublic
hea
lth ju
risdi
ctio
ns.
Bui
ld in
to p
rogr
am d
esig
n w
ays
to s
uppo
rt lo
cal h
ealth
dep
artm
ents
to s
usta
in e
xpan
ded
cont
act t
raci
ng
and
emer
genc
y ep
idem
ic re
spon
se c
apac
ity o
ver t
he m
ediu
m to
long
-term
In
Mas
sach
uset
ts, t
here
is a
bal
anci
ng o
f cas
eloa
d be
twee
n lo
cal p
ublic
hea
lth b
oard
s an
d st
ate-
wid
e tra
cers
. Loc
al p
ublic
hea
lth b
oard
s tu
rn to
the
surg
e co
ntac
t tra
cers
pro
vide
d by
the
Com
mun
ity T
estin
g C
olla
bora
tive
(CTC
) whe
n ne
eded
. The
CTC
def
ers
to th
e lo
cal h
ealth
boa
rds
to le
ad c
ompl
ex c
asew
ork
and
case
wor
k in
hig
h ris
k po
pula
tions
(con
greg
ate
setti
ngs,
dis
ease
clu
ster
s, h
ealth
car
e w
orke
rs,
com
plex
cas
es).
JHU
Del
oitte
Dev
elop
a ro
les
and
resp
onsi
bilit
ies
guid
elin
es/p
roto
col t
hat o
utlin
es P
H s
taff
role
s an
d co
ntac
t tra
cing
te
ams
role
s; o
ffer t
rain
ing
for c
onta
ct tr
acin
g te
ams
to le
arn
from
PH
loca
l and
sta
te s
taff.
Res
olve
/Vita
l Stra
tegi
esE
stab
lish
gove
rnan
ce s
truct
ure
and
rele
vant
gov
ernm
ent a
genc
ies'
and
org
aniz
atio
ns' r
oles
in c
onta
ct
traci
ng. S
ee s
ectio
n 1
Gov
erna
nce:
http
s://c
onta
cttra
cing
play
book
.reso
lvet
osav
eliv
es.
org/
chec
klis
ts/p
roto
cols
. D
eter
min
e pr
otoc
ol fo
r loc
atin
g an
d no
tifyi
ng c
onta
cts
outs
ide
of th
e ju
risdi
ctio
n in
coo
pera
tion
with
the
juris
dict
ion
whe
re th
e co
ntac
t res
ides
.R
ocke
felle
rH
ealth
dep
artm
ents
nee
d to
be
appr
opria
tely
sta
ffed
and
empo
wer
ed w
hile
man
agin
g in
crea
sed
wor
kloa
ds a
cros
s ju
risdi
ctio
ns. C
entra
lized
dec
isio
n-m
akin
g fo
r pub
lic h
ealth
dep
artm
ents
lead
s to
bet
ter
coor
dina
tion
for t
estin
g an
d co
ntac
t tra
cing
impl
emen
tatio
n.
NG
AR
egar
dles
s of
a s
tate
’s p
ublic
hea
lth a
utho
rity
stru
ctur
e, c
oord
inat
ion
and
buy-
in o
f loc
al p
ublic
hea
lth
with
a s
tate
’s c
onta
ct tr
acin
g st
rate
gy w
ill b
e es
sent
ial.
Sta
te h
ealth
age
ncie
s w
ill n
eed
to p
lay
a vi
tal r
ole
in a
sses
sing
sta
te-w
ide
need
s, d
evel
opin
g a
shar
ed s
trate
gy a
nd v
isio
n, s
uppo
rting
coo
rdin
atio
n an
d lin
kage
s ac
ross
sys
tem
s, c
entra
lizin
g an
d le
vera
ging
tech
nolo
gy to
ena
ble
shar
ing
of in
form
atio
n, a
nd
impl
emen
ting
as w
ell a
s de
ploy
ing
and
surg
ing
reso
urce
s as
nec
essa
ry.
