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 * Introduction
 * Glossary
 * Future vision for public health
 * Checklists
   * Contact tracing protocols & forms
   * Public health workforce
   * Technology solutions
   * Case reporting
   * Clinical consultation
   * Services to support people in isolation and quarantine
   * Facilities for out-of-home isolation and quarantine
   * Public communication
   * Metrics & monitoring
   * Privacy and data sharing
 * About
   * About & contact us
   * Resolve to Save Lives

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INTRODUCTION

This playbook aims to provide clear and actionable technical guidance and tools
for U.S. health departments to rapidly set up and implement contact tracing to
support COVID-19 containment.

LIVING DOCUMENT This playbook is a dynamic, “living” document. Global knowledge
pertaining to COVID-19 is rapidly evolving. Feedback and suggestions can be sent
to covid19-ct@vitalstrategies.org.

Date of last update: December 21, 2020

COVID-19 CONTACT TRACING PLAYBOOK

Published by Resolve to Save Lives, an initiative of Vital Strategies

As U.S. states roll out plans to gradually reopen society, there are four
essential actions that governments must commit to—and invest in—now so they can
reopen society as quickly and safely as possible while preventing another
explosive spread of the COVID-19. (Figure 1)

Contact tracing will be a key component of any successful suppression effort to
“box in” COVID-19. 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. Read about "Box it in"...


Figure 1. Box It In

Contact tracing is a tried and true public health measure that has been
successfully used to contain communicable diseases, such as HIV, sexually
transmitted infections, and tuberculosis. As in all public health responses,
tools must be adapted to meet the challenges of each microbe. Contact tracing
for COVID-19 must be executed on a significantly larger scale, adapting to
unique challenges of the virus including asymptomatic spread. Countries
including China, Germany, South Korea and Singapore have all done this
successfully.

It is urgent for U.S. state and local health departments to quickly prepare and
implement contact tracing to box in COVID-19.

4 STEPS

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 up to 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.

10 DOMAINS

A successful COVID-19 contact tracing program is comprised of ten domains:

     

 1.  Contact tracing protocols and forms. Effective contact tracing protocols
     clearly define processes around isolation for cases and quarantine for
     close contacts. This includes whether isolation and quarantine are legally
     mandated or voluntary, priority thresholds for in-person outreach (e.g.,
     congregate settings), definition of close contacts, determination of how to
     manage laboratory-confirmed and probable cases, definition of the social
     supports package and eligibility, and arrangement of clinical linkages for
     contacts. The public health workforce conducting contact tracing and case
     investigation will rely on clear and precise forms and scripts to guide
     activities and communication with cases and contacts.

     
     

 2.  Public health workforce. Thousands of people will be needed to properly
     conduct the four contact tracing steps noted above. The approach relies on
     rapid and efficient recruitment, training, and deployment under the
     management of the state, local and/or territorial health department.
     Workforce training should include knowledge and skill-based exercises in
     order to create rapport, address concerns and barriers to contact
     elicitation or isolation and quarantine, and appropriately assess support
     needs to ensure adherence with public health recommendations.

     
     

 3.  Digital and technology solutions. Digital applications (or apps) can
     facilitate the massive scale-up of contact tracing that will be needed to
     help to box in COVID-19. Apps can augment traditional public health
     activities, for example by rapidly finding cases' contact information,
     sharing their contacts more easily, and providing isolation and quarantine
     support. All digital solutions must be driven by people trained in public
     health response, explicitly support workflows for contact tracing, and
     adhere to the highest privacy standards. Governance of data systems,
     ownership and stewardship of all case and contact-related data collected,
     maintained or disseminated must remain the responsibility of the applicable
     local public health authority. Customer Relationship Management (CRM)
     solutions will provide an infrastructure by which the public health
     workforce functions optimally.

     
     

 4.  Case reporting. The success of contact tracing to interrupt disease
     transmission hinges on the timeliness of case identification. The sooner a
     case is identified, the sooner the contacts can be elicited and notified of
     their exposure, thereby reducing the chances that they will further spread
     disease. Effective contact tracing relies on timely and complete case
     reporting by public and commercial laboratories and medical care providers;
     and linking these reports to health departments’ case management systems.
     COVID is a nationally notifiable disease and must be reported to public
     health. Electronic Lab Reporting (ELR) from commercial and clinical labs
     when integrated with disease management systems of the health departments
     would reduce the time to beginning a case investigation and subsequently
     identifying contacts.

     
     

 5.  Clinical consultation. Cases and contacts may require symptom management
     advice and clinical consultation during isolation and quarantine periods.
     Some people may have telephone or video access to their regular primary
     care provider. For those who do not have access to a regular primary care
     provider, health departments should establish a pool of providers for
     on-call clinical consultation by telemedicine.

     
     

 6.  Services to support people in isolation and quarantine. Support for
     contacts in quarantine and cases in isolation can improve people’s safety,
     comfort, and adherence to isolation and quarantine guidance. For many
     contacts, provision of basic resources, such as daily check-in phone calls,
     health education materials, masks or face coverings, thermometers, hand
     sanitizers and gloves, may be enough. For others, “wraparound services”
     (including food, laundry, pharmacy services, garbage removal services) may
     be necessary. Financial supports may be needed to help those in quarantine
     and isolation meet basic needs and to compensate for lost wages. When
     people who care for children, older adults or other dependents are put in
     isolation or quarantine, the people they care for could be left in
     untenable situations. Alternative caregiving services should be provided in
     these situations.

     
     

 7.  Facilities for out-of-home isolation and quarantine. In some situations,
     people with COVID-19 or their contacts may be unable to isolate safely at
     home. Health departments should define criteria for offering alternative
     housing in these instances. Out-of-home accommodation for isolation or
     quarantine periods may be necessary for people who live with high-risk
     individuals, are precariously housed, unsheltered or experiencing
     homelessness, live in congregate settings, or who otherwise cannot remain
     in their current residence. Existing facilities in the community, such as
     hotels, single-room dormitories, or temporary housing facilities can be
     contracted with to provide this service.

     
     

 8.  Public communication. For contact tracing to be successful, the public must
     understand that their participation and adherence to public health
     recommendations (including isolation and quarantine) are essential to
     suppress the epidemic, protect the health of people in the community, and
     reopen society. Health departments should establish themselves as credible
     and trusted information sources and managers of the crisis. Best practice
     communication strategies include daily press briefings by a trusted source,
     engaging with trusted community leaders and officials to adapt messaging to
     the local culture and context and to reach out to their communities,
     leveraging media outlets, hosting a hotline (or other way for the public to
     ask questions), and producing and sharing educational resources (such as
     FAQs and fact sheets).

     
     

 9.  Metrics and monitoring. Routine monitoring and assessment of contact
     tracing efforts will reveal whether the process is functioning as intended,
     whether the program is achieving the goal of reduced disease transmission
     in the community, and if not, what changes should be made. A dashboard can
     track key performance indicators.

     
     

 10. Privacy and data sharing. Privacy protection is critically important,
     legally required and necessary to maintain the public trust, but the
     complexity of privacy laws can slow adoption of a contact tracing process.
     To both scale the process and protect privacy, consider policy
     simplification, proactive assessment and resolution of specific data
     sharing use cases and seek to design and build in privacy and security.

     

The COVID-19 Contact Tracing Playbook provides actionable technical guidance,
including implementation checklists and tools, for each domain of a successful
contact tracing program. U.S. state and local health departments can use this
playbook to rapidly set up and implement contact tracing programs for successful
COVID-19 containment.








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 * COVID-19 Contact Tracing Playbook
 * 4 STEPS
 * 10 DOMAINS

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