Innovations in COVID-19 Case Investigation and Contact Tracing

By Maryam B. Haddad, Jody E. McLean, Sue S. Feldman, Erin E. Sizemore and Melanie M. Taylor

Established in 1878, Public Health Reports is one of SAGE’s oldest journals and the official journal of the U.S. Surgeon General and U.S. Public Health Service. Public Health Reports articles in 1918–1920 tracked the unfolding influenza pandemic, concluding that transmission risk could be lowered through personal measures such as avoiding crowding, staying in the open air, washing hands, and wearing masks. Other advice: stay home when you are sick (isolate) or if you were recently exposed and might be about to get sick (quarantine).

These established prevention strategies reemerged during the early days of the COVID-19 pandemic, before vaccines, at-home test kits, and treatments became available. In this context, health departments around the United States developed numerous approaches to meet the unprecedented demands for COVID-19 case investigation and contact tracing. The November/December 2022 supplement of Public Health Reports, “Innovative Approaches to COVID-19 Case Investigation and Contact Tracing,” provides firsthand examples of how health departments across the United States pivoted and innovated, trained new contact tracers, incorporated new community partners, and developed innovative digital tools.

We are delighted to bring you these stories, sharing lessons from geographic areas as varied as Chicago, New York City, and Salt Lake City neighborhoods, to a rural American Indian reservation, to college campuses. Because each jurisdiction operates in a unique social and political context, some health departments combined resources across jurisdictions, while others customized preexisting processes, and others incorporated new technology platforms.

Articles in this supplement also describe technologic innovations. Smartphone apps enabled anonymous notification of potential SARS-CoV-2 exposures in 26 U.S. states and the District of Columbia, enabling earlier notification than seen with conventional contact tracing in Washington state and in California. In one state that did not offer exposure notification, a university developed its own smartphone app. This technology is less resource-intensive than conventional contact tracing, and a national survey suggests public acceptability. However, modeling suggests that at least 50% of smartphone users would need to opt to activate the exposure notification app to substantially reduce secondary cases among contacts.

Although incorporating technology often introduced efficiency, the importance of system interoperability is a common theme across articles in this issue. Many health departments worked with new partners in the technology sector that had not previously supported public health workflows. Different platforms were often used for each step in the cascade that includes case detection, case reporting, case investigation, contact tracing, and symptom monitoring. The variability in approaches across public health jurisdictions and over time also created complexities and opportunities. Determining which elements from that workflow to retain and then improving interoperability should be a focus in planning for future public health challenges.

Other articles in this issue underscore the value of face-to-face interactions and the importance of trusting relationships. Public health field teams visited homes and hired community members in areas of economic hardship. Health departments prioritized providing outreach in the person’s native language. They directly identified and removed geographic, economic, and cultural barriers to accessing care. Unsurprisingly, health department outreach was most effective when community members perceived public health recommendations as coming from trusted sources. COVID-19 created multiple stressors for the public health sector, health care delivery systems, and the community at large. Those stressors notwithstanding, COVID-19 also provided new opportunities for ongoing collaboration.

During the first 2 years of the COVID-19 pandemic, most publications focused on describing this new pathogen and its variants, the spectrum of diseases it causes, diagnostic and treatment tools, and vaccine effectiveness. The November/December 2022 supplement of Public Health Reports, “Innovative Approaches to COVID-19 Case Investigation and Contact Tracing,” provides a different perspective: how health departments in the United States worked to protect the communities they continue to serve each day. Read the supplement here. LEARN MORE.

Findings and conclusions are those of the authors and do not necessarily reflect the official position of the Centers for Disease Control and Prevention (CDC). CDC is not responsible for the content of external publications, nor does CDC endorse the information contained in external links.

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Supplement Details
Innovations in COVID-19 Case Investigation and Contact Tracing
Guest editors: Maryam B. Haddad, Jody E. McLean, Sue S. Feldman, Erin E. Sizemore and Melanie M. Taylor
First published November/December 2022
Public Health Reports

About the Authors

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Maryam B. Haddad, PhD, FNP is a nurse epidemiologist with the Division of Tuberculosis Elimination, in the National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention, at the U.S. Centers for Disease Control and Prevention (CDC), where her work focuses on detecting and interrupting Mycobacterium tuberculosis transmission through molecular epidemiology and outbreak investigations. Dr. Haddad volunteers with refugees and asylum seekers as a family nurse practitioner and teaches introductory epidemiology to nursing students at Emory University. She also served on CDC’s COVID-19 Response as a member of the State, Tribal, Local, and Territorial Task Force during 2020–2022.

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Jody E. McLean, MPH is a geneticist with the Division of Health and Nutrition Examination Surveys, in the National Center for Health Statistics (NCHS), at the U.S. Centers for Disease Control and Prevention (CDC). Ms. McLean is the Project Officer for the National Health and Nutrition Examination Survey (NHANES) DNA specimen repository, genetic data repository, and big biological data projects. She also served on CDC’s COVID-19 Response as a member of the Case Surveillance Task Force and the State, Tribal, Local, and Territorial Task Force during 2020–2022.

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Sue S. Feldman, PhD, RN is a is a Professor and Director of Graduate Programs in Health Informatics in Health Services Administration in the School of Health Professions at the University of Alabama at Birmingham (UAB). Dr. Feldman teaches in the Clinical Informatics program, the Master of Science in Health Informatics program, and in the PhD program. She has a dual appointment in the Heersink School of Medicine, where she is a Senior Scientist in the Informatics Institute and a Fellow at the Center for the Study of Community Health. In August 2020, UAB piloted a smartphone application that allowed Alabama residents to anonymously send and receive COVID-19 exposure alerts; exposure notification was eventually offered in 26 U.S. states and the District of Columbia.

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Erin E. Sizemore, MPH is a surveillance health scientist with the National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention, at the U.S. Centers for Disease Control and Prevention (CDC). For the past 15 years, her work has focused on the intersection of public health and information technology to support efficient data collection and integration, leading to appropriate public health interventions and action. She also served on CDC’s COVID-19 Response as a member of the Case Surveillance Task Force and the State, Tribal, Local, and Territorial Task Force during 2020–2022.

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Melanie M. Taylor MD, MPH is an infectious disease/internal medicine physician. She is a medical epidemiologist with the Division of HIV Prevention, in the National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention, at the U.S. Centers for Disease Control and Prevention (CDC). She served as the lead or deputy lead for the CDC COVID-19 Response’s Contact Tracing and Innovations Section in the State, Tribal, Local, and Territorial Task Force during August 2020–June 2021. Dr. Taylor is a practicing HIV physician at the Phoenix Indian Medical Center and a clinical associate professor with the University of Arizona College of Medicine. She is assigned to the Arizona Department of Health Services where she assists with STD, HIV, and congenital syphilis prevention and treatment.