Inte
ract
ions
be
twee
n co
ntac
t tra
cing
team
s an
d ot
her s
ervi
ce
prov
ider
s re
leva
nt
to s
uppo
rted
isol
atio
n
CD
C
Par
tner
s in
Hea
lthFo
r con
tact
trac
ing
to b
e ef
fect
ive,
car
e co
ordi
natio
n an
d so
cial
sup
port
refe
rral
s m
ust b
e bu
ilt in
to
prog
ram
des
ign
and
wor
kfor
ce p
lann
ing
to e
nsur
e al
l are
abl
e to
saf
ely
isol
ate/
quar
antin
e as
nee
ded
JHU
Del
oitte
Use
pro
toco
ls to
def
ine
inte
ract
ions
, rol
es a
nd re
spon
sibi
litie
s fo
r ser
vice
s pr
ovid
ers
that
sup
port
isol
atio
n ca
pabi
litie
s.R
esol
ve/V
ital S
trate
gies
A c
heck
list f
or e
stab
lishi
ng w
rap-
arou
nd p
olic
ies
and
soci
al s
uppo
rt se
rvic
es: h
ttps:
//con
tact
traci
ngpl
aybo
ok.re
solv
etos
avel
ives
.org
/che
cklis
ts/s
uppo
rtsA
che
cklis
t for
set
ting
up te
lem
edic
ine
for c
onta
cts
and
case
s in
clud
ing
polic
ies,
ser
vice
pro
visi
on, a
nd
linka
ges
to s
uppo
rt an
d ca
re re
sour
ces:
http
s://c
onta
cttra
cing
play
book
.reso
lvet
osav
eliv
es.
org/
chec
klis
ts/c
onsu
lt R
ocke
felle
rC
onta
ct tr
acin
g te
ams
shou
ld h
ave
acce
ss to
reso
urce
s an
d tra
inin
gs to
follo
w u
p on
em
ergi
ng n
eeds
to
prov
ide
wra
p-ar
ound
ser
vice
s.
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
11
Inte
ract
ions
be
twee
n co
ntac
t tra
cing
team
s an
d ot
her s
ervi
ce
prov
ider
s re
leva
nt
to s
uppo
rted
isol
atio
n
NG
AW
hen
deve
lopi
ng p
roto
cols
, sta
tes
may
con
side
r dev
elop
ing
a so
cial
sup
port
serv
ices
pac
kage
and
be
gin
iden
tifyi
ng c
omm
unity
-bas
ed o
rgan
izat
ions
that
can
pro
vide
suc
h se
rvic
es a
t no
cost
to th
e st
ate
or in
divi
dual
. Del
awar
e is
par
tner
ing
with
Hea
lthy
Com
mun
ities
Del
awar
e to
pro
vide
nec
essa
ry s
uppo
rt se
rvic
es, s
uch
as g
roce
ry d
eliv
ery
or a
ltern
ativ
e ho
usin
g, to
ena
ble
indi
vidu
als
in a
t-ris
k co
mm
uniti
es to
sa
fely
sel
f-iso
late
. Et
hics
Saf
ety
of c
onta
ct
traci
ng p
erso
nnel
CD
CG
uida
nce
on ri
sk a
sses
smen
t of h
ealth
wor
kers
and
oth
ers
with
pot
entia
l exp
osur
e to
Cov
id-1
9: h
ttps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-n
cov/
hcp/
guid
ance
-ris
k-as
sesm
ent-h
cp.h
tml
Eve
ry e
ffort
shou
ld b
e m
ade
to in
terv
iew
the
clie
nt b
y te
leph
one
or v
ideo
con
fere
nce
inst
ead
of in
-pe
rson
. For
in-p
erso
n in
terv
iew
s, re
com
men
ded
infe
ctio
n pr
even
tion
and
cont
rol p
ract
ices
at a
hom
e or
no
n-ho
me
resi
dent
ial s
ettin
g ca
n be
foun
d on
CD
C’s
Eva
luat
ing
PU
Is R
esid
entia
l pag
e: h
ttps:
//ww
w.c
dc.
gov/
coro
navi
rus/
2019
-nco
v/ph
p/gu
idan
ce-e
valu
atin
g-pu
i.htm
l. P
artn
ers
in H
ealth
Wha
t men
tal h
ealth
ser
vice
s/to
ols
will
be
prov
ided
to c
onta
ct tr
acin
g st
aff?
How
will
men
tal h
ealth
be
prio
ritiz
ed fo
r sta
ff m
embe
rs?
JHU
Del
oitte
Offe
r rob
ust t
rain
ings
aro
und
scen
ario
s of
saf
ety
conc
erns
for c
onta
ct tr
acin
g pe
rson
nel.
