Results from state/territorial health agency surveys provide insights to how COVID-19 case investigation and contact tracing programs developed and evolved in response to changing pandemic conditions.

In our article in the Journal of Public Health Management and Practice, “COVID-19 Case Investigation and Contact Tracing Programs and Practice: Snapshots from the Field,” we aimed to characterize how case investigation and contact tracing (CI/CT) programs developed and adapted in the first year of the pandemic. In the early stages of COVID-19 response, our understanding of how state and territorial health agencies were standing up and implementing CI/CT programs was often based on anecdotal evidence, media reports, and scans of online information. Our goals were to systematically capture the status of COVID-19 CI/CT programs and practice in the US, and to inform the national discourse about COVID-19 contact tracing with “ground truth” from state and territorial health agencies.  

To this end, the Association of State and Territorial Health Officials (ASTHO) administered two rapid queries of state and territorial health agencies in November 2020 and April 2021. We received responses from 27 and 24 jurisdictions, respectively, with 16 jurisdictions participating in both surveys. While findings from these short surveys should not be over-generalized, these snapshots from the field provided valuable insights to how CI/CT programs responded to the evolving nature of the COVID-19 pandemic.

Workforce Development in an Evolving Public Health Pandemic Response

Our rapid queries captured CI/CT workforce changes over time, such as agency-reported staff capacity. In November 2020, a majority (70%) of responding health agencies indicated that they did not have enough case investigators and contact tracers to meet their needs. Notably, jurisdictions during this time were experiencing a significant surge of COVID-19 cases, which expanded CI/CT program workloads and likely impacted their reports of staff capacity. Five months later, however, a majority (63%) of respondents indicated that they did have enough case investigators and contact tracers to meet their demands. What drove these changes in staff capacity? A variety of factors may have been at play, including changing disease transmission rates and process adaptations that streamlined programmatic efforts, such as CI/CT prioritization and case-driven notification.

Our findings highlight that the size of the CI/CT workforce itself was also in flux. In April 2021, 42% of respondents indicated that they were planning or in the process of scaling down their workforce. Drops in case counts and increasing immunity (through vaccination or infection) may have influenced this shift. Respondents, however, noted that staffing needs change over time due to surges in disease transmission, viral variants, and other events, such as schools reopening. As the pandemic continues to evolve—and as COVID-19 CI/CT staff are integrated into other communicable disease programs—flexible staffing plans that are responsive to changes in COVID-19 disease transmission and local context will be critical.

The dynamic and flexible nature of the CI/CT workforce paired with their experience engaging community members make this workforce uniquely qualified to continue to build and strengthen relationships between governmental public health, community organizations, and individual community members. We believe that these relationships will be the foundation upon which the remaining response to COVID-19 and any future infectious disease outbreak response efforts will be built.

Challenges Impacting COVID-19 Contact Tracing Programs

Our rapid queries showed that CI/CT program challenges changed over time. Three of the top challenges, however—public acceptance and trust, technology and data systems, and long-term/sustainable funding—were consistent across the November 2020 and April 2021 surveys. Qualitative responses featured in our article describe how these challenges impacted COVID-19 CI/CT program implementation:  

• Public acceptance and trust: Respondents highlighted how concerns about sharing personal health information, frustrations with isolation and quarantine guidelines, and pandemic fatigue impacted the public’s willingness to engage with CI/CT services.
• Technology and data systems: Respondents noted that interoperability issues impacted efforts to integrate CI/CT datasets with existing public health surveillance systems. Modifying or adopting new data systems to support COVID-19 CI/CT programs also presented challenges.
• Long-term/sustainable funding: Respondents highlighted the need for sustained funding to support workforce development efforts and maintain COVID-19 CI/CT programs activities long-term.

While we have seen progress in each of these areas, the persistence of these challenges across our November 2020 and April 2021 surveys suggests that they warrant continued exploration and action from public health leaders. As the public health system transitions to sustained management of COVID-19, strong relationships between public health agencies and the communities they serve will be critical to advancing public health measures geared at decreasing COVID-19 transmission and increasing vaccination. The CI/CT workforce is well-positioned to support these efforts, but to do so effectively, we must explore new ways to engage and build trust with the community, modernize the digital tools and technologies available to support this workforce, and ensure that CI/CT programs are sustainably funded.

For further information on ASTHO’s rapid queries and our findings, read our practice brief report in the July 2022 issue of the Journal of Public Health Management and Practice.

READ:

• COVID-19 Case Investigation and Contact Tracing Programs and Practice: Snapshots from the Field

Elizabeth Ruebush is the Senior Director for Public Health Data Modernization at ASTHO and previously served as the organization’s technical lead for infectious disease outbreak response and recovery. She received a Master of Public Health from Johns Hopkins University and a Bachelor of Arts from Williams College.

Paris Harper-Hardy is Director of Evaluation and Assessment at ASTHO. Her work focuses on supporting ASTHO’s programmatic teams to coordinate and improve data collection activities to Health Agencies. Originally from Philadelphia, Paris has lived throughout the east coast, earning degrees from Cornell University, the University of Georgia, and Emory University.

Meredith Allen is the Vice President of Health Security at ASTHO, focusing the last two years on state health agency response to COVID-19. Also originally from Philadelphia, Meredith has previously worked in local public health as an Epidemiologist and has degrees from University of Delaware, Harvard University, and Drexel University.

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