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The following figure summarizes the four areas of consideration outlined in the document and key questions to be answered in adapting contact tracing, as needed, to the COVID-19 pandemic response in a given jurisdiction Each question is explored in detail in the following text Workforce Adaptations Can staff roles be re-evaluated to fill gaps? Can additional staff be recruited? Can additional staff be quickly trained? From where and how should staff be recruited? Epidemiology Adaptations Can higher impact activities (e g , notification of cases and close contacts) be prioritized? Can turnaround time for test results be reduced in order to reduce the number of contacts that need to be traced? Can monitoring of close contacts be prioritized? Can close contacts be further prioritized for follow-up, such as those in congregate settings? Can the duration and/or frequency of follow-up be revised? Can a household unit be traced and monitored together? Can the testing strategy for contacts be modified? Systems Adaptations Can SMS, apps, or other technology or software be used to support remote follow-up? Is self-monitoring an option? Can digital tools be used to improve efficiency of contact tracing? Will digital proximity (bluetooth enabled applications) be adopted? Can digital tools be used to monitor workforce performance and support enhanced data utilization? Financial, Logistical and Operational Adaptations Can financial resources be reallocated or used more efficiently to support a scale-up? Are logistical and operational supports for contact tracers in place to support a scale-up? Are logistical and operational supports for isolated and quarantined individuals in place to support a scale-up? Can local organizations and networks support the government public health authority?
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Who is the intended audience of this document? This document is for CDC country offices, ministries of health, sub-national public health authorities, and other implementing partners in non-US settings While select adaptations may be relevant for any jurisdiction, the document focuses on adaptations that might be especially useful in low- and middle-income countries Document Rationale Contact tracing is a key component of controlling transmission of infectious diseases Contact tracing for the current COVID-19 pandemic however, is distinct from that undertaken for other diseases (e g , Ebola, HIV, TB) because in nearly all countries the number of cases and contacts has outpaced the capacity of the public health system to quickly notify and quarantine all contacts and isolate all cases As a result, contact tracing programs will need to prioritize activities to ensure that human and financial resources are utilized most effectively Necessary adaptations will depend not only on setting, but also will need to adapt over time, to best suit the current epidemiology of the outbreak Measures that are feasible when there is one case or even one cluster of cases, may not be feasible once hundreds or thousands of new cases are reported a day The following document outlines considerations for modifying contact tracing protocols to maximize efficient use of limited resources Within the following document, these adaptations are grouped into the following four categories: Workforce Adaptations (i e , who will do the case investigations and contact tracing) à Ideally existing staff from the public health agency in country (e g , Ministry of Health, National Centers for Disease Control, Field Epidemiology Training Program) would be able to implement these efforts This document will review ways to build the workforce if this is not feasible with current staff Epidemiologic Adaptations (e g , which contacts will be followed) à Ideally all cases will be investigated, all contacts will be listed, and then all contacts will be quarantined and monitored for 14 days after last exposure to a potentially infectious person This document will review how to prioritize activities and contacts if this is not feasible System Adaptations (e g , how will cases and contacts be notified and monitored) à Ideally all cases and contacts will be contacted directly by public health officers, either in person or by phone This document will review ways to improve the process if this is not feasible Financial, Logistical, and Operational Adaptations (e g , what resources will be available to support the system designed) à Ideally, financial, human, and logistical resources for contact tracing would be sufficient to meet the need This document reviews how to adapt when these resources are limited These adaptations however have trade-offs In some settings and under some circumstances, contact tracing may not be sufficient to contain transmission This is particularly true in settings of widespread community transmission, and of particular concern for this pandemic given the role of asymptomatic transmission In such as context, national or sub-national stay-at-home orders may need to be reissued, such that the whole population will be asked to quarantine (except for essential workers) The CDC COVIDTracer is a useful tool to determine modeled trajectory of COVID-19 cases under different contact tracing scale-up scenarios, to help determine an appropriate scale-up of contact tracing efforts Contact tracing is the focus of this document However, contact tracing programs cannot operate in isolation Contact tracing works to help contain an outbreak when integrated into a robust response that includes implementation of community mitigation measures (including but not limited to maintaining physical distancing in public places, limiting outings, avoiding large gatherings, wearing cloth face coverings, washing hands often, and cleaning high-touch surfaces routinely), as well as isolation of cases and testing
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