Res
olve
/Vita
l Stra
tegi
esR
ocke
felle
rLa
unch
larg
e-sc
ale
PS
A c
ampa
igns
to d
emys
tify
cont
act t
raci
ng a
nd to
pro
mot
e su
cces
s st
orie
s.N
GA
Priv
acy
of c
onta
cts
CD
C
Min
imum
pro
fess
iona
l sta
ndar
ds s
houl
d in
clud
e pr
ovid
ing
empl
oyee
s w
ith a
ppro
pria
te in
form
atio
n an
d/or
trai
ning
rega
rdin
g co
nfid
entia
l gui
delin
es a
nd le
gal r
egul
atio
ns. A
ll pu
blic
hea
lth s
taff
invo
lved
in
case
inve
stig
atio
n an
d co
ntac
t tra
cing
act
iviti
es w
ith a
cces
s to
suc
h in
form
atio
n sh
ould
sig
n a
conf
iden
tialit
y st
atem
ent a
ckno
wle
dgin
g th
e le
gal r
equi
rem
ents
not
to d
iscl
ose
CO
VID
-19
info
rmat
ion.
E
fforts
to lo
cate
and
com
mun
icat
e w
ith c
lient
s an
d cl
ose
cont
acts
mus
t be
carr
ied
out i
n a
man
ner t
hat
pres
erve
s th
e co
nfid
entia
lity
and
priv
acy
of a
ll in
volv
ed. T
his
incl
udes
nev
er re
veal
ing
the
nam
e of
the
clie
nt to
a c
lose
con
tact
unl
ess
perm
issi
on h
as b
een
give
n (p
refe
rabl
y in
writ
ing)
, and
not
giv
ing
conf
iden
tial i
nfor
mat
ion
to th
ird p
artie
s (e
.g.,
room
mat
es, n
eigh
bors
, fam
ily m
embe
rs).
Lega
l and
eth
ical
con
cern
s fo
r priv
acy
and
conf
iden
tialit
y ex
tend
bey
ond
CO
VID
-19.
All
pers
onal
in
form
atio
n re
gard
ing
any
CO
VID
-19
clie
nts
and
cont
acts
sho
uld
be a
fford
ed th
e sa
me
prot
ectio
ns.
Cor
e tra
inin
g re
com
men
datio
ns fo
r pro
tect
ing
heal
th in
form
atio
n: h
ttps:
//ww
w.c
dc.g
ov/c
oron
aviru
s/20
19-
ncov
/php
/con
tact
-trac
ing/
list-r
equi
rem
ents
-for-
prot
ectin
g-he
alth
-info
.htm
lP
artn
ers
in H
ealth
A c
heck
list f
or b
uild
ing
priv
acy
and
data
sec
urity
into
con
tact
trac
ing
prog
ram
s: h
ttps:
//con
tact
traci
ngpl
aybo
ok.re
solv
etos
avel
ives
.org
/che
cklis
ts/p
rivac
y-an
d-da
ta-s
harin
gJH
UD
eloi
tteO
ffer t
rain
ings
for H
IPA
A c
ompl
ianc
e an
d on
goin
g kn
owle
dge
asse
ssm
ents
for a
ll co
ntac
t tra
cing
pe
rson
nel.
Res
olve
/Vita
l Stra
tegi
esId
entif
y an
d do
cum
ent p
roto
cols
for m
aint
aini
ng c
onfid
entia
lity
durin
g co
ntac
t tra
cing
, e.g
., an
y re
quire
men
ts fo
r sto
rage
of n
otes
and
dat
a, a
nd s
peci
al c
onsi
dera
tions
whe
n co
nduc
ting
cont
act t
raci
ng
from
hom
e. F
ollo
w H
IPA
A re
gula
tions
.A
che
cklis
t for
bui
ldin
g pr
ivac
y an
d da
ta s
ecur
ity in
to c
onta
ct tr
acin
g pr
ogra
ms:
http
s://c
onta
cttra
cing
play
book
.reso
lvet
osav
eliv
es.o
rg/c
heck
lists
/priv
acy-
and-
data
-sha
ring
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
12
Priv
acy
of c
onta
cts
Roc
kefe
ller
Eve
ryon
e in
volv
ed in
con
tact
trac
ing
mus
t be
give
n cl
ear i
nfor
mat
ion
abou
t wha
t inf
orm
atio
n w
ill b
e co
llect
ed, h
ow it
will
be
kept
sec
ure,
how
it w
ill b
e us
ed, a
nd w
hat r
esou
rces
will
be
prov
ided
to a
nyon
e or
dere
d to
sel
f-qua
rant
ine.
