How Scripts for Case Investigation and Contact Tracing Evolved During the COVID-19 Pandemic

Posted on April 18, 2024 by Cara Orfield

This entry is part 9 of 10 in the series May 2024

A new study examines how the design and modification of COVID-19 case investigation and contact tracing interview scripts can help inform future pandemic responses.

Case investigation and contact tracing (CI/CT) are vital practices for public health agencies seeking to identify exposure and reduce transmission and outbreaks of communicable diseases. During the COVID-19 pandemic, public health agencies relied on CI/CT to better understand the disease; prevent spread; and provide people with information about testing, vaccines, and other supportive services. Our study, “Design and Modification of COVID-19 Case Investigation and Contact Tracing Interview Scripts,” examined CI/CT interview scripts from 14 health departments across the United States to determine how they changed as the pandemic evolved.

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Because of the novelty of the disease and rapidly changing circumstances, public health agencies needed to develop COVID-19 CI/CT scripts quickly, often using the scripts that were available for other communicable diseases, such as sexually transmitted infections, tuberculosis, and HIV. Most also incorporated guidance from the Centers for Disease Control and Prevention about CI/CT after it was first released in May 2020. As understanding of the disease progressed, health departments continued to revise their interview scripts to meet local needs and processes.

We examined 52 CI/CT interview scripts from three points—most initial scripts were time stamped May 2020, interim scripts spanned September 2020 to September 2021, and many current scripts (as of April 2022) were time stamped January 2022. We also interviewed 36 officials across 14 state, local, and tribal public health departments to better understand how and why they revised their scripts.

Key Takeaways

Over time, the length of scripts increased substantially: the average number of elements (that is, questions or statements) per interview script roughly doubled between initial and current interview scripts for CI and roughly tripled for CT.
Drivers of script changes included changes in our understanding of how the virus spreads, risk factors and symptoms, new treatments, new variants, vaccine development, and adjustments to the Centers for Disease Control and Prevention’s official isolation and quarantine guidance.
Almost half of key informants reported that some changes to their interview scripts came from a desire to better reach and support specific populations.
Current interview scripts from urban health departments included substantially more elements—specifically, in areas of additional support and isolation or quarantine recommendations—than those from rural health departments.
Local health departments included more elements in interview scripts than state health departments.
Health departments that used a decentralized approach to CI/CT (that is, local health departments led the CI/CT efforts with some state support) included far more elements in their interview scripts than those using a centralized approach.

Recommendations

Insights from our study, “Design and Modification of COVID-19 Case Investigation and Contact Tracing Interview Scripts,” provide important guidance for CI/CT in future disease outbreaks. This includes (1) collecting information about demographics and potential risk factors, (2) educating members of the public about the disease and its symptoms, (3) offering mitigation guidance, and (4) providing sufficient support and resources to help people act on that guidance.

CI/CT interviews also provided an important opportunity for public health departments to build rapport, answer questions, build trust, and help address misinformation.

Acknowledgement of Co-authors:

Penny Loosier, PhD, MPH, is a health scientist with the Centers for Disease Control and Prevention. Sarah Wagner, BA, is a survey analyst at Mathematica. E. Rain Sabin, BA, is a former research associate at Mathematica. Michelle Fiscus, MD FAAP, is a senior policy consultant at the National Academy for State Health Policy. Holly Matulewicz, MA, is a principal survey researcher at Mathematica. Divya Vohra, PhD, MPH, is a senior researcher at Mathematica. Melanie M. Taylor, MD, MPH, is a medical officer with the Centers for Disease Control and Prevention. Elise C. Caruso, MPH, is a behavioral scientist with the Centers for Disease Control and Prevention. Nickolas DeLuca, PhD, is a branch chief with the Centers for Disease Control and Prevention. Patrick K. Moonan, DrPH, is an epidemiologist with the Centers for Disease Control and Prevention. John E. Oeltmann, PhD, is an epidemiologist with the Centers for Disease Control and Prevention. Phoebe Thorpe, MD, MPH, is a medical officer with the Centers for Disease Control and Prevention.

Author Profile

Cara Orfield: Cara Orfield, MPP, is a senior researcher at Mathematica. Her research focuses on health care programs and policies for families with low income and people without insurance.