N
GA
Dat
a m
anag
emen
tC
DC
Det
erm
ine
wha
t typ
e of
col
labo
rativ
e ag
reem
ents
can
be
set i
n pl
ace
for d
ata
shar
ing
betw
een
cont
act
traci
ng te
ams
and
loca
l and
sta
te p
ublic
hea
lth d
epar
tmen
ts. H
ow w
ill p
rivac
y an
d co
nfid
entia
lity
be
mai
ntai
ned?
Idea
lly la
bora
tory
, pro
vide
r, an
d co
ntac
t cas
e re
ports
sho
uld
be tr
ansm
itted
to th
e lo
cal h
ealth
aut
horit
y el
ectro
nica
lly a
nd th
en s
eam
less
ly im
porte
d in
to th
e sy
stem
in a
n au
tom
ated
fash
ion.
The
data
sys
tem
sho
uld
faci
litat
e m
any-
to-m
any
rela
tions
hip
map
ping
bet
wee
n id
entif
ied
case
s an
d co
ntac
ts in
ord
er to
sup
port
data
ana
lysi
s an
d so
urce
-spr
ead
map
ping
of C
OV
ID-1
9 tra
nsm
issi
on. T
he
data
sys
tem
sho
uld
be u
ser-
frien
dly,
flex
ible
and
acc
essi
ble
by m
obile
dev
ice,
as
wel
l as
a la
ptop
or
desk
top
com
pute
r. A
clo
ud-b
ased
sys
tem
will
allo
w th
e gr
eate
st fl
exib
ility
and
ens
ure
rout
ine
data
st
orag
e, p
rote
ctio
n an
d up
datin
g, b
ut u
niqu
e ju
risdi
ctio
nal l
aws
and
regu
latio
ns m
ay n
eces
sita
te o
n-pr
emis
es d
ata
stor
age.
Par
tner
s in
Hea
lthU
sing
dat
a to
eva
luat
e ef
fect
iven
ess
and
guid
e qu
ality
impr
ovem
ent i
s ne
cess
ary
from
the
onse
t of t
he
prog
ram
. Car
eful
ly d
esig
ned
data
das
hboa
rds,
with
dat
a m
inim
ally
dis
aggr
egat
ed b
y ra
ce, e
thni
city
, ge
nder
, age
, and
loca
tion
prov
ide
real
-tim
e in
sigh
t int
o ho
w th
e di
seas
e is
spr
eadi
ng, a
nd w
here
to
dire
ct re
sour
ces.
Sys
tem
Inte
grat
ion
capa
bilit
y im
porta
nt to
cre
ate/
mai
ntai
n se
amle
ss b
ack-
end
conn
ectiv
ity to
sta
te
syst
em o
f rec
ord,
ope
ratin
g pa
rtner
s, a
nd d
igita
l aut
omat
ion
tool
s.In
Mas
sach
uset
ts, t
he C
omm
unity
Tra
cing
Col
labo
rativ
e (C
TC) u
sed
exis
ting,
cen
traliz
ed d
atab
ase
repo
sito
ry fo
r all
info
rmat
ion
surr
ound
ing
test
ing,
con
tact
trac
ing,
and
cas
e m
anag
emen
t. B
oth
the
CTC
an
d lo
cal h
ealth
dep
artm
ents
can
acc
ess
info
rmat
ion
JHU
Del
oitte
Res
olve
/Vita
l Stra
tegi
esD
escr
ibe
the
data
flow
from
cas
e re
porti
ng b
y cr
eatin
g a
data
map
. Ens
ure
case
man
agem
ent s
yste
m
can
acce
pt a
ll re
leva
nt la
bora
tory
resu
lts a
nd c
ase
iden
tifyi
ng in
form
atio
n. S
ee c
heck
list f
or c
ase
repo
rting
: http
s://c
onta
cttra
cing
play
book
.reso
lvet
osav
eliv
es.o
rg/c
heck
lists
/repo
rting
.R
ocke
felle
rA
ll di
gita
l con
tact
trac
ing
mus
t pro
tect
con
fiden
tialit
y an
d pr
ivac
y rig
hts
in o
rder
to m
axim
ize
trust
and
m
inim
ize
stig
ma
and
mis
info
rmat
ion,
esp
ecia
lly o
f vul
nera
ble
popu
latio
ns.
NG
A
Oth
er e
thic
s is
sues
CD
CS
et ta
rget
s fo
r sel
ect p
roce
ss a
nd o
utco
me
met
rics
(esp
ecia
lly fo
r tim
elin
ess
of p
atie
nt a
nd c
onta
ct
notif
icat
ion
and
self-
isol
atio
n/se
lf-qu
aran
tine)
to g
uide
adj
ustm
ents
to p
olic
ies
and
prot
ocol
s.P
artn
ers
in H
ealth
Con
tact
trac
ers
prov
ide
prac
tical
sel
f-hel
p an
d ef
fect
ive
refe
rral
s to
hea
lth c
are.
(Not
clin
ical
adv
ice,
te
lem
edic
ine,
HIP
AA
cent
ric E
MR
/EH
R.)
Hiri
ng lo
cal c
onta
ct tr
acer
s an
d ca
re c
oord
inat
ors
is im
porta
nt fo
r bot
h cu
ltura
l com
pete
ncy
and
iden
tific
atio
n/pr
ovis
ion
of s
ocia
l sup
ports
. Prio
ritiz
e hi
ring
from
har
dest
-hit
and
mos
t vul
nera
ble
com
mun
ities
; ens
ure
recr
uitin
g an
d w
orkf
orce
par
tner
hav
e cl
ear a
ccou
ntab
ility
for e
quity
and
div
ersi
ty
in h
iring
.M
etric
s tra
ckin
g sh
ould
cen
ter o
n co
mpr
ehen
sive
ness
(“A
re w
e re
achi
ng e
very
one
we
need
to?”
) and
tim
elin
ess
(“H
ow lo
ng d
oes
it ta
ke to
reac
h so
meo
ne?”
). Th
ese
serv
e as
impo
rtant
indi
cato
rs o
f pot
entia
l vu
lner
abili
ties
com
mun
ity s
prea
d an
d in
form
adj
ustm
ents
to tr
acin
g pr
otoc
ols.
Con
tact
Tra
cing
Doc
umen
tatio
n A
ctiv
ity
13
Oth
er e
thic
s is
sues
JHU
Dig
ital C
onta
ct T
raci
ng fo
r Pan
dem
ic R
espo
nse:
Eth
ics
and
Gov
erna
nce
Gui
danc
e: h
ttps:
//mus
e.jh
u.ed
u/bo
ok/7
5831
D
eloi
tteC
onsi
der i
ssue
s re
late
d to
min
ority
hea
lth a
nd d
ispa
ritie
s.R
esol
ve/V
ital S
trate
gies
A c
heck
list f
or e
stab
lishi
ng ro
utin
e m
onito
ring
and
asse
ssm
ent m
etric
s of
con
tact
trac
ing
prog
ram
s:
http
s://c
onta
cttra
cing
play
book
.reso
lvet
osav
eliv
es.o
rg/c
heck
lists
/met
rics
Cov
id-1
9 co
ntra
ct tr
acin
g m
etric
s: h
ttps:
//vita
l.ent
.box
.com
/s/2
9g4o
j8rs
b7gt
843f
fw08
tbi4
p3zn
uuj
Roc
kefe
ller
Priv
acy
and
prot
ectio
n of
med
ical
reco
rds
and
data
are
ess
entia
l for
vul
nera
ble
popu
latio
ns w
hose
lega
l st
atus
or o
ther
iden
tity
mar
kers
can
put
them
at a
n in
crea
sed
risk.
N
GA
The
CD
C a
nd o
ther
exp
erts
reco
mm
end
case
inve
stig
ator
s an
d co
ntac
t tra
cers
dem
onst
rate
cul
tura
l co
mpe
tenc
y an
d lin
kage
s to
thei
r loc
al c
omm
uniti
es.
To h
ire it
s co
ntac
t tra
cing
wor
kfor
ce, O
rego
n fo
cuse
d on
recr
uitin
g in
divi
dual
s w
ith c
ultu
ral a
nd li
ngui
stic
co
mpe
tenc
e fo
r the
pop
ulat
ions
they
ser
ve, a
nd w
ill d
eplo
y te
ams
of p
ublic
hea
lth w
orke
rs to
dep
loy
with
in c
omm
uniti
es.
Health Department Checklist: Developing a Case Investigation & Contact Tracing Plan for Coronavirus Disease 2019 (COVID-19)Case investigation and contact tracing are well-honed skills that adapt easily to new public health demands and are effective tools to slow the spread of COVID-19 in a community. Thoughtful planning can help ensure that these activities facilitate compassionate care for the people affected by COVID-19 and also prevent community transmission of the virus.
This checklist is a supplement to CDC’s Health Departments: Interim Guidance on Developing a COVID-19 Case Investigation & Contact Tracing Plan and is a tool that can assist health departments in developing a comprehensive plan. This tool does not describe mandatory requirements or standards; rather, it highlights important areas for consideration.
For additional information, users can access the corresponding section of the guidance document listed in each header (i.e., Guidance Section #).
COVID-19 case investigation and contact tracing activities will vary based on the level of community transmission, characteristics of the community and their populations, and the local capacity to implement both case investigation and contact tracing.
Scaling Up Staffing Roles Involved in Case Investigation & Contact Tracing (Guidance Section II)
Staffing Plan Completed In Progress Not Started
Estimate # of case investigators/contact tracers needed
Recruit and hire surge workforce
- Include consideration for culturally and linguistically diverse populations that the jurisdiction serves
Develop organizational structure (identification of staff who will perform key roles identified in CDC guidance)
Training Completed In Progress Not Started
Develop training plan for current and new case investigators and contact tracers, including supervisors/leads
- Include knowledge-based and skills-based training as well as opportunities for continuous and peer-to-peer learning
Determine how training will be delivered
Determine how training will be tracked to ensure all staff are trained
CS317274 05/29/2020
2
Case Investigation & Contact Tracing Activities (Guidance Section IV & Guidance Section V)
Case Investigation & Contact Tracing Strategy Completed In Progress Not Started
Define close contact and contact elicitation window
Develop criteria for discontinuation of self-isolation and self-quarantine
Develop testing strategy for:
- Suspected and probable cases
- Asymptomatic and symptomatic contacts
- Outbreaks in congregate settings
- Possibly for community at-large
Develop case investigation strategy to prioritize cases if unable to investigate all confirmed and probable cases (triaging protocol likely needed)
Develop close contact monitoring strategy to prioritize close contacts to monitor and/or modify intensity of monitoring depending on public health resources available
Program Workflow Completed In Progress Not Started
Describe how cases are identified in your jurisdiction’s data management system (case report CMR, lab test, other)
Describe how case interview assignments are made
Diagram and/or describe in detail the program workflow with surge staff and their supervision incorporated
Procurement Completed In Progress Not Started
Procure any needed supplies, including PPE, COVID-19 kits for patients and contacts, materials/equipment for case investigation and contact tracing staff (e.g., laptops, tablets, cell phones)
Laboratory Services Completed In Progress Not Started
Establish linkage to testing sites
Develop understanding of statewide laboratory capacity and laboratory turnaround time for results reporting
Identify SARS-CoV-2 tests in use by laboratories serving the jurisdiction
Prototcols Completed In Progress Not Started
Develop protocol for triaging cases
- Obtaining necessary information to inform triaging
- Determining case assignment
Develop case investigation protocol
- Can include interview guides, call scripts
3
Prototcols Completed In Progress Not Started
- Protocol covers:
› Confidential notification
› Risk assessment
› Self-isolation instructions including any daily monitoring
› Linkage to self-isolation support services and medical services (if needed)
› Linkage to testing (if needed and available)
› Close contact elicitation
› Discontinuation of self-isolation
- Specimen collection for testing (if applicable to role), proper PPE use
- Case investigation when patients are unable to participate (including minors); proxy interviews
- Use of data collection forms and tools
- Establish timelines for 1st contact interviews
- Develop goals for timeliness of interviews
Develop contact tracing protocol
- Can include interview guides, call scripts
- Protocol covers:
› Confidential notification
› Risk assessment
› Self-quarantine instructions including daily monitoring
› Linkage to self-quarantine support services and medical services (if needed)
› Linkage to testing (if available)
› Discontinuation of self-quarantine
- Contact tracing activities when contacts are minors
- Specimen collection for testing (if applicable to role), proper PPE use
- Use of data collection forms and tools
- Establish timelines for 1st contact interviews
- Develop goals for timeliness of interviews
Case Investigation & Contact Tracing Activities (Guidance Section IV & Guidance Section V) continued
4
Prototcols Completed In Progress Not Started
Develop protocol for assessing need and eligibility of patients and contacts for support services, triaging requests, and providing linkage to needed services
Develop protocol for medical monitoring of patients with COVID-19 who are at higher risk for severe disease
Develop protocol for using interpretation services if case investigator/contact tracer is not fluent in primary language of patient with COVID-19 or close contact
Develop protocol for providing case investigation and contact tracing services to people who are deaf or who have hearing loss
Develop protocol for serving public health orders for isolation and quarantine, if applicable
Outbreaks (Guidance Section VI)
Complex Investigations Completed In Progress Not Started
Develop guidance for handling complex investigations (e.g., outbreaks in congregate living or workplace settings)
- Formation of interdisciplinary team(s)
- Triage protocol for handing over investigations to team
- Plan for surge staffing if needed
Special Considerations (Guidance Section VII)
Prototcols Completed In Progress Not Started
Develop protocol for managing case investigations when a patient is unable to participate (e.g., cognitively impaired, deceased, intubated, unconscious, a minor)
Develop protocol for interjurisdictional case investigation and contact tracing
Develop protocol for case investigation and contact tracing for flights (or other mode of public transportation) arriving in the US or between US states, or cruise ships arriving at US ports of entry
Building Community Support (Guidance Section VIII)
Communications and Community Engagement Strategy Completed In Progress Not Started
Develop a communications and community engagement strategy
- Engage local community leaders, public officials, and influencers
- Develop clear, empowering messages that create awareness of case investigation and contact tracing activities and encourage acceptance
› Also share messages that dispel misinformation and direct public to reliable sources
- Use all available communication channels to reinforce messages
Case Investigation & Contact Tracing Activities (Guidance Section IV & Guidance Section V) continued
5
Communications and Community Engagement Strategy Completed In Progress Not Started
- Ensure messages and materials are culturally sensitive
- Tailor messages to reach specific audiences, including vulnerable populations in the community
- Develop or adapt existing health education materials to share with patients and close contacts
› Translate into primary languages of affected community members (also consider translating data collection instruments)
› Include materials for low literacy levels and that are graphics-based (more images than text)
- Identify communication avenues (social media, newspapers, TV news stories, billboards, TV ads)
Data Management (Guidance Section IX)
Data Management Infrastructure Completed In Progress Not Started
Develop and implement data management infrastructure
- Laboratory, provider, and contact case reports should be transmitted electronically and seamlessly imported into the system in an automated fashion
- Develop modules for:
› Case investigations of confirmed and probable cases,
› Patient risk assessment (including contact elicitation),
› Contact investigation (including risk assessment)
› Should be editable without the need for vendors/contractors
› Should be able to link multiple individuals within the system
- Establish user roles in data management system
- Develop routine canned reports for feedback to staff
- Develop routine canned reports to review program successes and identify areas for improvement
- Develop interview forms for patients and close contacts that incorporate critical data elements
- Collaborate with healthcare providers for data sharing (e.g., access to electronic health records)
- Ensure that local data security and confidentiality standards are being met
Building Community Support (Guidance Section VIII) continued
6
Evaluating Success (Guidance Section X)
Evaluation and Quality Improvement Completed In Progress Not Started
Develop plan for evaluation and quality improvement
- Consider setting targets for select metrics
- Select process and outcome metrics to routinely review
- Use reports to identify areas for training and help leadership identify any necessary program adjustments
- Identify staff member who will run reports
- Identify staff who will receive reports
- Determine frequency reports will be run
Develop protocol for supervisory review and feedback on case and contact investigations
Confidentiality and Consent (Guidance Section XI)
Security and Confidentiality Completed In Progress Not Started
Develop plan addressing security and confidentiality
- Assess standards currently in place to protect patient information and determine if modifications are needed for COVID-19
Develop Protocols for:
- Security of confidential case investigation and contact tracing information
- Maintaining confidentiality, including legal requirements for public health personnel
Support Services to Consider (Guidance Section XII)
Support Services Completed In Progress Not Started
Develop plan for providing support services
- Assess services available for patients, contacts, and their families
- Fill critical gaps in wraparound services
- Establish eligibility criteria
- Provide alternate housing to support the isolation of patients and quarantine of close contacts who are unable to do so safely at their home
- Provide telemedicine safety net pool of providers for on-call clinical consult with patients and contacts who do not have a primary healthcare provider
- Partner with local community groups and organizations that can help support specific populations
- Establish processes for connecting patients and contacts to support services
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